Monday, July 17, 2023

Training as a Substitute for Ignorance

 State Rep. Judy Amabile said [excited delerium] is "bullsh-t." She's asking the Attorney General to drop a law enforcement training requirement surrounding it.

Chris Vanderveen, 9News (7/12/2023)


It seems like everyone is a law enforcement expert, no experience or training required.

Media, activists and now local governmental officials have leapt onto an interesting bandwagon in an effort to unfairly discredit law enforcement officers. In this case, it is to suggest that the term "excited delirium" often used to describe individuals encountered (not exclusively) by first responders in fact is a broad and imprecise diagnosis used to excuse police brutality targeting minority males. Don't believe me?

Excited delirium (ExDS), also known as agitated delirium (AgDS) or hyperactive delirium syndrome with severe agitation, is a controversial diagnosis sometimes characterized as a potentially fatal state of extreme agitation and delirium. It is typically diagnosed postmortem in young adult males, disproportionally (sic) black men, who were physically restrained at the time of death, most often by law enforcement personnel. (Wiki)

Got it?

Apparently, beginning in 2020, international medical groups began to question the vitality of EXDS as a diagnosis for cause of death when someone who is apparently healthy, strong as an ox one minute, successfully fighting off a dozen cops in the process, suddenly dies. The exact mechanism of death was imperfectly described, leading some individuals to consider that medical examiners might be papering over something sinister. Consequently, many organizations have chosen to drop EXDS from its vocabulary. Totally up to them, of course.

That doesn't exactly solve the real world problem, which astute readers need not be reminded of: No matter what you call it, what does the reasonable, rational officer/deputy/trooper do when they encounter someone who is, to put it politely, losing their shit in a manner resistant to appeals to reason? If the need arises to fight with this person, are they in some imminent danger of dying suddenly? If so, what are the cops supposed to do about it?

Before it became a thing, authoritative research recognized a phenomenon not just regarding in-custody deaths, but in people found, well, dead.

Approximately two thirds of EXD victims die at the scene or during transport by paramedics or police. Victims who do not immediately come to police attention are often found dead in the bathroom surrounded by wet towels and/or clothing and empty ice trays, apparently succumbing during failed attempts to rapidly cool down. Excited Delirium, WestJEM, NIH National Library of Medicine (Feb 2011).

The article associates EXDS with cocaine use, and talks a lot of fancy heart ailment jargon. Suffice to say that the authors had no real axe to grind (their research related to positional asphyxia is interesting in what it doesn't conclude) and wanted to provide information to those who might have to care for these individuals in the back of an ambulance, or in an ER. It wasn't bullshit, it was the real, messy world encountered every single day by police officers, firefighters and emergency department employees dealing with violent, dangerous and potentially fatally ill people.

So, okay. Let's, for a moment, decide that our heroes at POST insist law enforcement stop teaching police recruits about EXDS. What is the purpose of such a request? What does the present training cause police officers to do if they encounter a suspected case that Colorado lawmakers would like to see changed?

Current training suggests that the officers do whatever they can to relieve the victim's respiratory distress and call for emergency medical care.

Officers do not make a diagnosis at the point of contact, any more than an arrest on probable cause is a verdict. It is simply a way to create a decision model that is relatively easy to follow, and begins the process of bringing to bear the right resources.

Some years ago I was driving around town - marked car, blue uniform, doing sergeant stuff, which meant I was near a coffee shop. A car was in the nearby intersection, people milling around it. Okay, even in my distracted supervisor state I knew this was not normal. I activated the overhead lights (on the first try) let dispatch know I had some kind of traffic incident in an intersection (correctly identifying it without a map) and walked up to talk to the driver.

It was an older woman - about my age now - who was obviously...well, out of it. She didn't know who she was, where she was, when she was. She could have been:

Drunk,

Overdosing on medication,

Diabetic,

A Stroke victim,

The list goes on and on. I had been taught - in classes mandated by the State - that disorientation, slurred speech and inappropriate driving decisions in the absence of an odor of alcohol were a medical emergency. I need not know, and didn't particularly care, exactly what was going on. I was there to do two things. Render the scene safe, and call for professional medical responders. The woman needed trained paramedics, and she needed to be evaluated for a trip to the hospital.

As it turned out, the medics gave her a little tablet to munch on and... She was diabetic. It woke her right up. After that, everything was simple.

I tell this story not because I'm a hero. It's because I had proper instruction, which allowed me to make an informed decision. The woman got the proper treatment, I got my coffee.

If an officer, properly trained, believes the person with whom they are dealing is undergoing excited delirium and they call for medical assistance - does it matter if it turns out to be something else? If the correct protocol after a fight with an EXDS victim is to turn them onto their side, facilitate proper respiration and call for the paramedics... Isn't that what you'd want them to do?

The thought, of course, is that officers are killing people (in something of the manner of George Floyd) and then are being exonerated because, you know, excited delirium. Okay, but isn't that a separate issue? The ultimate offense that led to the officers' successful prosecution in Minneapolis is that they all knew what they were supposed to do. They'd been properly trained. At least one of them expressed it during the event. They just didn't do it.

One need not imagine what might have occurred if that training had been withheld, rather than neglected.

Very few police officers are cavalier about their responsibility to look after the welfare of even those with whom they've had a violent encounter. Nearly every first responder knows that, once the scene is safe, treating the injuries of victims - including the person in custody - is paramount.

I think it's a wonderful idea to prevent officers from receiving training that might save a life, don't you? Now, that's some bullshit right there.


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