The entity, Excited Delirium Syndrome, has been the focus of much discussion over the past 10 to 15 years. Typically, this entity is used as the cause of death of highly agitated persons who are in police custody, who are not uncommonly restrained and or incapacitated by electrical devices. Following a complete autopsy, the forensic pathologist cannot define a specific anatomic cause of death, but frequently identifies psychostimulant intoxication, such as methamphetamine and cocaine, often in the presence of alcohol, as a contributing factor underlying causation of death.
Due to these individuals presenting in such an agitated and bizarre manner, police officers are often called to the scene. The usual course of events is after the police have witnessed their behavior, there is an effort to restrain the individual using various methods of force, such as maximal restraints, baton strikes, chemical “pepper” sprays or electrical devices. Not uncommonly, during or after the use of such methods of restraint, the individual suddenly experience a cardiac arrhythmia, which culminates in sudden cardiac death.
Pathophysiologic process which leads to sudden death in Excited Delirium Syndrome