Prehospital resuscitation of a man with excited delirium and cardiopulmonary arrest.

Features consistent with the syndrome known as excited delirium (ExDS) have been associated with law enforcement restraint-related death. The pathophysiology and exact causative factors of restraint-related death associated with ExDS remain unclear. We present a case of successful field resuscitation of a man with ExDS who experienced cardiopulmonary arrest while being restrained by law enforcement officers. Despite the presence of a severe lactic acidosis on emergency department admission, the patient recovered following prehospital treatment with advanced cardiac life support measures and intravenous sodium bicarbonate, likely in part due to early recognition of the disease process.

Emergency department documentation of alleged excessive use of force.

BACKGROUND: Patients' complaints of excessive use of force (EUOF) by police occur frequently in emergency departments (EDs). Limited, if any, education or guidelines exist for documenting alleged EUOF despite extensive instruction for other forms of potential abuse or assault. Our objective was to examine the documentation by ED staff when patients complained of EUOF. METHODS: A retrospective cohort design was used, identifying every use of force over a 1-year period by a single law enforcement agency that was followed by an ED visit within 24 hours. Charts were then analyzed for complaints of excessive force. For these cases, documentation was evaluated using standards for other forms of abuse and assault. RESULTS: Of 187 ED visits, 32 (17%) involved patients who were unable to give a history and 20 (11%) had nontrauma evaluations only. Of the remaining 135, there were 13 documented complaints (10%) of EUOF. Of these, 8 complaints (62%) described the mechanism of injury completely and 10 complaints (77%) had a complete description of the injury. No charts discussed whether the examination was consistent with the history. Inappropriate subjective terminology was used in 7 charts (54%), and the police description of events was described as fact in 7 charts (54%). Guilt was assigned in 5 charts (39%). DISCUSSION: In one ED, EUOF complaints were not documented to the standards for other forms of alleged assault and abuse. There may be a benefit to further education and guidelines on how to deal with ED presentations of EUOF.

Use of force by law enforcement: an evaluation of safetyand injury.

BACKGROUND: Little is known about the frequency and types of injuries sustained from law enforcement use of force (UOF). The purpose of this study was to examine injury patterns and subject conditions after law enforcement UOF under real-life conditions. METHODS: A retrospective cohort design was used to examine every UOF by a single police department from January through December, 2006. Data were collected from law enforcement UOF forms as well as medical records and included conditions surrounding the UOF, medical histories, and data from emergency department (ED) evaluations and hospital admissions. RESULTS: Of 888 individuals subjected to force during the study period, 86.9% were men and the average body mass index was 25.8. Ages ranged from 10 to 77 years; juveniles comprised 5.6%. Of the types of force used by police, 73.7% were blows with arms or legs; 15.9% were Taser, 4.6% were capsicum spray, 1.7% were K-9, 0.7% were impact weapons, and 0.2% were firearms. Of the 630 (70.9%) with medical records, 78.7% had a substance abuse or psychiatric history. ED evaluations occurred for 187 (21.1% of) incidents. When laboratory workup occurred, 75.5% had positive urine toxicology and 45.9% had positive ethanol levels. Admission occurred in 15.5% (29) of ED presentations (3.3% of all subjects); of these, 9 (31.0%) were for UOF-related injury. Two subjects in the study died: one as a result of firearm injury and one by suicide after UOF; both were declared dead on scene. DISCUSSION: Significant injuries related to law enforcement UOF in one city were rare and the only deaths were related to firearm use. A large percentage of those subjected to UOF had diagnoses of substance abuse and/or psychiatric conditions, and most hospital admissions were for problems unrelated to the UOF.

Conducted electrical weapon use by law enforcement: an evaluation of safety and injury.

INTRODUCTION: Controversy persists over the safety of conducted electrical weapons (CEWs), which are increasingly used by law enforcement agencies around the world. The purpose of this study was to examine injury patterns and physiologic conditions after CEW use under real life conditions. METHODS: A retrospective, cohort design was used, examining all CEW uses by one police department during a 6-year period. Data were collected from use-of-force forms and medical records and included conditions surrounding the use of force, medical histories, and data from emergency department evaluations and hospital admissions. RESULTS: Of 1,101 individuals subjected to (Taser M26 and X26) CEW use during the study period, 92.6% were male, the average body mass index was 26.2, and the age range was 9 to 73 years. Of the 886 (80.5%) with medical records, 46.8% had a psychiatric history and 72.9% had a substance abuse history. Emergency department (ED) evaluations occurred for 295 (26.8%) incidents. Of chief complaints, 41.7% were trauma related, 26.8% were for altered mental status, and 21.7% were for psychiatric evaluation. On presentation, 17.6% had a pulse >120, 1.7% were febrile, and 30.9% were altered; 1.4% met criteria associated with "excited delirium." When laboratory workup occurred, 70.6% had positive urine toxicology and 44.8% had positive alcohol levels. Troponin I was positive for one patient. Other laboratory abnormalities were rare, although extensive evaluations were infrequently done. Admission occurred in 24.4% of ED presentations (6.5% of all subjects); of discharge diagnoses for these patients, 59.7% were psychiatric, 22.2% were for unrelated trauma, 11.1% were for restraint-related trauma, and 6.9% were for unrelated medical diagnoses. No patients died. CONCLUSIONS: Significant injuries related to 6 years of law enforcement CEW use in one city were rare. A large percentage of those subjected to CEW use had diagnoses of substance abuse and/or psychiatric conditions. Most admissions after CEW use were unrelated to law enforcement restraint.