The Greensboro City Council has heard hours of testimony about the death of Marcus Deon Smith on Sept. 8, 2018, but none of the speakers have talked about Bells Mania more commonly called excited delirium.
The Journal of Emergency Medical Services (JEMS) has the description of an event very similar to the events in Greensboro on Sept. 8, one major difference is that in the JEMS example the police use Tasers to subdue the man who is violent but in both instances a man who is out of control is eventually restrained by the police and dies shortly after being place in restraints.
The definition of excited delirium in the JEMS article is “A condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature and superhuman strength.”
In the police body camera videos released by the Greensboro Police Department Smith exhibits many of those symptoms. He isn’t violent, but he does try to break out the windows of the police car when he is placed inside.
According to the JEMS article, “In particular, excited delirium patients will, for no known reason, strike at objects made of glass.”
The JEMS article states that autopsies of people who died from excited delirium, “consistently revealed the presence of stimulant drugs and alcohol in the blood.” Smith had both cocaine and alcohol as well as other drugs in his system according to the autopsy report which would be consistent with patients who died from excited delirium.
The JEMS article states, “This scenario plays out almost daily in cities across the nation. Law enforcement is called to investigate a crazed individual who may have committed a crime. A prolonged struggle ensues – with or without a conducted energy device (CED), also known as Taser, being deployed. The patient suffers a cardio-respiratory arrest and dies.”
Except that the Greensboro Police didn’t use Tasers on Smith, it is a fairly accurate description of what happened and if it is accurate and what Smith died from was excited delirium, according to the JEMS article preventing his death would have been difficult.
Perhaps you should send that JEMS article to the state medical examiner because the Smith case was still ruled a homicide last time I checked.
By the way,
“Some degree of controversy surrounds the diagnosis of ExDS. Because many patients with ExDS die while in police custody, civil liberties groups have raised concern that the diagnosis is used to conceal excessive use of force.5 The syndrome is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and the American Psychological Association has not yet decided whether to officially recognize it.5 Much about excited delirium remains unknown, and research into the syndrome’s pathogenesis and optimal treatment is ongoing.”
https://www.emsworld.com/216063/ce-article-excited-delirium
“…if it is accurate and what Smith died from was excited delirium… blah, blah, blah.”
Who to believe? Dr. Hammer or the State Medical Examiner?
I do not necessarily agree that Mr. Smith was suffering from excited delirium. While his erratic behavior had some similarities to a true excited delirium case, I believe that is where it ends. Excited delirium is quite possibly one of the most dangerous encounters an officer may have; and EMS and Fire as well. Generally a person suffering from excited delirium who exhibit “super human” strength, profuse sweating, and overheating; they usually take off some or all of their clothes. Another similarity in this case is the unfortunate death of Mr. Smith. Sadly, most excited delirium cases end in an in-custody death. EMS, Fire, and Police protocol should be written and in place to specifically and appropriately address excited delirium. Physically restraining someone long enough form EMS personnel to administer a sedative is like trying to ride a bull for 8 seconds. Using more and more officers to “dog pile” the person might well lead to asphyxiation. Luckily, these cases are not as common as one might think. They do, however, have the potential to be on the rise. With ever-increasing mental health conditions not be appropriately addressed or monitored for medication compliance and the rise of drug use for “self-medication”, these cases could see an uptick in prevalence.
From a psychology perspective, he almost perfectly fits the Excited Delirium/Bell’s Mania profile. Taking off clothes often happens at the beginning or near the middle of the episode, and isn’t required. He is profusely sweating and constantly being drawn towards lights of patrol vehicles which is another common sign. The really unfortunate thing about these cases is the extremely high mortality rate. Because of EMS protocol, they can’t sedate or even enter the scene until the subject is properly restrained, and this normally occurs at the use of a taser or the moment of sudden calm. Death typically follows within minutes and seconds of sudden calm without immediate intensive care intervention including medications and respiration to eliminate the potassium and acid build up in the body. This man was on drugs known to sometimes lead to ExDS as well as alcohol. The best way to prevent mortality is to catch it in the earliest stages and get immediate medical attention, which is generally long before citizens dial 911. The fault doesn’t just lie on the law enforcement community, but also on general lack of knowledge by citizens and proper medical and mental health care prior to the event. Just the ruling of the homicide doesn’t necessarily mean the officers or paramedics or anyone involved was a murderer.