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Breaking News – A Person Being Restrained Now Can’t Die from Excited Delirium!

Updated: Jan 8

As reported in the New York Times on the 11th October 2023, “California has become the first US state to ban the use of “excited delirium” as a cause of death, rejecting a term that prominent medical associations have said is rooted in bias and is often used to justify the deaths of people in police custody”.


The New York Times article goes on to say that: “The new legislation passed California’s State Assembly with unanimous support and received final legislative approval last month.


Michele Heisler, the medical director of Physicians for Human Rights, an advocacy group based in New York, called the signing of the bill a victory for “justice, police accountability, human rights and health.”


More recently, a number of major medical associations in the United States, including the American Medical Association and the American Psychiatric Association, have dismissed the term as pseudoscience.


In March 2023, the National Association of Medical Examiners became one of the latest to say that it should not be used as a cause of death.


When the American Medical Association announced its opposition to “excited delirium” in 2021, it said its decision had been based on reports that showed a pattern of using the term as “justification for excessive police force, disproportionately cited in cases with a racial bias where men die in law enforcement custody.”


This appears to be supported by the following comment in a research paper entitled ‘Excited Delirium’, Acute Behavioural Disturbance, Death and Diagnosis' published by the National Library of Medicine in 2022, which states: “The American Civil Liberties Union and Civil Rights attorneys in the United States have long argued that a post-mortem diagnosis of excited delirium is used to cover-up police officers' use of dangerous restraint (Garcia-Roberts, 2010; Sullivan, 2007). Their warnings have gone largely unheeded.”


In the UK, the Guardian Newspaper published an article on 1st July 2021 entitled – ‘Excited Delirium’; term linked to police restraint in UK medical guide condemned’ in which it stated: “Public health bodies and families say the term carries racial bias and is used to justify lethal use of force by police”.


The fact is that the term ‘excited delirium’ has been used for decades, primarily to provide an ‘excuse’ for the deaths of mostly people from under-represented groups in police custody. Mr Gipson said in a statement on Wednesday. “We will not stand by and let bad actors get away with murder any longer.” (As reported in the New York Times on the 11thOctober 2023).


The question now, is will other States across the US follow the lead set by California and do the same, and what about the police forces across the UK?

Now there is a long history going back to the origins of the term ‘excited delirium’ dating as far back as the late 1990’s (approximately 1998-99 period).

And the term ‘excited delirium has been associated with the high-profile deaths of people like George Floyd and Eric Garner in the USA and Christopher Alder and Jacob Michael both of whom died in police custody here in the UK.

With regards to 25-year-old Jacob Michael, an article in the Guardian Newspaper on the 1st February 2012 stated: “The parents of a 25-year-old man who died in police custody have been angered by a Home Office pathologist's finding that their son died of "excited delirium", a medical term that is not recognised by the Department of Health.”

Question…is the term excited delirium being overly used in the USA and here is the UK to support the use of restraint techniques that pose a high risk of death, especially when less lethal restraint options are available?

Now I’ve been around a long time and as a former head of police training, I was there in the beginning when the term ‘excited delirium’ was first introduced.

In April 2002 at a PCA (Police Complaints Authority) Safer Restraint Conference held in Westminster it was suggested (way back then) that:

“Some pathologists, however, feel the term positional asphyxia is misused in many of these cases. They believe that the proper diagnosis is excited delirium, which can, they say, be caused by drugs, alcohol, a psychiatric illness or a combination of these.”

The 2002 Safer Restraint Report went on to say: “Whatever the terminology used, the PCA believes that restraining someone in the ways described above, particularly for any length of time, can pose severe risks as can leaving a detainee unattended in any position that might restrict their breathing.

Even if the position itself does not present a danger, the detainee may be suffering from a physical, medical or psychiatric condition or the effects of alcohol or drugs, which combined with the restraint, could make them more vulnerable.”

Here is the key – “Whatever the terminology used….”

I believe NFPS Ltd has been at the forefront of implementing restraint techniques and systems that reduce the risk of serious injury and death (caused by whatever name you wish to call it), simply by dealing with the common-sense facts.

For example, if someone is being restrained and they say “I can’t breathe” we initially have two options: (1) don’t believe them based on some personal or institutional bias and take a chance that they don’t die, or (2) believe them and take appropriate actions that will save a life.

If someone being restrained is ignoring pain and continuing to struggle beyond the normal point of exhaustion, we again initially have two choices: (1) continue to apply higher levels of manual force and restraint in an attempt to keep control at the risk of them dying, or (2) adjust your holds, release them or apply a form of mechanical restraint towards bringing the manual restraint to an end quickly, in an attempt to save a person’s life. These are not exhaustive examples, they are just one of many common-sense approaches to managing risk.

We have a duty of care to the person being restrained. We are not their judge or jury. We are agents whose job is to preserve safety, support the well-being, whilst minimising risk, including risks to the person being restrained.

It doesn’t matter what terminology, narrative or excuse is used the fact is someone has died on your watch. A life has been lost.

Back in April 2002 at the PCA Safer Restraint Conference the following was also stated:

“The police service is responding to criticism and striving to minimise risk, continually evaluating techniques and keeping officers’ training up to date in terms of best practice and the human rights context. The personal safety manual, for example, devotes a chapter to Acute Behavioural Disturbance, it’s possible causes and implications along with the signs and symptoms to identify risk factors. Positional asphyxia and the dangers of restraining someone in the prone position for too long are covered in similar detail.

The manual also clearly states that neck holds carry inherent risks and are not acceptable.”

On the 28th November 2005 the House of Lords and House of Commons Joint Committee On Human Rights - Third Report was published.

In it, it states:

"Despite the dearth of statistics in this area, it is clear that the unsafe use of restraint is an ongoing problem across all forms of detention. Evidence from the MHAC and INQUEST cites a number of recent deaths involving control and restraint. The report of the Inquiry into the Death of David ("Rocky") Bennett, a detained psychiatric patient who died after having been restrained in a prone position for 25 minutes, contained strong criticism of the control and restraint procedures, as did the Report of the Inquest into the Death of Roger Sylvester, who died in custody following the use of restraint.

Reliance on prone restraint is a matter of concern for compliance with Article 2, given the known dangers of this position, evidenced by previous deaths......

We emphasise that Article 2 requires that patients and detainees should not be placed at risk by the use of this position unless absolutely necessary to avert a greater risk to themselves or others, and that they should be restrained in this position for the shortest possible time necessary."

Do you remember the question we posed earlier…answer.  This is not an issue about what something is called. It is about what we need to do and not do to reduce risk, injury and death.

In many cases common sense is enough.


This also echoes what we wrote in a blog post dating back to 2020 ‘Subject Everything a Teacher Says To Our Own Careful Scrutiny’


It’s time we as an industry stopped hiding behind words in the misplaced belief that a ‘word’ or ‘words’ will somehow protect us.


It’s time we peeled all of the unnecessary layers away and got back to good basics.


You have seen in this article that for more than twenty years dangerous techniques have been highlighted and that recommendations have been constantly made that training needs to be kept up to date in terms of best practice and the Human Rights context, but that the reality is that nothing appears to change (PCA Conference April 2002).


Prone should not be used unless ‘absolutely necessary’.  That is to say that it is not down to an individual’s discretionary call based on a subjective ‘dynamic risk assessment’ done on the spot.


At NVC we have people with the operational experience and training knowledge in dealing with the prevention and management of high-risk restraint situations dating back over 25+ years.


The Human Rights definition of ‘Absolutely Necessary’ is a much stricter and more formal approach to risk reduction where a risk to life is present (see McCann vs United Kingdom).


Would you like to know more about ‘Absolutely Necessary’ in the right context?


Then contact us to find out how our training provides you with the knowledge, understanding and skills to train people correctly and manage risk effectively. 


Following training with us, we are only a phone-call away, to provide you with back-up, support and advice.

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