Eight Yukon officers attended a mental health training on excited delirium March 18.
Sean Barnette, Heartland Medical Direction director of training, taught the free two-hour class at the Yukon Police Department. Barnette is also a Tinker firefighter, as well as a paramedic; deputy sheriff; and tactical medic.
He also teaches paramedic training at Oklahoma City Community College.
Excited delirium is defined as a state of extreme mental and physiological excitement, characterized by extreme agitation, hyperthermia, hostility, exceptional strength and fatigue.
“The one thing … that I hope I can change your mindset with is how to recognize what’s going on when someone is saying they can’t breathe, and they actually can’t,” said Barnette.
The department’s 49 officers have all been trained on excited delirium. They each attended one of the five classes taught.
history began in mid-1800s
Barnette began the session with teaching the history of excited delirium.
In 1851, Dr. Luther Bell, who was one of the first mental health professionals to organize what is the American Psychiatric Association today, had 41 patients who exhibited “crazed mania.” Throughout his study, 30 of those patients died of sudden exhaustive death syndrome.
In 1881, the term excited delirium was created. Today, medical professionals have been unable to identify all that encompasses excited delirium.
There was a significant amount of people who died of sudden exhaustive death in 1946. Between 1948 and 1960 there were no sudden death reports, due to the development of psychiatric medicine.
However, between 1960 and 1980, the death reports resurfaced because of a heightened cocaine drug era, as well as the Vietnam War, Barnette said.
When officers come in contact with excited delirium, the patient’s mind and body are not linked.
They physically cannot calm down on their own because the body is in survival mode, Barnette said.
“They are literally in the process of actively dying,” he said.
A look at why it’s not part of CLEET, CIT training
Of the Yukon officers present at the March 18 session, there were two who were Crisis Intervention Team-certified.
CIT is a program of the Oklahoma Department of Mental Health and Substance Abuse Services that offers 40-hour training over a span of five days to officers and first responders.
Barnette said CIT training does not include excited delirium, as it is not considered a disease.
“It’s only a disease that’s taught, not the condition,” Barnette said. “It’s a subjective type of thing in the eyes of (the Council on Law Enforcement Education and Training). There’s not enough evidence to back this particular problem.”
He said it is a disservice for officers not to receive training on excited delirium, as many respond to it regularly.
Excited delirium is also not included in handbooks that CIT trains from. However, most symptoms that excited delirium patients exhibit is included in the Diagnostic and Statistical Manual of Mental Disorders, as well as the International Classification of Diseases, Barnette said.
Many doctors, like Heartland Medical director Bill Worden, have recognized that excited delirium is a legitimate condition and one that needs to be addressed.
What happens to the body of excited delirium patients
There are many factors that contribute to the condition, like lack of oxygen reaching the brain, cognitive functions and more. The state of mental confusion that patients experience can range from disorientation to delusions.
Typically, males in their mid to late thirties with a history of mental illness experience excited delirium.
Barnette said when many officers arrive on scene to a person having a mental health emergency, they usually assume they are on drugs.
“It’s a medical problem,” Barnette said. “It’s not their fault — they can’t help that they have a mental illness.”
Although, many mental illnesses are associated with psycho-stimulant abuse, he said.
He also noted the importance of maintaining a mindset of empathy toward people who have a mental illness.
“We have to treat people like people,” Barnette said.
It’s also crucial to understand everyone’s mental illness is different, he said.
Causes of delirium vary widely. Some can be triggered by imbalances in the body, as well as metabolic disorders and excessive dopamine.
When a patient is experiencing excited delirium, their body is maintaining an excessive amount of potassium, due to the exacerbation of constricting muscles. These problems cause the heart to beat abnormally, which can only go on for so long.
Because they’re basically undergoing an extremely dangerous workout, their body temperature can reach nearly 106 degrees Fahrenheit, making them remove all their clothing. Barnette said this should be a clue to law enforcement to immediately call emergency personnel to the scene.
Making sure the body is cooled is important, he added. When people tell officers they can’t breathe, officers typically reply with, “You’re talking,” as that is how they’ve been trained.
Barnette said it’s important to know two things happen when people breathe — ventilation and respiration. Excited delirium patients are receiving only a slight fraction of oxygen than people who are breathing normally, as they are not exhaling enough carbon dioxide.
He said tackling patients is not ideal, as they cannot effectively breathe.
How officers should respond
Barnette said excited delirium is not a crime. Many patients are violent toward objects, specifically, glass.
While officers are trained to give commands, many excited delirium patients will not be able to comprehend them, as their brain is overloaded by the body’s state of survival mode.
“They can’t hear you,” Barnette said.
Excited delirium patients are also more prone to resist officers because they only see them as a threat. To address this, many Oklahoma City officers meet with people in their community, who have mental illnesses, so they are more at ease when they have an emergency, he said.
Barnette also went over creating a plan with emergency personnel to determine the best response.
Dispatchers should prep officers with as much intel as can be gathered when a 911 call is received, he said. After calling EMS, officers should create space for the patient and call for backup.
Officers should also respectfully ask bystanders to stand back from the scene, he said. Once all emergency personnel are on scene, they should develop a unified response with everyone.
“This has to be a together thing,” he said.
Barnette also said these incidents take time.
During the next steps, the police department responding should assign one officer to speak with the subject to avoid confusion. Then officers should make an attempt to de-escalate the situation by issuing verbal commands.
If family members, friends and coworkers are on scene, officers should also speak with them to get to know the patient and see what can be done to help get them to the hospital safely, Barnette said.
Lastly, they should move to physical restraint of each extremity. Sedation may be necessary before moving them to an ambulance.
Paramedics are the only ones who can administer a sedative.
One of the Yukon officers said it’s crucial for law enforcement to receive excited delirium training.
“Are we going to be perfect every time?” Barnette said. “No, but we can deliver excellence in the pursuit of perfection.”
He also said since officers must receive many hours of training, medical information is typically pushed to the backburner.
“We’re always here to help,” he said.
Agencies must contact Heartland Medical to receive the training at their departments.