More That Officers Should Know About High-Risk ExDS Encounters

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In reporting another new study of excited delirium, researcher Dr. Darrell Ross offers additional insights for improving the safety of officers and subjects alike in these fraught confrontations.

The goal is not to train or expect officers to make clinical diagnoses in the field as psychiatric experts, Ross says. “But providing them with research findings can enhance their awareness and focus to properly direct their initial response and use-of-force control measures.”

In addition, officers’ recognition of subjects’ key behavioral symptoms can help EMS personnel choose appropriate medical intervention. And “should a death occur,” Ross writes, “officer observations can assist investigators and the medical examiner in assessing contributing factors.”

Ross of Valdosta (GA) State U. and his co-author Dr. Michael Hazlett of Western Illinois U. analyzed UOF reports of 635 violently resistant arrestees who exhibited symptoms of excited delirium syndrome [ExDS], as compiled by 17 police departments and sheriff’s agencies in six US states.

Here are highlights they think officers should know in preparation for a potential encounter:


Beyond violent behavior per se, which of course is not unique to ExDS situations, the new study identifies 12 telltale symptoms associated with the syndrome that officers can readily recognize: the 10 listed by Baldwin’s team in Item I above plus “incoherent speech” and “bizarre behavior.”

The most commonly confronted overall during the study period tended to be non-responsiveness to police…high pain tolerance…hyperactivity…incoherent speech…and extreme strength. Least common was attraction to glass (“rarely reported”). Nearly 60% of the subjects studied exhibited three to four ExDS symptoms, with 12% displaying seven to 10. No one displayed all 12.

Those in the seven-or-more category were significantly more likely to exhibit the most dangerous qualities, including extreme strength and unflagging stamina, high-pain tolerance, hyperactivity, bizarre behavior, and non-responsiveness. Those subjects were also most likely to be hot to the touch, fully or partially nude, sweating profusely, and breathing rapidly.
RESISTANCE. Simply stated, Ross writes, the greater the number of ExDS symptoms displayed, the higher the level of arrestee resistance—similar to what Baldwin and his team found. Ross describes three potential gradations of intensity

  • defensive resistance, such as pulling, prying, twisting, stiffening, or running away—actions “meant to defeat the officer’s efforts of control and not intended to harm”;
  • active resistance, where the arrestee uses personal weapons (grabbing, wrestling, punching, kicking) to physically assault the officer;
  • aggravated active resistance, severe felonious attacks with personal or other weapons that “may seriously injure or kill the officer.”

Overall, he explains, 75% of subjects exhibiting three to four symptoms presented defensive resistance. Those in the five- to six-symptom group resorted to active resistance more frequently (85% in that category did so), and those showing seven or more symptoms “were more likely to escalate” to active (75%) or aggravated (25%) attacks.

Even after being put on the ground in a prone position, about one-third of subjects showing five or more symptoms continued to present active or aggravated resistance, Ross finds.

At every level, “the behaviors and the type of resistance demonstrated by persons in excited delirium is unpredictable,” he states, “and officers must remain alert to protecting themselves as well as the arrestee throughout the interaction.”


To establish control, a conducted energy weapon [CEW] was used about 40% of the time against individuals showing five or more symptoms and assaultive behavior, Ross reports.

On average, two trigger pulls were needed to bring the assailant down, with the CEW typically discharged once more if resistance continued even after the subject was in a prone restraint position.

The weight of one or two officers was placed on the back of a grounded subject for one to five minutes in about 90% of the cases, and arrestees were hobbled in about one-third of the incidents—tactics that some critics have argued are potentially deadly for subjects.

To the contrary, Ross stresses, none of the study subjects died regardless of the force measures used—“a significant finding.” Arrestees did not sustain any injury about 80% of time and suffered serious injury (such as broken or dislocated bones or head trauma) in only 3% of instances. “A high percentage of arrestee injuries resulted from their violent resistance,” he says.

Ross and Hazlett devote significant space in their paper to discussing the desirability of employing a CEW to control subjects exhibiting five or more ExDS symptoms.

“While there is no risk-free use of force device or technique,” they state, “scientific research consistently shows that the CEW reduces the risk of injury or death with arrestees…. [A]rrestees exhibiting symptoms of ExDS are generally impervious to pain and the CEW provides a viable and safe use of force response to overcome [their] combative behaviors.”
In short, the study supports the conclusion of other researchers that a CEW is “the preferred [nonlethal] use-of-force device when faced with violent and agitated arrestees.”


Ross urges that agencies provide training on ExDS to “officers, dispatchers, administrators, emergency medical personnel, and investigators.” By policy, he says, these stakeholders, along with mental health professionals, should train together to coordinate an effective response to ExDS emergencies whenever feasible.

He recommends that a checklist of symptoms be provided to dispatchers so they can “obtain as much information as possible about [a subject’s] behaviors when dispatching officers to the scene.” Once there, officers should apply force measures, control, and restraint “quickly to minimize the arrestee’s exertional activity and shorten the confrontation,” he advises.
The symptom checklist should also “be embedded into the department’s response-to-resistance report form, so officers can fully document” their observations, as well as their verbal and physical attempts at control.
A full report on the study, titled “Assessing the symptoms associated with excited delirium syndrome and the use of conducted energy weapons,” is published in the Forensic Research & Criminology International Journal. It can be accessed free of charge by clicking here.

Dr. Ross, a professor and department head for sociology, anthropology, and criminal justice at Valdosta State, can be reached at: dross@valdosta.edu

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