Annotated Bibliography: Criminal Justice and Excited Delirium

Annotated Bibliography: Criminal Justice and Excited Delirium

Baldwin, S. (2014). Excited delirium syndrome (ExDS): Understanding the issues and reducing the risks associated with police use of force (Unpublished doctoral dissertation). Carleton University, Ottawa, Canada.

In this dissertation, Baldwin focuses on an investigation of the meaning attributed to the excited delirium syndrome and the influence of this meaning on the actions, risks, and benefits of medicalization. The basis of this examination is the author’s observation of the contentious labeling of a broad cluster of features that indicate a medical emergency among various professionals, including law enforcement, emergency physicians, paramedics, and medical examiners. The author notes that a standardized and concise label for the assignment of meaning is necessary for effective recognition, intervention, and treatment of subjects. Based on a mixed methods research to analyze reports of police use of force, Baldwin aims to develop a standardized label for ExDS that can help in high-risk medical situations and law enforcement training or policy concerning the use of force. The study yields findings that ExDS features have a strong predictive reliability in identifying a medical emergency or probable case of ExDS. In terms of training, the research observes that prevalent training on ExDS is effective in attributing the meaning of a medical emergency and as a result prioritizing medical attention.

This source will be vital for understanding the chosen topic because of the implications of its findings on intervention strategies, risk factors, and officer safety concerns. The dissertation utilizes excerpts from reports of the use of force by officers and assesses the extreme and violent nature of encounters with probable cases of ExDS. This information is valuable in the study because it offers first-hand and practical understanding of situations involving ExDS in criminal justice contexts.

Di Maio, V. J. M., & Di Maio, T. G. (2005). Traditional explanations for death due to excited delirium syndrome. In Excited delirium syndrome: Cause of death and prevention (chapter 3). Retrieved from

In this article, the authors review the process and events of an episode of ExDS to support their argument that two of the traditional explanations of deaths resulting from the syndrome are incorrect. According to these explanations, deaths from excited delirium are the results of restraint or positional asphyxia, on one hand, and the use of a neck hold, on the other hand. The authors’ contention is that death related to the syndrome is the outcome of a combination of normal physiological changes associated with a struggle and the effects of use of illicit drugs, medications, and natural disease. They observe that both medicinal and illegal drugs can combine with reactions to stress to accentuate usual physiological reactions in an individual suffering from the syndrome, making them lethal. The authors utilize medical and practical justifications to prove that the two medical explanations are incorrect.

This article is necessary for the current research because of its assertion that asphyxia and neck hold, which are common events in contact between law enforcement and individuals suffering from ExDS, are not the causes of deaths related to the syndrome. The article’s statement is significant in the context of the chosen topic due to its implication that law enforcement measures may not be the principal factors in the deaths of ExDS patients in custody.

Hall, C. A. (2016). Excited delirium. In Encyclopedia of Forensic and Legal Medicine (2nd ed.). (Vol. 2, pp. 441-452). Oxford, UK: Elsevier.

This article by Hall is a summary assessment of excited delirium, its definition, pathophysiology, metabolic state, symptoms, and necessary interventions and management approaches. The author recognizes ExDS as a syndrome that embodies an acute medical crisis in law enforcement contexts owing to the bizarre and violent behaviors that affected individuals display. Based on an extensive evaluation of the syndrome and its features, Hall recognizes the need for appropriate interventions to address the condition, beginning with recognition of its nature and the establishment of physical control. These actions are essential to ensure that physical control of the individual and the condition can apply in an environment of safety from the perspectives of both the victim and care provider.

The value of this article in the current research lies in the author’s approach to treating the syndrome as a medical emergency that poses a problem for law enforcement. The article evaluates the features and significance of the syndrome from the perspective of law enforcement, noting that the range of possible psychomotor manifestations of the syndrome could be bizarre, necessitating the involvement of the police. The article is contributing to the topic in terms of its evaluation of the range of the syndrome’s features that is relevant in the context of criminal justice and law enforcement processes. Knowledge and evaluation from the article are essential in understanding the approaches and methods that professionals in the criminal justice system could apply to handle cases of ExDS effectively.

Shields, L. B., Rolf, C. M., & Hunsaker, J. C. (2015). Sudden death due to acute cocaine toxicity-excited delirium in a body packer. Journal of Forensic Sciences, 60(6), 1647-1651. doi:10.1111/1556-4029.12860

This article presents the case of excited delirium in a “mule” or “body packer” caused by cocaine, the hard drug, as a way of proving that excited delirium and resultant death could be the outcome of cocaine use or induction. The authors note that excited delirium is a life-threatening medical condition which symptoms include agitation and violent behavior. They observe that cocaine-induced excited delirium involves fatal intoxication with cocaine, stimulating symptoms such as hyperthermia, agitation, delirium, and respiratory arrest. The article uses the case of an individual who smuggled cocaine by inserting three rubber packets containing cocaine in the rectum, stating that investigators had suspected homicide when the individual had sharp and blunt force injuries. Moreover, a toxicological examination of blood revealed high concentrations of alcohol and cocaine. Using this case as an example, Shields, Rolf, and Hunsaker argue that forensic pathologists ought to consider the possibility of cocaine-induced excited delirium when individuals die suddenly after exhibiting extraordinary strength, resistance to pain, and aggression.

In the context of the current study, this article concerns the suggestion of an alternative cause in cases of sudden deaths of individuals who encounter law enforcement. The work of Shields, Rolf, and Hunsaker is also significant for the current research to show that law enforcement procedures not always are the main reasons of deaths of ExDS patients in custody. It suggests that alternative effects or processes connected to the actions and lives of offenders could be the underlying causes of their deaths.

Strote, J., Walsh, M., Auerbach, D., Burns, T., & Maher, P. (2014). Medical conditions and restraint in patients experiencing excited delirium. The American Journal of Emergency Medicine, 32(9), 1093-1096. doi:10.1016/j.ajem.2014.05.023

Strote, Walsh, Auerbach, Burns, and Maher describe the medical conditions and circumstances surrounding the restraint of individuals that law enforcement has identified to be suffering from excited delirium. The authors note the common association of deaths from or related to excited delirium syndrome with law reinforcement restraints, arguing that the pathophysiology that underlies such deaths is unclear. They picked individuals that law enforcement had determined to have ExDS in the course of encounters over a three-year period. The researchers reviewed the circumstances, medical records, and police narratives around restraints by law enforcement during the use of force in these cases, including abnormalities and final diagnoses. The findings portrayed that 84% of the cases were tachycardic while 7% were hyperthermic (Strote et al., 2014). Over three quarters (77%) of patients tested positive for stimulants while others had low pH levels, elevated lactate, and high creatinine kinase levels (Strote et al., 2014). The research concluded that cases of ExDS identified by officers rarely involved persons who required high restraint or medical conditions that implied high risks of abrupt deaths.

The article’s value for the current research lies in the conclusion that the syndrome’s low specificity in predicting the risk of sudden death becomes challenging for criminal justice and law enforcement systems. The article’s assessments and findings demonstrate the issues that law enforcement procedures face in relation to predictions of the risks of sudden deaths of individuals in custody.

Vilke, G. M., Chan, T. C., Savaser, D., & Neuman, T. (2014). Response to “hemodynamic consequences of restraints in the prone position in excited delirium syndrome”. Journal of Forensic and Legal Medicine, 27, 82-84. doi:10.1016/j.jflm.2014.05.003

This article is a letter to the editor of a journal in reaction to an article by another scholar. The scholar had enumerated the adverse consequences of restraints of individuals with excited delirium syndrome. The authors discredit the scholar’s arguments, pointing out errors in the logical process that he had made in reaching his conclusions about the dangers of restraints such as those employed in law enforcement contexts. While they underline the fallacies of the scholar’s argumentation, they do not present direct evidence to dispute that restraints such as those that law enforcement officers employ could lead to the deaths of individuals in custody.

The contribution of this article to the current study concerns the claim that the deaths of individuals with ExDS while in custody could be the outcome of actions other than law enforcement restraints. The article is essential for the research because it enhances the case for a more extensive investigation of the causes of deaths of individuals in custody rather than directly blames the restraints of law enforcement.