10. EXCITED DELIRIUM                                    
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Symptoms and identification of excited delirium                                    
Individuals can experience medical emergencies brought on through mental, medical, or substance abuse issues, such as excited delirium or psychosis. Policy √     √ √                     √    
notes that members should be aware that excited delirium exists and may warrant special care.
Excited delirium is defined as “a state of extreme mental and physiological excitement, characterized by extreme agitation, hyperthermia, hostility,       √                       √    
exceptional strength and endurance without apparent fatigue” (Morrison and Sadler, 2001).
Excited delirium may present as combative, incoherent, non-compliant, and unresponsive behaviour. √                                  
Subjects may exhibit the following symptoms or behaviour: removal of clothing; bizarre and violent behaviour; running in heavy street traffic; hyperactivity;       √                       √    
aggression; smashing objects, particularly windows and glass; non-responsive to police presence or verbal extreme paranoia; incoherent shouting, unintelligible
speech, animal sounds; flight behaviour; lid lift (eyes opening so wide the whites of the eyes are completely visible); unusual strength; intervention; imperviousness
to pain; ability to resist numerous police officers over an extended period of time; overheating (hyperthermia); or profuse sweating or no sweating at all.
All members must familiarize themselves with the common signs of excited delirium.        √                       √    
Protocol in dealing with excited delirium                                    
Ambulance should be called as soon as possible if excited delirium is noted. (Emergency health services involvement is warranted as early as possible in the restraint process.) √     √ √                     √    
Intervention should be delayed until ambulance is present in cases of excited delirium, though consideration must also be given to containing the subject. √                                  
Individuals experiencing excited delirium require medical treatment, which first requires that they be restrained.       √                       √    
If possible, promptly go to the hospital to relay observations to health care personnel to ensure information is properly relayed.       √                       √    
If there is evidence of substance abuse, seize as an exhibit.       √                       √    
In considering intervention options for excited delirium cases, the use of the CEW in a probe-mode deployment may be the most effective response to establish control.       √                       √    
When a subject who has been “hit with a CEW” is detained in detention facility,
the guard or other members must be aware of that fact and closely monitor the		               √                    
subject’s health and safety due to increased risk for excited delirium.
An optimal response strategy should include the following:       √                       √    
EMS to attend with members;
● ensure there are enough members on the scene for a quick and effective “hands on” (control) in an effort to minimize the incidence of physical confrontation (note: On its own, the CEW is not intended as a restraint device);
● one member on CEW;
● control of arms and legs during CEW deployment cycle;
● apply approved restraints;
● when safe to do so, remove the subject from the prone position as soon as possible after control is established;
● if no EMS is present at the scene and the subject suddenly becomes quiet and stops resisting, EMS should be summoned and preparation be made for CPR; and
● as excited delirium is a medical emergency, all subjects should be transported via EMS, where possible, and placed in health services care as soon as possible.
Member training regarding excited delirium                                    
Member training includes education and awareness about excited delirium and resuscitation of unresponsive subjects, in conjunction with CEW application.         √