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Excited Delirium Syndrome (ExDS), or Sudden Unexpected Death in Custody (SUDIC), is a term recognized by the National Association of Medical Examiners and defined as, “the sudden death of an individual, during or following an episode of excited delirium, in which an autopsy fails to reveal evidence of sufficient trauma or natural disease to explain the death. In virtually all such cases, the episode of excited delirium is terminated by a struggle with police or medical personnel, and the use of physical restraint (DiMaio, 2006).”

The Institute for the Prevention of In-Custody Deaths, Inc. (IPICD) suggests there are two types of people prone to Excited Delirium (typically male between the ages of 35-44 years).

1. People suffering from psychiatric stress (1/3 of the time, the subject will have a diagnosed mental illness, with schizophrenia most common.)

2. People with chronic illicit stimulant abuse (cocaine and methamphetamine are most common, though alcohol and anti-psychotic drugs may also be a component).

Frequently, subjects experiencing Excited Delirium may appear to be acting bizarrely, sweating profusely, demonstrating extraordinary strength and endurance with an immunity to pain, and possibly muscle rigidity. Subjects may complain, “I can’t breathe” and become suddenly tranquil following a struggle with law enforcement officers (IPICD, 2015). There are no reliable indicators of the impending death of the involved subject, which may occur less than 5 minutes following their restraint (Hall, 2012).

It is typically recommended law enforcement officers use a team take-down approach to restrain subjects suspected of Excited Delirium, with a reasonableness in the number of any Taser applications, and provide medical attention as soon as possible to stabilize the underlying physiological processes. There has been no direct medical correlation between the restrained, prone position of the subject and the associated ExDS death (Hall, 2012)


Is ExDS a medical condition or the result of a law enforcement use of force? Why or why not?

What/who should be the determining authority?

How does the finding and understanding of this condition affect the evaluation of reasonableness in a law enforcement use of force associated with an in-custody death involving ExDS?


DiMaio, T. (2005). Excited Delirium Syndrome: Cause of Death and Prevention. CRC Press, Boca Raton, FL.

Hall, C. (2012). Faculty of Medicine at British Columbia (Force Science Institute).

Institute for the Prevention of In-Custody Deaths, Inc.

Report of the Council on Science and Public Health, CSAPH Report 6-A-09, Page 4, Line 33.

Wetli, C. (2009). Behavioral Emergencies for the Emergency Physician. Cambridge University Press, Cambridge MA.

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