The Missing Links Of RBSD

A few months ago I wrote an article called; “The Four Pillars Of Combatives Training”. In this posting, I stated that any “reputable” self-protection program should cover, in depth, what I call the “Four Pillars Of Combatives” being:

• The Pre Event Show

• The Surprise Guest

• The Main Event

• The Post Event show

With “Reality Based Self Defence” (RBSD) becoming the flavor of the month, everyone and their dog is hopping on the bandwagon, and calling what they do RBSD hoping to cash in on the gravy train; just read any mainstream martial arts magazine and you will see what I mean.

What I find very interesting, and even frustrating, about many who teach what they call RBSD, is that they have a tendency to only teach/instruct in one or two of the above noted pillars. In fact, many only concentrate on the “Main Event” (slamming and jamming) and spend little, if any time, covering the other three pillars. Why?, lack of knowledge ?, comfort level ?, willful blindness ?, plain ignorance ?, or all of the above? These charlatans do not understand the “holistic” connectivity that each pillar has with one another when it comes to the physical, psychological, and legal components of survival; not unlike the pieces of a puzzle coming together to make a whole. No one pillar is any stronger or weaker than the other, each depending upon one another for integrated strength. Much like a house of cards, if one pillars collapses, then the rest “may” fall as well; the end result being a less desirable outcome to you.

Case in Point, “The Post Event Pillar”. After you have won the physical fight, the aftermath of your actions will now take front and center stage. Has your instructor prepared you for this pillar? “SOME” of the topics that should be discussed and internalized here include:

SEVERE INJURY OR EVEN DEATH ISSUES:

Just recently, here in Victoria, a fight took place at a local university where a student was punched once, and as a result, fell backwards hitting his head on a cement sidewalk. The victim of this assault is still in hospital, in a coma, and has had two surgeries to relieve pressure to his brain. Have you internalized the fact that your physical actions, unlike in the dojo or training studio, will cause severe injury or even death ? If not, come to grips with this fact, or you will fail to act when the time comes. A lot of people only give this lip service. I have heard this statement time and time again; “Oh I didn’t want to really hurt him, I just wanted him to leave me alone.”, and as a result, the victim did not act with enough righteous indignation to protect themselves.

Have you also accepted the fact that you could be seriously injured or even killed? Have you made peace with your Deity, if any , and have you put things in order in your personal/family life? Have you decided what you will fight for, knowing that if you do fight, serious injury or even death is always lurking it’s ugly head with every shot thrown? Unlike the movies where after a fight people walk away, you may not !!!!!

POST TARUMATIC STRESS DISORDER (PTSD) ISSUES:

After the physical fight, are you prepared for the psychological battle that may ensue? I know a number of people who won the physical fight, but the demons of untreated PTSD, as a result of their actions in a physical fight, changed their lives to the point of self-destruction through substance abuse (alcohol and drugs), with some even turning to suicide, in an attempt to numb the psychological pain and torment. PTSD can be managed, and managed successfully in most cases. The first step is understanding the cyclical nature of PTSD, its outward and inward manifestations, and then seeking out those professionals who can act as guides providing you with PTSD coping skills. No one, and I mean NO ONE, no matter how big, how physical or psychologically strong, is immune from PTSD.

UNWANTED PUBLICITY AND ARM CHAIR QUARTERBACKING IN THE MEDIA ISSUES:

If your physical actions in a self-protection situation causes severe injury or even death, are you prepared to have your name splashed in all forms of media; T.V, Radio, Newspapers? Often, the media believes, “If it bleeds, it leads.” The goal is to sell, sell, sell; we need to catch the reader/viewer/listener’s attention. Because of the lack of full disclosure, the media tends to go with witness reports, which are often times lacking, and as a result, what “actually” happened is lost for the sake of making a deadline. One can be judged in the courtroom of “public opinion” based upon the power of media reports no matter how right or wrong. Are you prepared to have the media knocking on your door, your neighbor’s door, or even at your place of employment wanting a comment from you, friends or even distance acquaintances about who you are, what happened, your personal or family relationships or anything else they can dig up be it positive or negative?

LEGAL CONSEQUENCES TO ACTIONS ISSUES:

Are you prepared for the legal consequences, both criminal and civil, for your actions? Have you picked a good lawyer who specializes in self-defence cases? Best to do that now, rather than at the police station, when the totality of the circumstances could cloud your judgment as to who, and more importantly, who not to pick as a lawyer to talk to. Have you decided what to say, or not to say, if interviewed by the police. Have you insulated yourself civilly should a civil tort be launched as a result of your actions? Do you know the laws surrounding self-protection in the jurisdiction in which you live? Does your instructor teach techniques within the understanding of the law? Are you physically and emotionally prepared to go to jail for your actions no matter how right or wrong.

WORK/EMPLOYMENT PROBLEM ISSUES:

Because of the above noted issues, and due to scapegoating in some cases, have you come to grips with what might take place at work. As a result of PTSD, injury, unwanted media attention, and legal consequences, fellow workers who you thought were your friends, may now treat you as the black sheep of the family. How are you going to deal with the fact that you may be fired or put on “administrative leave” (be it justifiable or not) as a result of your actions? How is this going to affect your finances?

FAMILY STRAIN ISSUES:

With the cascading effect of the above noted issues, have you thought about what kind of strain (financial, legal, public ) your family will now be under? What kind of “war chest” have you put aside, to protect you and your family from these heavy burdens. In some cases, NOT all, families cannot cope with the “Post Event Pillar” of violence, which has resulted in the separation of even the strongest relationships.

I hope the reader can appreciate the fact that when it comes to Self-Protection, there is much much more to RBSD than just “slamming and Jamming”. Remember, Proper-Pre Planning Prevents Piss Poor Performance. Knowledge and the understanding and application of that knowledge is power. I would encourage everyone who places themselves into harms way, to seek out those “reputable” RBSD instructors who understand and teach/discuss what I call; “The Four Pillars Of Combatives Training.”

Cerebral Food For Thought !!!!!

Strength and Honor

Darren Laur

January 18, 2009 at 6:42 pm | Uncategorized | No comment

The Four Pillars Of Combatives Training

What I find interesting in the RBSD field is the lack of a “holistic” or “Integrated” approach to teaching what I like to call the “Four Pillars” of combatives. As many on this forum will appreciate, there is more to self-protection that just the physical (one of the pillars). This fact eludes many who continue to believe that the other three pillars that I am going to briefly discuss are just “fluff” or “psycho babble” and as such, have no place in the training regime. So what are the four pillars ??????

Pillar #1: Pre Event Show

Pillar #2: The Surprise Guest

Pillar#3: The Main Event

Pillar#4: Post Event Show

The Pre Event Show:

This pillar contains information specific to pre-contact attributes which include but are not limited to:

• Victimology

• Predatorology

• Use Of Force and the Law

• Verbal and non-verbal skills and attributes

• Pre-assaultive indicators

• De-escalation skills and attributes

• Semantics

• Predator/Prey psychology

• Understanding and harnessing the emotional, psychological, and physical effects of fear

• Making peace with the Grim Reaper

• Understanding the “Way Of The Street”

• Warrior Spirit

• Awareness skills and attributes

I, as well as many other instructors, believe that many confrontations can be averted or even won at this pillar.

The Surprise Guest

Contrary to popular belief, many attacks are initiated utilizing the element of surprise. It is because of this fact, one must incorporate the physical, psychological, and emotional skills that are “congruent” with the body’s natural reactions to a surprise attack be it with a knife, club, gun, or empty handed. This must be done from any and all positions, be it prone, sitting, or standing and in any environment. Many fail to understand this pillar and as such, become cannon fodder to their attacker.

The Main Event:

If one survives the “surprise guest”, or is fortunate enough due to “awareness” to see the fight coming, next comes the main event (the physical fight). At this pillar, Gross Motor skills applied in a compound attack combined with offensive mindset reign supreme. Fine complex motor skills have no place at this stage of the confrontation, but many still teach such skills out of ignorance or willful blindness.

The Post Event Show:

After you have won the fight, the aftermath of your actions now take front stage, which may include but are not limited to:

• Severe Injury/death

• Moral and Legal consequences (both criminal and civil) to your actions

• Post traumatic stress issues

• Unwanted publicity and arm chair quarterbacking in your local media

• Family strain

• Work/employment problems

• Scapegoating

• Jail

Any “reputable” self-protection program will cover, in depth, all four pillars. IMO, many programs out there in the “RBSD” market concentrate solely on the “Main Event” with very little emphasis or attention placed onto the pre-event, the surprise guest, or the post event pillars. If what you are studying does not cover the above noted information, then you ARE NOT, IMO, best preparing yourself for REAL WORLD violence, and all its ugly faces.

Strength and Honor

Darren Laur

January 18, 2009 at 6:42 pm | Uncategorized | No comment

The Fog

The “Fog Of War” is where one side tries to guess an enemy’s strength and intentions, which introduces many unknowns. Incomplete, erroneous, or no information leads commanders to make “best guesses” to fight a battle. The “Fog Of War” is in my opinion also very relevant to the street as well.

Another analogy that I found, to explain the Fog Of War, is as follows:

“ Most of us know how the game of chess is played. Each side has the same number of pieces, we know the movement and power of each piece and we can see the location of each one on the board. Introduce a simple concept to illustrate the fog of war by playing chess while being able to see only the squares that are occupied by the opponent. We can keep track of the chessmen on our side and where an opponent piece may occupy a square, but we do not know if that piece is a pawn or bishop. It places a different perspective on playing the game.”

Since I have always said that personal combat, street fighting, or self-protection is a war in microcosm, how can we as teachers, coaches, instructors, and students learn from the concept of the “Fog Of War”, thus accounting for the unexpected? Simple answer; we can’t, but we can “MINIMIZE” its effects !!! This is why as readers of situations that have happened, (Case Studies), we can usually see some simple answers, but at the same time the person who found themselves in the middle of the street situation at hand could not see the situation in the same light. So we learn through case study analysis about what not to do if we find ourselves in a similar situation, thus minimizing danger to us.

Flexibility also reduces the threat of the unexpected. Personal combat is fluid and malleable. Physical techniques taught in self protection MUST also be fluid and malleable. We must teach based upon tactically sound “principals” and “functionality”, rather than “rote” and “perfect technique” As Clint Eastwood said in Heart Break Ridge; “One must be able to improvise, adapt, and overcome in time of battle”

Redundancy can also reduce the threat of the unexpected. We know that most plans do not survive first contact. As a result, for every plan “A” strategy, we better train for plan “B” and plan “C”. Students must seek to “synergize” and “integrate” their combative attributes and tools, and be able to deploy them at the most decisive moment. It has been said that a finger alone is a poke, a clenched fist, where fingers fit together (flexibility, integration and redundancy), can be deadly.

Realistic scenario based replication training is also a must. This best replicates the “Fog Of War” on a personal level, which then builds and compounds Flexibility, Redundancy, Synergy, and Integration. If video taped, it also allows one to “Case Study” through analysis.

I hope this post will generate some other thoughts on this topic.

Strength and Honor
Darren Laur

January 18, 2009 at 6:41 pm | Uncategorized | No comment

The Church Of Combative Truth

First, let me share with the reader that I am a person who believes in God: but this is not a posting on belief systems when it comes to religion, but rather a comparison of what I see taking place between religious factions around the world, and how it compares to the similarities of what is taking place in the field of modern combatives/RBSD today.

Not unlike religion, modern combatives/RBSD also have a variety of different denominations and sects, each with their own belief systems, tactical Bibles, and verbiage, with some even wearing a specific type of identifiable uniform to separate their style/belief from others. All have faithful followers, some of whom I would clearly call “zealots”, but all have congregations of “faithful” followers that will defend their leader, prophet, or in some cases Demi-God, if questioned or attacked by those either inside or outside of their “Church Of Combative Truth”

Today, those who travel and preach the “Church Of Combative Truth”, are growing in numbers, primarily due to everyone hoping on the RBSD bandwagon to make MONEY, and as result, many believe that they have found the “secret” to combative enlightenment which they want to sell to you and others. What I find blasphemous, however, is how many “cults” are being spawned as a result of the combatives/RBSD phenomena, and the negligent and even dangerous tools and techniques that are being promoted and taught to some. It is also interesting to note how many of these cults do not see eye to eye with one another, and infact go out of their way to attack their competition’s beliefs through negative propaganda, and at times truly false information.

With current world events, many outside the “Church of Combative Truth” are seeking enlightenment, understanding, and knowledge to keep both themselves, and others they love, safe when confronted with violence. To entice these sheep into their flock, many of these “cults” will prey upon human nature to entice potential members into their Church Of Combative Truth, with promises of tactical enlightenment that guarantee 100% effectiveness. Once in, these cults begin preaching their flawed “beliefs”, which through repetition and over time, can and do become one’s truth. If these truths are “questioned” or not “blindly” followed, then one needs to repent or be subjected to both a psychological and physical attack resulting in separation and isolation from the collective. The end result, human automatons that will continue to propagate tactically flawed principals of combatives to the uneducated, that fly in the face of real violence, and which will get one hurt or even killed.

I am a teacher in the “Church of Combative Truth”, who is constantly re-evaluating what it is I share with my student base. Why ???? Because what I teach could mean the difference between life and death. I constantly challenge my students to acid test everything we do, against the litmus paper of true violence. I encourage my students and instructors to explore other’s “truths” and to leave the “sanctuary” of our school and its beliefs for the purpose of growth when it comes to combatives. As instructors, we begin to believe that our “truth” is the only truth, and as such, sometimes teach with blinders of self-righteousness fully affixed. We need to encourage exploration and open mindedness, thus allowing us to test and evaluate other truths, never loosing the focus of soundly based combative principals as a foundation to work form.

In the end, if students and instructors are allowed to question, explore, test, and apply; one will find there are no “secrets” when it comes to combative truths, but rather certain combative “principals”, than when applied, will be constant when dealing with violence. Stay away from the CULTS within our industry, they teach “secrets” and demand that you “blindly” follow their authority for the purpose of protectionism which, like it or not, is grounded in financial gain rather than the true sharing of self protection principals.

Strength and Honor

Darren Laur

January 18, 2009 at 6:40 pm | Uncategorized | No comment

The Body Beautiful

In my line of work (LEO), it never ceases to amaze me to see the amount of trauma that the body can take, but yet keep functioning. Why is this so important ????, because the only guaranteed knockout in combatives is a direct Central Nervous System attack.

Hit here, strike there, to get a knockdown, are common themes that I hear in many combative/martial art classes. IMO the opponent/attacker dictates the fight by how he reacts, or more importantly does not react, to what it is I am doing to them.

The body beautiful is like the Timex watch; It can take a liking and keep on ticking. If you go into battle believing that this or that technique will work, you are potentially pre-planning for failure. A compound committed attack using one’s full arsenal (physical, tactical, and mental) without preconceived tool to target outcomes is an important attribute that the true student of combatives needs to internalize

Strength and Honor

Darren Laur

January 18, 2009 at 6:39 pm | Uncategorized | No comment

Tell It Like It Is

The street is a very ugly place, and one in which “politically correct” methods, techniques, and theories do not belong.

In a street confrontation, if I cannot talk or walk my way out, I will “Penetrate and Dominate” my opponent(s). Offensive mind set, warrior spirit, killer instinct, whatever you want to call it, this must be something that is embraced, harnessed, and used to one’s fullest advantage. You have to be just as violent as your attacker (or even more violent), if not, you will likely lose. Not very politically correct, but a realistic and modernistic view in today’s real world. My goal is to totally overwhelm my opponent, and to hurt him to the point that I, or a loved one, can escape as safely as possible. In the street, winning or losing CAN mean the difference between life and death. Having a respected athlete die in your arms as a result of a street predators tactics, does change one’s perspective on the reality of it all. Combine this personal experience, with the victimizations that I see on a daily basis in my job, from the result of street violence, can give one a clear and present understanding of what the consequences are if you do not WIN the street fight !!!!!

What I find extremely troubling and down right negligent, is some of the stuff that people are promoting as “street” self-defence:

· No touch knock outs
· Combat Ki
· Catching punches in the air and turning them into arm locks, wrist locks.

Give me a break !!!!!! What these people are teaching is not self-defence, but rather self-defeat. Acid test everything first. There is no such thing as reality, but reality itself. As trainers and students of combatives, we can acid test what we do in dynamic scenario based training to replicate reality to a point, but never to the point of 100%. Question, and question again, what you are learning or even teaching when it come to street combatives. Never get caught up in a “system” that advertises that they have the answer to everything. It has been my experience that these charlatans prey on the sheep of the martial arts community for nothing more than the old mighty buck.

For those who say they teach their system of fighting to SEALS, DELTA, FBI, RUSSIAN SPECIAL FORCES, and any other spec warfare or elite police Emergency Response Teams HTH Skills ( in an attempt to promote their style of fighting as street effective), good for you, but in most cases, these warriors aren’t the predators you will be facing on the street who use totally different S.O.P’s than those listed above (remember know thy enemy). Think about this one for a moment. As well, talk to any grunt on one of the above-mentioned teams, I know I have, and they will tell you that the last thing they want to do is to go toe to toe with an enemy/opponent. That is why they are given warrior tools such as guns, grenades, and knives. Do these teams run into HTH combative situations? Yes they do. But this is the “rare” exception and not the rule. What these teams do possess and which needs to be understood and harnessed by those of us teaching combatives is “Warrior Spirit”. I truly believe that this one very important attribute is what makes these units, and warriors serving in them, so formidable and dangerous.

The reason for this post, Richard and other “Modern Realists” need to be heard, even if what they say is a bitter pill to swallow by those who are more “traditional”. It is time that these people dig their heads out from beneath the sand. Violence is not a politically correct beast, dealing with it effectively can not be either.

Strength and Honor

Darren Laur

January 18, 2009 at 6:38 pm | Uncategorized | No comment

Surprise, The Criminal’s Advantage

Are We Training For All Probabilities

Recently, I had a great discussion with a former street thug (who cleaned his life up several years ago, and is now married and has several children) about the who, what, where, when, how, and why of his target selection in his past life. Many of the principals that this person shared with me can be found in both my street 101 and Gladiator School articles. (It should be noted that the two previously mentioned articles were written well before speaking to the subject who spawned this article). Our discussions confirmed to me that most of these guys do utilize similar operating procedures. What peaked my interest, however, was some of his comments about his favorite technique, that of SURPRISE, and the context in which he used it.

Throughout our conversation, this former predator kept hounding on the fact that surprise and overwhelming violence was his primary tactics in what I like to call, the shock and awe phase of total psychological and physical dominance that most predators depend upon when engaging a target. When combined with the fact that he always used the psychological advantage of surprise, combined with physical advantage of first strike, he mentioned many martial arts and self-defence techniques taught were neutralized due to the fact that most were predicated on the fact that the intended target (combatant/mark/victim) “KNEW” that they were going to be assaulted.

This comment really got me thinking about the realities of the street and what I have both empirically and experientially observed and investigated as an LEO. Although many assaults that I have attended did involve the cognitive ability to recognize that a physical encounter was about to take place, many also involved the guerilla tactic of hit and run where surprise was the tipping point, which benefited the attacker. To illustrate this concept, this former street thug stated that there were several occasion where he targeted individuals who were much stronger and tougher than he was, so to tip the scales in his favor, he would always “sucker” them from a position of advantage and then continue to beat them into submission to the point where they would be hospitalized. This was also the same tactic he would use when preying upon targets that he did not know, for property type crimes (robberies).

Of course, as I was talking to this rehabilitated street thug, I was continually thinking about how I would counter this tactic, to which the answer “AWARENESS” immediately came to mind. If through awareness I could identify this potential threat, then I would take away the predator’s primary tactic of surprise, thus likely causing the threat to pick another easier target. Although a sound hypothesis that is taught by many in our field (including myself), it was challenged by my new best friend who I would consider to be an EXPERT in the field of applied street violence. Although he looked for those who had no situational awareness as primary targets, at times he did pick those who knew he was there, and used a street “interview” or “ruse” to his advantage until close enough to strike, utilizing the element of surprise and overwhelming force.

So what did I take from this very enlightening discussion:

• In training, we need to start ingraining stimulus response scenarios where the fighter is taken by complete and total surprise. Although most scenario-based training has an element of knowledge, expectance, and co-operation about it, we need to safely but realistically create the “holy shit” moments as well.

• In training we need to create some drills that will ensure that we hit to hurt but not to injure thus replicating immediate action drills from positions of disadvantage. (here at the school we call this the commit to hit drill)

• In training, we need to build in the Murphy moments where the predator is just outside of arms/legs reach, armed with a weapon intent on causing death or grievous bodily injury, rather than holding it out at arms length within one’s sphere of influence where most weapon counter measure techniques are effective.

• We need to accept the fact that in some circumstances (ambush) there may be nothing we can do to prevent such an attack. In fact, depending upon the feral intent of the designated attack, you may be knocked out or even seriously injured to the point where your ability to counter attack will be effectively neutralized. (This can be seen in a number of video clips that I will have up on my website within the next couple of days where the ambush and multiple opponent threat are omni present in real world violence)

Yes, I do believe that AWARENESS is an important skill that will dissuade many street predators that are on the hunt for property, body, or life type crimes from picking you as a target, but like the above noted information suggests, sometimes awareness will not be good enough. In some situations, because of awareness, you will know that a physical attack is about to occur thus allowing for an escape or physical interdiction, but the reality is, if attacked, you will NOT likely see it coming (ambush) and will probably be fighting from a position of disadvantage (serious injury, multiple threats, weapons). Start training for these foreseeable scenarios now as safely and as realistically as possible.

Some who read this will disagree with what I have written, and will continue to believe that their fantasy defences and traditional ways of dealing with their altered perception of street violence will be good enough in the real world. WAKE UP……… Reality Sucks Brothers and Sisters, and we need to start adapting and improvising our training methods because the street predator knows no bounds!!!!!!

Darren

January 18, 2009 at 6:35 pm | Uncategorized | No comment

Excited Delirium and its Correlation to Sudden and Unexpected Death Proximal to Restraint

A Review Of The Current and Relevant Medical Literature

By Sgt Darren Laur

Victoria Police Department

September 2004

Caveat:

The purpose of this paper is to shed some light, create meaningful dialogue, and encourage further scientific and medical research into the multi-factoral issues surrounding sudden and unexpected death proximal to restraint. Although a rare occurrence in Canada, sudden and unexpected death proximal to police use of force and restraint is a reality that is gaining more and more public attention not just in our country, but internationally as well. Often, the causes of these deaths are attributed by some in the media, special interest groups, and the general public to a specific force option used by police during arrest (Taser, pepper spray, physical restraint), due to the fact that their proximity to death make a cause and effect correlation easier to accept and understand, even when these same force options have been medically discounted as contributing to the cause of death later at autopsy. Looking for causation in sudden and unexpected death proximal to restraint is an emotionally charged subject, which up until very recently had very few answers. However, based upon both the scientific research and the medical literature reviewed for this paper, the writer will be suggesting that in some cases it may not be the force option used that causes death, but rather a severe and some times fatal medical condition known as, “Excited Delirium”.

I am not a medical professional, and as such, I make no medical assumptions or findings in this paper. I am, however, a trained police investigator and thus I have attempted to gather both the scientific and medical research that I believe to be relevant, specific to Excited Delirium, so that those with the expertise can review and hopefully begin to find answers to some of the questions that others and I have in this topic area. What I have learned thus far in my research of both the scientific and medical literature is that the causes of death attributed to Excited Delirium, proximal to restraint, are medically “multi-factoral”. What appears to be missing in the literature, however, is a “synthesis” of the scientific and medical opinion from a variety of differing specialties into one document. Each medical discipline mentioned in this paper (Pathologists, Psychologists, Psychiatrists, Pharmacologists, Neurologists, Cardiac Electrical Physiologists, and Exercise Physiologists), appear to hold a piece of the puzzle to the understanding of Excited Delirium, but no one has gathered these opinions, or put the pieces of the puzzles together, into a clearer understanding of the phenomena of death associated with Excited Delirium, thus the reason for this paper.

The information contained in this paper should be shared with all first responders and medical care workers who may come into contact with those experiencing excited delirium. If your agency has experienced a sudden and unexpected death proximal to restraint, this paper should also be shared with investigators, coroners, medical examiners, pathologists, and lawyers or anyone else who is involved in the investigation of the death.

“Research is to see what everyone else has seen, and think what no one else has thought”

Albert Szent-Gyorgy (Nobelish 1927)

INTRODUCTION:

Police receive a call of a male, semi-clothed, yelling and screaming at the top of his lungs and acting very bizarre in the downtown core.  Upon arrival, police attempt to communicate with this male unsuccessfully, due to the fact that he is totally incoherent, and appears to be suffering from either a psychosis, or drug induced delirium.  As police continue their negotiation with this male, he begins to walk out into traffic, becoming a danger to himself and/or others, at which time the officers attempt to take this male into custody under the authority of the Mental Health Act.  Upon physical contact with this male, he immediately begins to fight with police resulting in a protracted physical encounter at the conclusion of which, the subject is finally taken under control and handcuffed.  While waiting transport, the suspect is still physically resisting his restraint and upon arrival of the wagon or Provincial Ambulance Service, it is noted that the male has stopped breathing and has no pulse.  Attempts at resuscitation by both paramedics and emergency room staff are futile, and the suspect is pronounced dead at hospital. At autopsy, the pathologist finds there is insufficient evidence to establish a cause of death.

Although the above noted hypothetical is “believed” to be a rare occurrence, a very similar incident happened to the Victoria Police Department (Dawson, 1999). After reviewing the mountains of medical literature on the topic of “In-Custody Death”, it is estimated that in the United States of America alone, there are between 50 and 125 in-custody deaths of similar circumstances every year (Conner, 2002).  This is an estimate as there are no official statistics available at this time. It should be noted, however, that since January 2003, federal legislation was passed in the United States requiring all law enforcement agencies to not only report, but also categorize all in-custody deaths. It is hoped that the Bureau of Justice Statistics will have a statistical report available, specific to this topic area, in the fall of 2005. In Canada, we too face a similar issue in that there is no central national repository that collects statistics on sudden and unexpected death, proximal to restraint, attributed to Excited Delirium. Although most provincial coroners do keep statistics on sudden deaths attributed to law enforcement, most do not break these deaths down into specific categories. As such, all deaths, including shootings and suicides while in police custody, are lumped into one category. Very recently, however, some provinces such as Ontario are now beginning to capture this data. It is because of this fact, that in Canada, it is believed that on average there are between 6-10 sudden and unexpected deaths, proximal to restraint by law enforcement, yearly across our country, a number that appears to be reflected in the Canadian literature and Provincial Coroner reports reviewed for this paper. It is also interesting to note that of those who die suddenly and unexpectedly proximal to restraint, 77% die at the scene of their arrest, or while being transported to cells or hospital. (Ross, 1998)

For the purpose of this paper, I am not going to refer to the commonly used term “In- Custody Death“, due to the fact that it does traditionally group all deaths while in police custody, including shootings and suicides, into one category. Instead, I am going to specifically look at the medical condition of Excited Delirium as it relates to “Sudden and Unexpected Death Proximal to Restraint.”

HISTORY:

The incidents of sudden and unexpected deaths proximal to restraint first came to the attention of law enforcement in the early 1980’s, due to the increased empirical data of deaths associated with police use of force, especially where a suspect was placed into a maximal prone restraint which is better known as being hog-tied. In 1995, the terms “hog-tie and “hobble” became interchangeable (Stratton, 1995) and for the purpose of this paper, need to be differentiated. The maximal prone restraint method (hog-tie), involves securing both wrists and ankles together behind the back, while the “hobble” is the tactic of securing the ankles together (without connecting them to the wrists), to inhibit the subject from placing the soles of their feet in contact with the ground whether they’re in a back down or face down prone position. (Lawrence, 2004)

It should also be noted that deaths similar in nature to those occurring in law enforcement are being experienced in psychiatric and geriatric care facilities where patients/residents are required to be restrained for their safety and security (Paterson et al., 2003). In fact, since 1995, there have been 20 reported deaths in U.S. medical facilities as a result of physical restraint being used by medical staff personnel (Joint Commission for Accreditation Of Health Care Organization, 1998)

In 1988 Dr. Reay, a King County medical examiner in Washington State, USA, began to hypothesize that sudden and unexpected deaths proximal to restraint appeared to be associated with something that he and others termed “Positional Asphyxiation”. Positional Asphyxiation was associated with a suspect being hogtied after being physically restrained, hands and feet secured behind the back, and the suspect placed in the prone position (Maximal Prone Restraint).  Dr. Reay in his research, concluded that such a restraint, associated with the prone position, was responsible for sudden and unexpected deaths proximal to restraint due to asphyxia (Reay, Flinger, Stillwell, & Arnold, 1992).

Due to Dr. Reay’s research, many law enforcement agencies around the world began to prohibit the use of the hog-tie restraint, and provided training to their members on the issues surrounding “Positional Asphyxia”, in an attempt to combat the incidence of sudden and unexpected deaths proximal to restraint.  Although Dr. Reay’s research was ground breaking, including his recommendations to law enforcement, subjects were still dying suddenly and unexpectedly in police custody in the United States and Canada, even though not placed in a face down hog-tied position.

In 1998, a lawsuit was decided in the state of California, Price v. the County of San Diego. Dr. T. C. Chan, Dr. G. M. Vilke and Dr. Tom Neuman, physicians from the Department of Emergency Medicine, University of California San Diego Medical Center replicated the Reay study (Chan, Vilke, Neuman, & Clausen, 1997) and came to conclusions that did not support the original research conducted by Reay. The results of these research efforts were presented during this trial. The result can best be described by a quote from the court’s decision:

After Dr. Reay’s retraction, little evidence is left that suggests that the hog-tie restraint can cause asphyxia. All of the scientists who have sanctioned the concept of positional asphyxia have relied to some degree on Dr. Reay’s work. The UCSD study has proven Dr. Reay’s work to be faulty, which impugns the scientific articles that followed it. Like a house of cards, the evidence for positional asphyxia has fallen completely (Ann Price et al., Plaintiffs, v. County of San Diego et al., Defendants, 1998).

The problem that exists is that subjects are still dying, suddenly and unexpectedly, in circumstances similar to the case involving Daniel Price.

A further 1998 retrospective study looked at 61 cases of sudden and unexpected deaths proximal to restraint (Ross, 1998). Dr. Ross found that only 38% of all subjects who had died had been placed in the prone hog-tied position, due to this fact, he reported that Excited Delirium was more related to the sudden deaths than to the restraint position, because apparent positional asphyxiation during restraint accounted in only 20% of the 61 deaths reviewed.

A further 1999 research study that looked at the effects of positional restraint on heart rate and oxygen levels (Schmidt & Snowden, 1999) found that healthy persons, even after physical exertion, are at little risk when held in the hog-tie position and placed onto their side.

Most reported cases of sudden and unexpected death proximal to restraint involve young men in an “excited” state or one of “agitated delirium” as a result of psychiatric illness or intoxication from illicit drug use. These individuals were combative, violent, and often struggled or suffered traumatic injuries as a result of a confrontation with law enforcement before their placement in the restraint position (Chan, Vilke, & Neuman, 1998). Again, it is important to note in the review of the medical literature, that subjects used in testing, including those in the Reay, Chan, and Snowden studies, were in fact healthy adult volunteers who were not representative of restraint subjects in medical and law enforcement settings, that are experiencing an Excited Delirium because of psychosis or drug, and due to this fact, some medical professionals questioned the validity of these studies. As an example, in Dr Chan’s research (Chan, Neuman, Clausen, Eisele & Vilke, 2004) the following test criteria were utilized:

• Test subjects were ten healthy male volunteers between 18 and 45 years of age.

• The weights utilized in testing, and placed separately between the shoulder blades of the volunteers, were 25lbs and 50lbs each.

• Subjects were not physically stressed maximally prior to the application of restraints and weight loads.

• Once restrained, test subjects did not physically resist their restraints, but rather passively submitted to testing.

In contrast to Dr. Chan’s research criteria, in most cases of sudden and unexpected death proximal to restraint reviewed for this paper, the subjects restrained were:

• Experiencing an Excited Delirium due to psychosis or drug.

• Most had “maximally” resisted arrest and restraint procedures prior, during, and after restraint, thus placing increased loads on their ventilation/breathing process.

• On average, in policing circumstances, there are usually between 3-5 officers involved in the restraint process, with a total combined weight far greater than the 25lbs and 50lbs utilized in Dr. Chan’s research.

Based upon the above noted research, it is no wonder that some in the medical field are of the opinion that the correlation of Dr. Chan’s research to actual street application and conditions is somewhat questionable. In fact, Dr. Chan and his co-authors stated:

” Our study has limitations. First, as this was a laboratory physiology study, we could not reproduce all conditions encountered in the field setting with such cases. In particular, we did not simulate trauma, struggle, drug intoxication, and other physiologic and psychologic stresses that commonly occur with individuals who are being restrained in the field setting. Second the amount of weights selected for this study may not reproduce the actual amount of weight force used on individuals during the restraint process.” (Chan, Neuman, Clausen, Eisele & Vilke, 2004 pg 118)

THE MODERN EMERGENCE OF EXCITED DILIRIUM:

In 1998, the Ontario Coroner’s Office published a retrospective study of 21 cases of unexpected death in people with Excited Delirium that occurred between 1988 and 1995 within the province of Ontario (Pollanen, A., Cairns, & Young, 1998). Of the cases reported, 18 deaths occurred while the subject was in police custody. In all 21 cases, Dr Pollanen found that “many deaths related to Excited Delirium are associated with restraint in the prone position”(p. 1607) and that all of the subjects who died had lapsed into “tranquility” shortly after being restrained. Other findings in Dr Pollanen’s medical research included:

• Twelve (12) subjects (57%) experienced Excited Delirium caused by a psychiatric disorder

• Eight (8) subjects (38%) experienced cocaine induced psychosis

• Eighteen (18) of the deaths (86%) happened while in police custody and could not be resuscitated

• Eight (8) of the 18 (44%) people restrained in the prone position also suffered chest compression from the body weight of 1 to 5 people who were restraining them.

• Four (4) (19%), had been pepper sprayed

• Four (4) (19%) had heart disease at the time of death

• Two (2) (10%) of the deaths happened in hospital after being in a coma for several days

• Six (6) people with cocaine Excited Delirium had cocaine levels similar to recreational users and lower than those who actually died from cocaine intoxication

• Levels of cocaine associated with recreational use may be sufficient to cause Excited Delirium.

• Of the deaths, none were Taser related.

Another study, involving the examination of the sudden and unexpected deaths of 21 males, occurring between 1992 and 1996 (O’Halloran & Frank, 2000) reported:

• One death associated with Taser use, the rest with other force options;

• Best estimates for the time held in a prone position was 2-12 minutes;

• Eight (8) had a history of mental illness excluding substance abuse;

• Eight (8) had a history of substance abuse;

• Seventeen (17) appeared to be “acutely delirious”;

• Eleven (11) had stimulant drugs in their system;

• • • 8 cocaine (concentration ranged from 0.02 to 5.4 mg/L [mean, 1.4mg/L])

    • 2 methamphetamine

    • 1 had both cocaine and methamphetamine/amphetamine

• Six (6) could be considered obese while 6 were normal weight

• At postmortem, temperature was only taken in 3 cases with one reported to be hyperthermic (the relevance of hyperthermia will be discussed later in this report).

• Six (6) were noted to be sweaty prior to death

This was the first report the author found that mentioned the correlation between dopamine levels specific to cocaine, bi-polar disorder, and schizophrenia (this too will be mentioned later in this paper).

A third research project related to the sudden and unexpected death of subjects requiring restraint for Excited Delirium (Stratton, Rogers, Brickett, & Gruzinski, 2001) reported the following factors:

• Study period between 1992-1998 in the Los Angeles area;

• Looked at 18 deaths resulting from 216 arrests made of subjects requiring restraint for Excited Delirium;

• 198 Excited Delirium subjects who were physically arrested and hobbled DID NOT die;

• Unique to these data is a description of the initial cardiopulmonary arrest rhythm in 72% (13) of the sudden death cases;

• Associated with the 18 deaths was a struggle by the victim which resulted in forced restraint;

• 78% had stimulant drugs in their system;

• 56% had chronic disease;

• 56% were classified as obese;

• All cardiopulmonary arrests were unanticipated and proceeded by a short period (estimates 5 minutes or less) during which the victim ceased in struggling against restraints and developed a labored or shallow breathing pattern.

• Of the 18 incidents, 5 were Taser related

• Remaining 13 deaths, other force options, excluding firearms, were used

• Report mentioned “severe metabolic acidosis” specific to Excited Delirium although the presence of metabolic acidosis was not determined in this study.

As a result of the above-published medical studies and research, as well as the questions being raised specific to the medical validity of positional asphyxia, the medical community now began to focus on research surrounding the biological and physiological effects of a new medical phenomena that they termed “Excited Delirium” specific to sudden and unexpected death proximal to restraint.

Although identified as a new medical phenomenon in law enforcement, as mentioned earlier, problems similar to Excited Delirium have been reported in the medical literature since the mid 19^th Century (Bell, 1849).  In 1849, Dr. Luther Bell, physician and Superintendent of the McLeon Asylum for the Insane in Somerville Ma, was the first medical professional to describe Excited Delirium stating, “Victims of this organic mental disorder may be apathetic or depressed, or excited with fear or rage accompanied by sympathetic nervous system arousal.” Dr. Bell had spent more than twelve years treating those admitted to his hospital. From 1836 to 1848 Dr. Bell admitted over 1700 patients and among those, 40 cases manifested a “peculiar” form of delirium. At least three-quarters of these cases, according to Dr. Bell, terminated fatally, with the remainder recovering fully.

A further report from the UK (Paterson et al., 2003) outlined the following information specific to death proximal to restraint in medical institutions:

• In mental health, before effective treatment for the acute phase of mania or psychosis was available, death as a consequence of exhaustion in patients was not uncommon.

• In a South Carolina hospital from 1915-1937, there were 360 deaths in which the cause was listed to be, “Exhaustion due to mental excitement”.

• In 1946, Dr. Shulack appears to be the first medical professional to describe this phenomenon as “sudden exhaustive death in excited manics”.

• In a 1952 study by Bellak et al, they describe the onset and symptoms of this syndrome as:

• • • Sustained motor and mental excitement with continued activity for a period of time

    • Rapid, thready, pulse

    • Profuse clammy perspiration

    • Fall in blood pressure

    • Hyperthermia

    • Delirium and death

(Note: very similar to what we are seeing now as will be mentioned later in this paper):

The literature review conducted to date confirms that Excited Delirium death, associated proximal to restraint, is not just a phenomena experienced by law enforcement, but also in psychiatric and geriatric care facilities (Joint Commission for Accreditation of Healthcare Organizations, 1998). In this published report, researchers found a total of 20 deaths associated with physical restraint in hospitals, psychiatric care facilities, as well as geriatric care facilities in the United States. A further report found in the Cormorant (Weis, 1988) reported about 145 deaths in chronic care facilities. As well, in a report authored by The Office of the Ombudsman for Mental Health and Mental Retardation in Minnesota (Office of The Ombudsman For Mental Health and Mental Retardation, 2004), they located 142 “reported” restraint associated deaths in mental health facilities between 1988 and 1999. As can be appreciated, sudden and unexpected death proximal to restraint is not just a policing concern, but rather an important factor for any occupation where the restraint of those experiencing Excited Delirium is a reality; some of those fields of work include; paramedics, fire first responders, emergency room staff, as well as psychiatric and geriatric care workers.

CURRENT RESEARCH INTO EXCITED DELIRIUM:

The reasons for sudden and unexpected Excited Delirium deaths proximal to restraint are very complex and multi-factoral and as such, new research is coming to light every few months. In Canada, Chris Lawrence (Ontario Police College) working with other medical experts such as Wanda Mohr (Associate Professor, Psychiatric Mental Health Nursing, University of Medicine and Dentistry New Jersey) as well as physicians has been conducting groundbreaking research into the medical literature associated with Excited Delirium. These authors have also developed an investigator protocol for police relating to the types of death associated to Excited Delirium (Lawrence & Mohr, 2004). In the United States an overview of the situation relating Excited Delirium to cocaine is available (Barkley Burnett & Adler, 2004).

According to Lawrence, sudden and unexpected deaths proximal to restraint fall into two specific categories:

1. Subjects die from conditions that leave evidence readily apparent at autopsy, and;

1. Subjects die and there is insufficient evidence to establish a cause of death at autopsy.

According to the medical literature reviewed for this paper, there appears to be three specific groups of people who are most prone to sudden and unexpected death proximal to restraint attributed to Excited Delirium:

1. Those who are suffering from psychiatric illness (bipolar, schizophrenia). This is also noted in a study where both agitated and non-agitated subjects suffering from schizophrenia died suddenly and unexpectedly (Rosh, Sampson, & Hirsch, 2003).

1. Those who are chronic illicit stimulant substance abuse users (cocaine, methamphetamines) including marijuana and alcohol.

1. Combination of mental illness and substance abuse.

The common outward presenting body autonomics related to excited delirium include:

• Unbelievable strength

• Impervious to pain

• Able to offer effective resistance against multiple officers

• Overheating (hyperthermia)

• Sweating

• Bizarre and violent behaviour

• Aggression

• Hyperactivity

• Extreme paranoia

• Incoherent shouting

When police officers are dealing with those experiencing Excited Delirium, both manias specific to psychiatric illness as well as drug induced psychosis, often present outwardly in the same manner. Based on the basic level of medical training provided to police officers, it is unreasonable to expect them to make any medical assessment to differentiate between the three causes of Excited Delirium.

Based on the literature reviewed, it seems reasonable that Excited Delirium causes a person’s sympathetic nervous system to shift into hyper drive. Such a shift may in fact occur long before police arrival. It may be that the subject is near physiological exhaustion even though they may not present so upon physical arrest. When combined with the fact that these subjects may have to be physically restrained, police may be compounding the effects of the sympathetic nervous system to the point that the body, more specifically the heart, is unable to sustain the exertion.

As stated earlier, the causes of Excited Delirium are multifactoral. No one really knows for certain what is happening. Current medical research has been summarized well within the eMedicine article (Barkley Burnett & Adler, 2004). In the literature, current medical research indicates some of the following medical concerns play a contributory role, or synthesis, when it comes to Excited Delirium as it relates to sudden and unexpected deaths proximal to restraint:

Contributing Factor #1: Cocaine toxicity and Dopaminergic effect to heart muscle

It is widely accepted in the medical community that both illicit drugs, especially cocaine, as well as some psychotic prescription drugs, may cause the heart to be much more susceptible to an arrhythmia (Straus, Bleumink, Dieleman, 2004). Long term use of cocaine markedly increases norepinephrine raising the fact that long-term cocaine users, should they also accumulate excessive norepinephrine, may be primed for a malignant arrhythmia (Barkley Burnett & Adler, 2004). Other conditions that provide such an anatomic substrate include Wolfe-Parkinson-White syndrome and left ventricular enlargement. Even low levels of cocaine in a person’s system can cause tachydysrhythmias. (Barkley Burnett & Adler, 2004)

Contributing Factor #2: Cocaine toxicity to brain (hyperthermia)

In the hypothalamus, chronic cocaine use causes issues in the brain preventing it from clearing dopamine from the synapses resulting in delirium (Barkley Burnett & Adler, 2004) . Due to the fact that dopamine also plays a role in the regulation of core body temperature, increased dopaminergic neurotransmission “may” contribute to psychostimulant-induced hyperthermia. It is hypothesized that hyperthermia “may” result from extensive muscular activity in the setting of warm ambient temperature and, perhaps, humidity (summer months or even hot rooms with poor ventilation) in combination with aberrant thermoregulation in the hypothalamus and mesolimbic system. Chronic cocaine use only multiplies this hyperthermic reaction to very dangerous levels. This is one reason why in those who die from excited delirium, at autopsy, D1 receptors in the brain are not affected upon medical examination. (Barkley Burnett & Adler, 2004)

The above noted is also supported by the National Association Of medical Examiners (Stephens, Jentzen, Karch, Wetli, & Mash, 2004). In this medical paper, several doctors found that chronic drug use is necessary to induce the changes in the neurochemistry that lead to Excited Delirium. The presence of hyperthermia (core temp>103 degrees F, 41 degree C) is strongly supportive of cocaine induced excited delirium. This position paper also went onto to say, ” a catecholamine - mediated excited delirium, similar to cocaine, is becoming increasingly recognized and had been detected in patients with mental disorders taking anti-depressant medications. In psychotic patients who have stopped taking their anti-depressant medications the neurochemistry is similar to the effects of cocaine.” Again, this study draws a correlation of why bipolar/schizophrenia subjects, as well as those who are chronic users of cocaine, methamphetamine, and other illicit stimulants are prone to excited delirium.

Another reported factor that may cause Excited Delirium that is mentioned in some of the medical literature reviewed, and briefly mentioned in the previous paragraph, is the fact that it is not just the levels of drugs ingested (illicit or prescribed), but it is also possible that the sudden, self-imposed cessation of prescribed medication (non-complaint) causes the subject’s mental condition to deteriorate to a point where psychosis results. This deterioration can occur over a short or longer time period.

Contributing Factor #3: Cocaine Associated Rhabdomyolysis (CAR)

Rhabdomyolysis can be caused by severe over exertion of muscle (such as struggling with police or continued struggle against restraint once in custody) and can also be caused by many drugs of abuse including alcohol, as well as certain types of prescribed medications.(A.J. Ruttenber et al,1997, A.J. Ruttenber, McAnally & Wetli, 1999) According to some of the medical literature reviewed, once rhabdomyolysis begins, muscle cells break down and allow the contents of the cell to leach their contents into the blood stream making the heart much more susceptible to arrhythmia due to alterations in the potassium and sodium levels of the blood.

It is hypothesized (Barkley, Burnett & Adler, 2004) that long-term cocaine use, rather than short-term use, is responsible for persistent changes in dopaminergic function that places users at risk for both Excited Delirium and CAR. Elevations in muscle enzymes levels are observed in asymptomatic chronic cocaine users and in untreated persons with schizophrenia; this evidence lends support to the hypothesis that chronic alterations in dopaminergic function can affect skeletal muscle physiology.

Contributing Factor #4: Metabolic Acidosis:

In 1999, Hick, J et al raised awareness of the relationship between Metabolic Acidosis and its effects possibly contributing to sudden death during restraint (Hicks, Smith, & Lynch 1999). Hick’s Study found that there might be exacerbation of exercise induced lactic acidosis by sympathetic induced vasoconstriction, which could be enhanced by cocaine and other CNS stimulants. Due to the fact that the literature reports that delirium, both by psychosis or drug, may alter pain sensation, it allows for physical exertion far beyond normal physiological limits and may result in a severe acidosis with maximal sympathetic discharge.

Contributing Factor #5: Neuronal Catecholamine Release:

During violent activity there is going to be an abundant release of catecholamines into the blood stream that, according to the literature reviewed, can sensitize the heart and promote rhythm disturbances. It is also reported in the literature that catecholamines enhance the toxicity of cocaine, which can lead to seizures, respiratory arrest, and cardiac arrest (Mets, Jamdar, and Landry, 1996)

In a further research paper which looked at post exercise sudden deaths, (Dimsdale, Hartley, Guiney, Ruskin and Greenblatt, 1984), specific to Catecholamine release, reported the following:

“These biochemical abnormalities, although present only transiently during the post exercise period may contribute to the vulnerability of the metabolically stressed myocardium to other arrhythmogenic factors, such as coronary insufficiency or ischemia. One well-documented effect of a reduction in plasma potassium concentrations that may affect cardiac vulnerability to arrhythmias is the increase in vascular resistance caused by reductions in potassium, especially in the presence of high levels of catecholamines. If the coronary arteries constrict in response to the sharp fall in potassium after exercise, the risk of arrhythmia would be elevated in subjects whose coronary perfusion already was limited by pre-existing disease.”

Contributing Factor #6: Antipsychotic Drugs and Sudden Death:

Due to the fact that police are often called to assist with the restraint of those experiencing a psychotic event in hospital, investigators should know that there appears to be a link between Antipsychotic drugs used to “chemically restrain” violent patients, and sudden cardiac deaths (Straus SM, Bleumink GS, Dieleman JP, King JH & Stricker BH, 2004). It has been reported in the medical literature that three antipsychotic medications have an increased correlation to sudden and unexpected death in patients experiencing Excited Delirium type events; Haloperidol, Droperidol and Thioridazine. All three antipsychotic medications are reported to cause QTc interval prolongation and, on occasion, torsade de pointes and death. (Glassman AH, Bigger JT, 2001).

Contributing Factor #7: Genetic Susceptibility to Arrhythmia

Very recently, several studies (Lehnart et al., 2004: Priori & Napolitano, 2004: Vos & Paulussen, 2004) have reported that the identification of the molecular determinants of inherited arrhythmogenic disease has been pivotal to the understanding of several aspects of cardiac arrhythmias and sudden death. These researchers have found that there is a wide spectrum of clinical phenotypes caused by abnormal genes encoding for transmembrane cardiac ion channels that can cause sudden death. Here in Victoria during the coroner inquest of Anthony Dawson, a local medical geneticist, Dr Patrick MacLeod, found a rare gene in a specific First Nations family that makes one more susceptible to the negative effects of Excited Delirium.

Contributing Factor #8: Face Down Prone Restraint Proximal To Arrest:

It is interesting to note, from an empirical investigative standpoint, that in the majority, but not all, of sudden and unexpected deaths proximal to restraint involving a subject experiencing Excited Delirium, that most subjects had been restrained and left in a prone position. Although Dr Reay’s research, specific to positional asphyxia, has been put into question by Chan, Snowden, and Ross’s, independent research, (remember that Dr. Chan’s research has been medically questioned and challenged as well) there still appears to be some medical or physiological issues with restraining a subject who is experiencing Excited Delirium, for an extended period of time, in a prone position.

One keystone which was identified, and that appears periodically in the medical literature surrounding Excited Delirium, is the dangerous lowering of pH. If blood pH drops too low then death, attributed to cardiac arrest, is a certainty if pH is not corrected (Ortega-Carnieer, Bertos-Polo, & Gutierrez-Tirado, 2001). Some medical literature reviewed for this paper points to the fact that pH can be affected either metabolically through acidosis (very common in Excited Delirium) or through hypoventilation, a state in which a reduced amount of air enters the alveoli in the lungs, resulting in decreased levels of oxygen and increased levels of carbon dioxide in the blood. Causation of hypoventilation can be due to breathing that is too shallow hypopnoea or too slow bradypnea or to diminished lung function. (MedicineNet, 2004) Some medical literature also points to the fact that hypoventilation can be drug induced via dopamine (Zapata, 1980; Bisgard, Forster, Klein, Manohar, and Bullard, 1980), cocaine use (Bauman JL, DiDomenico RJ, 2002; Kolecki PF, Curry SC, 1997; Wilson LD, Shelat C, 2003) or through body positioning especially after exercise (Haouzi, Chenuel, & Chalon, 2002). Again, it should be emphasized that according to the medical literature reviewed, hypoventilation can be caused by a number of factors and not just body positioning. As a police investigator this is an important point due to the fact that persons who die, suddenly and unexpectedly proximal to restraint, are not always kept in a face down prone position after control is obtained.

Because we know that body position affects the control of breathing in exercise by altering the coupling between ventilation and pulmonary gas exchange, is it possible that the prone restraint interferes with this fundamental tenet of blood gas homeostasis for those in an Excited Delirium state who are kept in a face down prone position? In discussions with Dr Christine Hall, Program Director, FRCP Program in Emergency Medicine, during a seminar on Excited Delirium hosted by the Calgary Police Department, she hypothesized that hypoventilation may be contributing to a fatal shift in blood pH. In her hypothesis, individuals suffering from Excited Delirium who are restrained in a prone position may be unable to breathe rapidly enough to exchange carbon dioxide. Although these individuals have a clear airway and can speak, the restraint prevents them from breathing at a rate necessary and the excess carbon dioxide contributes to an academic state.

Given that a person who is experiencing Excited Delirium will likely have a sympathetic nervous system that will be kicked into hyper drive, coupled with the fact that there will likely be a protracted physical struggle (causing hyperventilation) with police resulting in some kind of physical restraint, would it not make sense that a prone restraint would likely affect the coupling between ventilation and pulmonary gas exchange. Could it be that a prone restraint position would cause a subject’s hyperventilation state to be transitioned into a restraint induced hypoventilation state (rather than asphyxiation), which would then lead to acute hypercapnia, which could then lead to a dangerous lowering of pH levels, which would then lead to ventricular fibrillation, which is another keystone in most Excited Delirium deaths? The harder the physical exertion prior, during, or after restraint, the greater the risks of hypoventilation if breathing is impaired, especially if the subject is left in a prone position. Could this also explain why it is common for subjects to state that they cannot breathe after a protracted physical fight that ultimately results in a prone restraint? Could it be that even though a subject is restrained in a face down prone position yelling and screaming, thus indicating that breathing is taking place, is it possible that CO2 is not being dissipated efficiently due to hypoventilation, thus causing the chemoreceptors that regulate ventilation to register consciously that one is not breathing? The medical literature reviewed stated that dead space, or wasted ventilation, occurs when lung regions are “well ventilated” but underperfused or, conversely, when well-perfused alveoli are ventilated with gas that contains a high fraction of CO2. (Merck Manual, 2004). As noted in the Albany New York Regional Emergency Medical Organization protocol for overdose (REMO, 2004), “Most prehospital OD arrests are from hypoventilation and hypoxia.” This was also echoed in the Vanderbilt University Medical Center Lifeflight protocol for general management of the toxicological emergency (Vanderbilt, 2004) where it was mentioned that, “hypoventilation and hypoxia often go unnoticed.”

To support the above noted hypothesis, in the paper ” Metabolic Acidosis in Restraint-associated Cardiac Arrest: A Case Study” (Hick, Smith, & Lynch, 1999), researchers found that when severe metabolic acidosis combined with stimulant drug use (notably cocaine) and exertion are all combined, profound metabolic acidosis can have significant negative cardiovascular effects which may contribute to cardiovascular collapse. In this paper they looked at the five following cases studies:

Case #1:

“A 36 year old man was acting extremely agitated and belligerent on a downtown sidewalk. When approached, he attacked a police officer and ran. He was subsequently subdued by several officers. He was transported to the ED (emergency department), where he continued to fight vigorously while lying prone with his hands cuffed behind him. Breath analysis was negative for ethanol. Shortly thereafter, the patient had a witnessed respiratory arrest. He was intubated within 4 minutes of his apnea. Shortly after intubation, a 15-second episode of asystole was noted; he recovered a sinus rhythm at a rate of 140 beats/min after epinephrine, atropine, and hyperventilation. His initial arterial blood gas (ABG) obtained 5 minutes after intubation was pH 6.46, pCO2 49mm Hg, p”O2 523 mm Hg, and a bicarbonate (HCO3) of 4 mEQ/L. Aggressive fluid resuscitation was begun with crystalloid and 100 mEq of sodium bicarbonate was given. Within 30 minutes, the patient awoke and was able to follow commands, but had a bilateral lower-extremity paraplegia. The patient was admitted to the intensive care unit (ICU). His serum lactate level obtained one hour after admission was more than 24 mEq/L. he was extubated the following day, by which time his paraplegia had completely resolved. His urine toxicology screen was positive for cocaine and he admitted to being cocaine-toxicated during his arrest. He ruled out for a myocardial infraction by creatine kinase (CK) isoenzymes, but had a several-day course of rhabdomyolysis with peak CK levels higher than 40,000 IU/L. He was aggressively hydrated and maintained a good urine output. He developed renal insufficiency with a peak creatinine of 3.7 mg/dl. He also developed evidence of liver injury with elevated liver transaminases and increased prothrombin and partial thromboplastin times. These abnormalities resolved after several days. He was discharged on hospital day 5 with good urine output and a creatinine of 3.2 mg/dl. He failed to keep his follow-up appointments.” (Hick, Smith, & Lynch, 1999 pg 239-40)

Case 2:

“A 39-year-old man with a history of unspecified psychiatric illness was brought to the emergency psychiatric area for evaluation of agitation and psychosis. The patient became violent and was restrained by several security guards. He was placed prone with his arms behind him. During the restraint process he became apneic and pulse less. He was moved across the hallway to the stabilization room in the ED and immediately intubated. He was initially in a nonperfusing bradycardia, which deteriorated into ventricular fibrillation, and then asystole. An external pacemaker was applied but failed to capture. Epinephrine, atropine, and bicarbonate were given without results. A thoracotomy was then performed, and after internal cardiac massage and defibrillation, he developed a perfusing rhythm. The ABG values obtained immediately after thoracotomy were pH 6.81, pCO2, 30 mm Hg, and po2 162 mm Hg. His initial anion gap was 37 mEq/L. He was given a total of 450 mEq of bicarbonate during the case. His hemodynamic status stabilized and the acidosis reversed within 12 hours. Life support was subsequently withdrawn two days later due to a persistent vegetative state. Urine toxicology was positive for cocaine; serum levels were not available.” (Hick, Smith, & Lynch, 1999 pg 240)

Case 3:

“A 30-year-old man stole a purse, and after a long foot chase was apprehended by two witnesses who sat on the patient to restrain him. He lost consciousness, and when the paramedics arrived, he was in cardiac arrest with an idioventricular rhythm. He was intubated orally in the field, CPR was begun, and over the next 10 minutes, he was given a total of 4 mg of epinephrine, 1 mg of atropine, and 0.4 mg of naloxone. No bicarbonate was given. He was transported to the ED, where the idioventricular rhythm became asystolic. Initial ABG levels obtained at ED arrival showed pH less than 6.8, pCO2 18 mm hG, and pO2 255 mm Hg. Serum bicarbonate was undetectable by standard assays. He received 150 mEq of sodium bicarbonate, escalating doses of epinephrine to 5 mg, and an additional 1 mg of atropine. An external pacer failed to capture. Transthoracic echocardiography showed a motionless heart, and resuscitative efforts were halted. Urine toxicology was positive for cocaine; serum levels were unavailable.” (Hick, Smith, & Lynch, 1999 pg 240)

Case 4:

“After firing a gun in an apartment, a 39-year-old man was apprehended and restrained by several police officers. He continued to struggle during transport in a prone position with his hands cuffed behind his back. Upon entering the ED, he violently kicked a door, and then had a sudden cardiopulmonary arrest. CPR was started, and the patient was moved to the stabilization area. The presenting rhythm was idioventricular. Despite epinephrine, atropine, and standard advanced life support, he failed to respond, and died. Initial ABG levels, immediately upon ED arrival were pH less than 6, pCO2 more than 100 mm Hg, and pO2 30 mm Hg. The anion gap was 24 mEq/L/Serum bicarbonate was undetectable by standard assays. A serum toxicology screen was positive for free cocaine. Autopsy revealed a nonthrombosed 75% left anterior descending coronary artery stenosis. Cause of death was attributed to “cocaine-induced excited delirium.” (Hick, Smith, & Lynch, 1999 pg 240)

Case 5:

“A 38-year-old man was observed standing in the middle of a local street, attempting to hit passing cars with his fists. Responding police personnel were not able to escort him from the street. The patient was wrestled to the ground, maced, and then carried to the median and placed on his side. He continued to struggle, and then had a sudden cardiorespiratory arrest. Paramedics were present and immediately intubated the patient. The initial rhythm was ventricular fibrillation, with defibrillation resulting in asystole. The patient received 1 mg of epinephrine, 1 mg of atropine, and 50 mEq of sodium bicarbonate with a transient return of pulses at a rate of 120 beats/min. He became pulse-less again. Five milligrams of epinephrine and an additional 50 mEq of sodium bicarbonate were given, again with return of pulses. The patient was transported to the ED where initial ABG levels were pH 6.25, pCO2 50 mm Hg, pO2 221 mm Hg, and bicarbonate 4 mEq/L. He was admitted to the ICU, where he required aggressive fluid and pressor support. Refractory hypotension and disseminated intravascular coagulation led to an eventual bradysasystolic arrest ten hours after admission. Resuscitative efforts were futile. Autopsy showed no anatomic cause of death. Serum toxicology revealed rising levels of benzoylecgonine, a cocaine metabolite, during the time from ED presentation until the patient’s death.” (Hick, Smith, & Lynch, 1999 pg 240-41)

Hick, Smith, & Lynch’s paper also reported, “As our awareness of these cases (the above noted 5) has grown, we have treated at least five additional patients, who continued to struggle against restraints until Emergency Department presentation. All admitted crack cocaine use once their mental status normalized. None of these patients experienced cardiac arrest, although one was hypotensive, with systolic blood pressure of 70mm Hg at presentation. Initial pH ranged from 6.76 to 7.16. These patients were treated with aggressive fluid resuscitation and those with pH<7.10 received sodium bicarbonate.” All of these patients resolved their acidosis and were discharged at a later date.

To support Hick, Smith, and Lynch’s observation and protocol, the following letter to the editor of the journal “Anaethesia” if offered (Allam, S., & Noble, J.S. 2001):

“We would like to report a case of cocaine-excited delirium in which the patient survived despite extreme acidosis.

A 25-year-old male patient jumped from a first-floor window to escape his pursuers who were allegedly chasing him with swords. Whilst giving a statement to the police, he suddenly ran off and was apprehended. Although initially conversant with the paramedics, he became drowsy, and in the ambulance had a clonic seizure lasting 1 min.

On arrival in casualty at 13:30 h, there was no eye opening, he was flexing to pain and making incomprehensible sounds. His pulse was 116 beats.min 1, blood pressure 100/40 mmHg, respiratory rate 28 breaths.min 1 and temperature 38.3 °C. The initial blood gases revealed a hydrogen ion concentration of 292 nmol.l 1 (pH 6.53), P a co 2 of 13.13 kPa, base deficit of 35.6 mmol.l 1 and a P a o 2 of 25.61 kPa on 10 l of oxygen via a trauma mask. Because the 12-lead ECG demonstrated tall, peaked T waves, he was assumed to be hyperkalaemic. He was intubated with a rapid sequence induction and manual in-line stabilisation of the head with 2 mg of alfentanil and 100 mg of propofol. Hyperventilation was instituted; he was given 10 ml of 10% calcium gluconate and 50 ml of 8.4% sodium bicarbonate. He had 1.5 l of 0.9% saline over 90 min. The initial plasma potassium level was 7 mmol.l 1, sodium 153 mmol.l 1, bicarbonate 12 mmol.l 1, anion gap 44 mmol.l 1, urea 8.4 mmol.l 1, creatinine 202 µmol.l 1.

By 14:00 h, his temperature had risen to 39.7 °C. He was given a total of 2 mg.kg 1 of dantrolene in two separate aliquots within 20 min. Ice packs and a fan were employed as cooling measures. Blood gases taken at 14:47 h revealed a hydrogen ion concentration of 40.1 nmol.l 1 (pH 7.4), P a co 2 of 4.28 kPa, base deficit of 3.8 mmol.l 1 and a P a o 2 of 42.92 kPa on an F i o 2 of 0.6. Repeat electrolytes showed potassium of 5.1 mmol.l 1 and an anion gap of 30 mmol.l 1. By 15:00 h, his temperature had decreased to 37.6 °C. X-rays of pelvis, cervical spine, chest and CT scan of head were normal. Bacteriological and biochemical analysis of the CSF was unremarkable.

He was admitted to the ICU and extubated at 20:00 h. Clotting studies were normal and the creatinine phosphokinase level peaked at 8460 µmol.l 1 the following day. He was discharged from the ICU the day after admission and from the hospital on the succeeding day with normal renal function. On further questioning, he admitted drinking heavily on the night preceding hospital admission, and to taking cocaine. Toxicological analysis of his urine showed no trace of opioids, benzodiazepines or amphetamines. Cocaine was omitted from the toxicological screen.

The paranoia, agitation and rapidly progressive pyrexia with which this patient presented are features of cocaine-excited delirium [1]. This condition occurs within 24 h of cocaine ingestion in habitual users. Coma and death result without intervention. The prompt administration of hyperventilation, passive cooling, sodium bicarbonate and dantrolene led to a remarkably swift correction of the acidosis and a successful outcome in this case. Survival after such a severe acidosis illustrates that the arterial hydrogen ion concentration gives a restricted view of what is happening at the intracellular and mitochondrial level.

We are reporting this case to increase awareness of cocaine-excited delirium and to suggest one potential management strategy for this potentially fatal syndrome.

References

1. Henry JA. Metabolic consequences of drug misuse. British Journal of Anaesthesia 2000; 85: 136-42.”(Allam, S., & Noble, J.S. 2001 pg 385)

As investigators, we cannot ignore the fact that there does appear to be an empirical correlation between restraint positions and death in Excited Delirium cases. If Dr. Reay was wrong about positional asphyxia, could the above noted paragraphs and case studies explain the nexus between restraint position and death? Only further medical research surrounding restraint positioning, hypoventilation, acute hypercapnia, hypoxia, and pH will answer these very important questions. Could it be that the hypoventilation, acute hypercapnia, hypoxia, and pH are the “tipping point”, in combination with the other multifactoral issues mentioned in this paper, that may cause the cascading slide into tranquility that might result in sudden and unexpected death if not treated in some, but not all, Excited Delirium cases no matter what the position of restraint (Park, Korn & Henderson, 2001)?

The writer does not suggest that there has never been a death associated with “Positional Asphyxia”, where individuals who have been physically exhausted and placed into a hog-tie position, often with loads placed on their chests from several police officers holding them face down over an extended period of time, die from respiratory failure due to asphyxia. The writer is suggesting, however, that there may be a larger number of sudden and unexpected deaths proximal to restraint cases, which may be associated to hypoventilation and pH issues, rather than positional asphyxia alone, in combination with the other multi-factoral issues surrounding these deaths that have been mentioned in this paper. Although there appears to be an empirical correlation between Excited Delirium, physical restraint, and sudden and unexpected death, the exact causal mechanisms are still medically unknown and it is because of this fact, that the casual inference that physical restraint position, or certain types of holds, are an independent predictor of death during physical restraint cannot be made definitively at this time until further scientific and medical research has been conducted. (Day, 2002)

Veterinary Similarities to Excited Delirium In The Animal Kingdom:

As a result of having this paper peer reviewed by other officers, Sgt Chris Butler (Calgary Police Service Skills and Procedure Unit) contacted the writer and advised that when he was a Park Ranger, he came across a similar pattern of sudden and unexpected death in the animal kingdom after a chase and subsequent capture of deer, bear, cougar and Big Horn Sheep. Known as “Capture Myopathy” or “Exertional Myopathy”, this phenomenon has been studied by veterinarians for over thirty years (Deer Digest, 2001), and the similarities to sudden and unexpected death proximal to restraint of a human experiencing Excited Delirium are remarkable. According to the veterinary literature reviewed (Fyffe, 2004; Caulkett N., & Haigh JC, 2001; Caulkett N, 2001) deaths from Capture Myopathy exhibit the following conditions in animals:

• Hyperthermia

• Hypoventilation

• Rhabdomyolysis

• Acidosis

• Extreme lowering of pH

• If death is not immediate after capture, it occurs soon after restraint and usually within 2-3 days

Again, in the veterinary papers reviewed, if the writer did not know that he was infact reading about Capture Myopathy, he would have honestly believed he was reading a paper on Excited Delirium. Due to the fact that Capture Myopathy is identified as a medical emergency in veterinary medicine, intervention protocols included (ZCOG, 1995):

• Calming measures

• Cooling measures

• Intravenous fluids

• Vitamin E combined with Selenium

• Sodium bicarbonate to combat acidosis

• Calcium channel blockers

(It is interesting to note that the above intervention protocol is very similar to those mentioned in the Hick, Smith, & Lynch paper, the Allam & Noble letter to the Journal Anaethesia, as well as a proposed medical intervention located in a paper by Park, Korn, & Henderson, 2000)

As in Excited Delirium cases, if not medically treated immediately, many of the pathologic changes mentioned above are irreversible and despite drastic medical intervention, animals suffering from Capture Myopathy will often die within minutes, not unlike those who are restrained suffering Excited Delirium.

Due to the uncanny similarities between Excited Delirium and Capture Myopathy, should the medical experts who are researching Excited Delirium be consulting with their brothers and sisters in veterinary medicine? Could the thirty years of studying Capture Myopathy by veterinarians, including their early intervention protocols, be of some benefit and assistance to those who are looking at developing protocols for Excited Delirium cases in humans?

CONCLUSION OF RESEARCH:

Excited Delirium is described as:

” A state of extreme mental and physiological excitement, characterized by extreme agitation, hyperthermia, epiphoria, hostility, exceptional strength and endurance without apparent fatigue” (Morrison & Sadler, 2001).

Throughout the medical literature reviewed, the one thing that all of the medical community can agree upon is that Excited Delirium is a “medical emergency” no matter what the cause (Barkley Burnett & Adler, 2004; Farnham & Kennedy, 1997; Lawrence & Cairns, 2001; Young, 1995).

Good practice guidance, specific to the use of force, suggests that restraint should be subject to risk assessment such that the risks involved are considered against the risks of alternatives (Paterson et al., 2003). There are going to be times in policing, as well as in health care, be it psychiatric or geriatric, where non-physical approaches to control will not be practicable or reasonable given the emergence of the situation, and physical restraint may represent the only intervention capable of protecting the subject or others from death or serious bodily injury. Physical restraint or control of those suffering Excited Delirium is intrinsically an option that always has with it risks, however, in some circumstances, these risks may be less dangerous than the alternatives available. As one medical professional stated at a workshop on Excited Delirium in Calgary, Alberta Canada, “There can be no medical treatment of these individuals without restraint”.

It may be that deaths, associated to Excited Delirium, can never be completely eradicated. Hopefully by understanding the processes that may be involved and communicating the information to police officers, paramedics and emergency medical teams we may be able to optimize the emergency systems responses to incidents involving people with Excited Delirium. In fact, this is the theme of a research proposal Chris Lawrence, Team Leader of the Defensive Tactics Training Section at the Ontario Police College, will be forwarding through Royal Roads University as his major project for the completion of a graduate degree. Chris has stated that our investigation and recommendations specific to this issue will greatly assist him in this project. While work has already started on this project the expected completion date is August 2005. In the meantime Chris has developed an “Investigator Protocol: Sudden In-Custody Death” which all departments and health care agencies should follow when investigating such a death. As well, there are some specific protocols that should be followed by anyone who has taken into custody, through physical restraint, a person reasonably believed to be suffering from Excited Delirium:

• Due to the fact that Excited Delirium is a medical emergency, all subjects should be transported to hospital via ambulance (Advanced Life Support Paramedics) and monitored closely including heart rate, blood pressure, respirations, CO2 levels, pH levels, and temperature.

• Given the empirical correlation between the maximal restraint position (hog-tie) and sudden and unexpected death, such a restraint should be strongly reconsidered for use by all law enforcement agencies until further medical research has been conducted.

• Once in custody and awaiting transport via ambulance, or while being transported in the ambulance, the restrained subject should be placed in a supine position. If the subject must be maintained on their side it is recommended that they be placed resting on their left side if possible.

• If reasonable and able to do so, have Advanced Life Support Paramedics on standby prior to a physical interdiction of a person who appears to be experiencing Excited Delirium.

• From a control/restraint/safety perspective, the quicker control can be established the better. It may be that the longer the physical confrontation goes on with a subject experiencing Excited Delirium, the higher the risk of an in custody death.

• If the restrained subject suddenly becomes quiet and stops resistance, pulse rate, blood pressure, and temperature should be recorded continually. Advanced life support should be summoned where available, and preparation for CPR should be made.

Although protocols for police, specific to dealing with subjects experiencing Excited Delirium are important, others who also interact with these types of persons; including paramedic staff, emergency room staff, and even pathologists should be looking at developing protocols, specific to Excited Delirium patients, as well. Research, introduction, and the application of such protocols for most professions are lacking greatly, based upon the literature review and personal interviews that were conducted for this paper. Dr. Christine Hall, Calgary Health Region, who has conducted research into the issues surrounding Excited Delirium, and according to the medical literature that she reviewed specific to this topic area, found that there has never been one successful save once a person experiencing Excited Delirium has fallen to cardiac arrest prior to arrival at hospital. Could one of the goals of the medical research into Excited Delirium be to develop a standard protocol for after care with a relevant and needed data collection process, concurrent with developing an after care protocol for human life retrieval? This is a goal that I hope the medical community will take a serious look at in the very near future here in Victoria, and one that we are facilitating utilizing a medically multi-disciplinary approach. If we can start the ball rolling, a multi-center medical study would be enormously helpful in answering some of the questions raised in this paper.

When someone dies suddenly and unexpectedly during or following an altercation with police officers without a cogent explanation, the subject’s family, the general public, and the media will be left to search for their own answers. The traditional approach of not releasing any information pending the outcome of a thorough investigation can exacerbate speculation, which can generate mistrust. A major step could be realized if such a cogent explanation, based in lay terminology, could be derived and delivered to the public. Such an explanation would not fit into a sound bite on the evening news but rather provide the basis for an investigative report, the type usually seen during prime time viewing hours. Without such an explanation the concept of sudden and unexpected death due to Excited Delirium runs the risk of becoming a mere media buzzword. It should also be stated that despite the highly controversial and newsworthy profile of these types of sudden and unexpected deaths proximal to restraint, they remain a rare event compared with the overall prevalence of restraint use in law enforcement and health care. (Day, 2002)

Due to the type of situation that surrounds a sudden and unexpected death associated to what seems to be Excited Delirium, rigorous study is virtually impossible, due in large part to ethical issues that must be considered. An alternative is to formulate hypotheses, based on the collective, have objective assessment of a diverse group of experts, and then test the hypotheses to the extent ethically and practically possible (something that we will be doing with our medical review committee in Victoria). The progress of such an effort needs to be communicated to the groups involved in such an event as well as the general public.

I hope this review of the medical literature, specific to Excited Delirium as it relates to sudden and unexpected death proximal to restraint, was of some assistance. The research into this very important and sometimes emotionally charged topic is truly multi-disciplinary and as such, this paper should be considered a “living” document. There is no doubt that as further scientific and medical research on Excited Delirium, and its’ relationship to sudden and unexpected death proximal to restraint becomes available, the information and hypothesis found in this paper will need to be updated as well.

Sgt Darren Laur

Victoria Police Department

To contact the writer:

E-mail: laurd@police.victoria.bc.ca

Phone: (250) 995-7392

Special Note:

Special thanks go to Chris Lawrence who has dedicated the past five years of his professional career as a police educator to the issues surrounding Excited Delirium. Chris pointed me in all the right directions, thus allowing me to quickly come up to speed on the medical research/literature mentioned in this paper. Thanks Chris, your passion and commitment to this issue is second to none, and will go along way in providing a possible protocol for “Human Life Retrieval” for those on the path to sudden and unexpected death proximal to restraint.

References

Allam, S., & Noble, J. S. (2001). Cocaine excited delirium and severe acidosis. Anaesthesia, 56(4), 385.

Zoo Conservation Outreach Group (1995). Capture Myopathy. Retrieved September 9, 2004 from

http://www.zcog.org/zcog%20frames/Capture%20Myopathy/Capture%20Myopathy.htm

January 18, 2009 at 6:34 pm | Uncategorized | No comment

Saving Face

This thread was spawned as a result of the earlier thread I wrote called “A Deadly Lesson”

“Saving Face” is one of the most important street commandments that most street predators and thugs consider sacrosanct. If at anytime you challenge a person’s “face” either verbally and or physically, you are likely going to be in for a fight. This is even truer if the person you are challenging has a peer group as an audience looking on. Allowing one to “save face” during the pre-contact phase can also offer a tactical advantage that you can take advantage of, here’s an example of what I mean:

Last year I was dispatched to attend a local high school for a report of a group of youths drinking. It was graduation and the student body was celebrating in the schools parking lot, something I did when I graduated as well many years ago. When I arrived I noted that the group was about 120 students. After calling for backup, we proceeded to walk into the group who were now dissipating. Within this group I observed a smaller group of ten males who considered themselves a gang. One of these gang members had a number of warrants for his arrest but I also knew that if I went into his crew to pull him out the fight would be on due to the fact that he would need to save face.

Proper Pre Planning Prevents Piss Poor Performance, knowing that this gang member would need to save face I came up with my plan of attack. I called him over to my location that was out or ear shot of his crew, but yet his crew could still watch the both of us.

I explained to this gang member that there were several warrants for his arrest and like it or not he would have to come with me. I further advised him that if he did not come voluntarily, I would have to physically retrain him which could result in injury. After advising the gang member of this fact, he looked at me and stated, “ LARS if I don’t fight you when I get out of court tomorrow my crew will beat me.”

Understanding this fact (saving face) I used it to my advantage. I advised the gang member that he had two options:

1. To resist my arrest which would likely result in him getting hurt and loosing face in front of his crew, or;
2. If he allowed me to hook him up, after the second handcuff was applied he could call me every name in the book. He could yell, scream, tug, and pull but he could not physically strike me in any way.

Upon giving this guy the above two options he stated; “ if I call you a fucking pig you won’t smoke me.” It was at this point that I knew I had him and that he would be compliant with my arrest. After weighing his two options for approximately twenty seconds the gang member stated; “okay Lars I will turn around and let you handcuff me.

As the guy turned around to allow me to handcuff, his crew began to show all kind of pre-assaultive signs, but as soon as I got the second handcuff on the gang member went into show mode calling me every name in the book, pulling, tugging, and resisting me in my attempts to escort him to may car. Upon seeing this his crew started cheering his actions yelling and screaming the fact that this guy was going to kick my ass once I got his back to cells.

Once back at the car, I shoved the guy in at which time he continued to put on the show kicking both the inside door and back window of my cruiser while yelling and screaming at the top of his lungs. His crew was still cheering his actions. Once we got a block away out of view of his crew, this gang member immediately stopped all his actions and said; “Thanks Lars.”

Why did he say this?, because I allowed him to save face in a difficult situation in front of his crew, which allowed for a win/win situation. He got what he wanted, and I got what I wanted.

Remember:

DO NOT CHALLENGE SOMEONE’S FACE, AND WHEREVER POSSIBLE ALLOW OTHERS TO SAVE FACE

Strength and Honor

Darren Laur

January 18, 2009 at 6:30 pm | Uncategorized | No comment

Salesmen, Cheats, and Liars

Everything You Need To Know About Reality Based Self Defence (RBSD) Instructors

Recently, I was reading a web page of a fairly well known RBSD instructor and author in the U.S., when flashing before my eyes, on his web site, was the following announcement/update:

“ So and So (name withheld) is Vancouver Island’s First Reality Based Instructor”

Being a person who calls Vancouver Island his home, I know of several individuals/instructors who have been teaching “Modern Combatives/ Self Protection” for many years, myself included, who have spent thousands of hours both researching and acid testing what it is that we teach and do. This new “Vancouver Island’s First Reality Based Instructor” got his credentials after attending a 20-hour program. Can anyone else see the irony here other than myself ?????? Things that make you go hmmmmmmm!!!!!!

The term “Reality Based Self Defence” has become the catch phrase of choice in the new millennia amongst those who teach what they call street effective training. Just pick up the current issues of any of the better-known martial art magazines, and it seems that every page is littered with advertisements of Joe Schmuck’s RBSD School. Much like the Ninja craze in the early 1980’s, and the MMA craze of the late 1990’s; Reality Based Self Defence is the newest and the hottest thing in the market today. Using the term “RBSD” will guarantee you large financial rewards due to the fact that those who are seeking such training, are being attracted to those unscrupulous teachers, instructors, and schools who use the term RBSD as the bait to lure the unsuspecting and naïve student into their lair. Once lured, these charlatans play into the human desire and want of “flash”, and usually hook the student into nothing more than a watered down martial art program that has no place in the reality of the street while rolling around in the mud, the blood, and the beer. In fact, what these charlatans are teaching is not self-protection, but rather “self defeat” at the expense, and to the detriment of those who do not know any better, the uninformed student.

Let’s look at the term “ Reality Based Self Defence”

• “Reality Based”: If a teacher, instructor, or coach is teaching from what they believe to be their reality (no matter how divergent from “actual” reality their principals and beliefs are), then what they are teaching is, in their perception and belief, Reality Based Self Defence. Some of the training principals and techniques that I have seen passed off as RBSD would only be useful in the movie The Wizard Of Oz. But yet to these instructors, that is their reality when it comes to combatives.

• “Self Defence”: I have always hated this term. Why ?, it paints the mental picture that one has to wait for the aggressor to do something to them first, before one can take protective measures. IMO, this term also creates the less desirable “defensive” mindset that we need to stay away from.

Rather than Reality Based Self Defence, I consider the terms; Combatives, Self Protection, Self-Offence, and Fighting more desirable. Although these names are not as catchy as RBSD, they are more distinct and fitting to the topic IMO.

On the street, “results” are what matters, and not a name or phrase. The purpose of this posting is to shed some light, IMO, on what to look out for when choosing a school or teacher so that you do not run into one of these “fly by night”, “one course wonder” RBSD instructors. You need to ensure that you choose a Self Protection instructor or school as you would your family doctor. In both cases you may be placing your life in their hands. Some questions that need to be answered when choosing a school or instructor:

• How long has the instructor been involved in teaching/studying combatives
• What is the instructors credentials and where did they get them from and can they be verified by you
• Does the instructor have lesson plans or course training standards that can be viewed by you
• What is the instructors background
• Is the instructor well known for their expertise
• Does the instructor have references that can be easily checked by you
• Does the instructor practice what they preaches, if not stay away
• Does the instructor consider themselves a demi-God, and the students their flock, if so stay away
• Does the instructor teach what he calls “SECRET” techniques, if so stay away because there are no secret techniques in combatives
• Is the system taught, practiced, and applied by rote; if so stay away
• Do students practice in street clothing rather than martial art garb
• Are classes taught only in the closed environments of the dojo or training studio, or does the training take place in open environments under all kinds of conditions, if not stay away
• Is sensory deprivation training utilized to replicate fighting with an injury or disability, if not stay away
• Does the instructor give credit to others, or do they lay claim to everything being taught in combatives as theirs, if so stay away
• Are techniques being taught, sport based, if so stay away
• Are students required to memorize complicated techniques, if so stay away
• Does the instructor talk about the emotional, biological, and physical effects of fear in combat from a modern rather than philosophical perspective, if not stay away
• Does the instructor deal with survival stress inoculation training, if not stay away
• Is class time dedicated to learning and practicing everything related to combatives, if not stay away
• Does the instructor continually seek out new information from others, thus allowing themselves and their students to grow. If not stay away
• Does the instructor allow students to adapt, overcome, and improvise in combat or is the instructor’s way the only way, if so stay away
• Is there a heavy emphasis or reliance on pain compliance or joint manipulations, if so stay away
• Does the instructor teach all ranges of combat (psychological, pre-contact, weapons; knife-club- gun, kicking, punching, standing clinch , ground) if not stay away
• Does the instructor put more emphasis on the physical rather than the mental, if so stay away
• Does the instructor/school utilize scenario based replication training on an ongoing basis, and are these session video taped for your own visual feed back, if not stay away
• Does the instructor/school want you to sign a contract where you have to pay several months up front? What are the real costs ? Is it all about MONEY, if so stay away
• Are questions permitted in classes, and does the instructor answer them to your satisfaction. If they don’t know the answer to a question will they research it and get back to you, if not stay away
• Does the instructor understand and discuss the legal ramifications as it relates to self protection/Use Of Force , if not stay away
• Are training materials available to the student, if not stay away
• Is the training practical and realistic from “YOUR” perspective, if not walk away
• Are private or semi private lessons available, if so how much
• Does the instructor continually update and provide crime prevention awareness strategies, if not stay away
• Are the use of and defence against weapons (gun, knife, impact weapons, oleoresin capsicum spray) offered, if not stay away
• Are multiple opponent strategies discussed and practiced, if not stay away
• Will the instructor/school allow you to watch several classes and speak to students, if not stay away
• Do you feel comfortable with the instructor/school and other students, if not stay away

These are but a few of the questions that should be asked and answered when seeking out those instructors and schools who approach the topic of combatives from a professional standpoint. If you, the reader of this posting, have other questions that should be asked, please post them if you see fit.

Remember, do your homework, and ask the important questions. This industry is infested with those who say they are “certified” RBSD instructors, when in fact they are nothing more than salesmen, cheats, and liars. Two quotes that come to mind:

1. Buyer beware

1. There’s a sucker born every minute

Strength and Honor

Darren Laur

January 18, 2009 at 6:29 pm | Uncategorized | No comment

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