Sudden Custody Death Syndrome

Sudden custody death syndrome; no aspect of Use of Force is more personally devastating to those involved than a subjects death. Whether from Excited Delirium, Positional, or Restraint Asphyxia, when a subject dies in custody, the resultant personal traumas and civil litigation s can and often do have far reaching effects.

The following are not meant to be ‘medical’ explanations of the types of Sudden Custody Death occurrences but simply my own layman's terms for what occurs.

Excited Delirium—This is essentially a lifestyle problem, created by ongoing drug and alcohol abuse. Then in a use of force situation, the side effect factors come together to produce this particular sudden custody death.

Long term abuse, especially, of cocaine and hard liquor appears to disrupt certain natural inhibitors in the subject’s brain. These inhibitors would normally limit the amount of adrenaline released at any given time (maintaining a safe reserve). The combination of drug and alcohol abuse and use of force/restraint produces a spike in the adrenals which is off the normal scale. Unfortunately when resistance then stops, there is insufficient adrenaline left in the body to drive the heart. Death results.

Positional Asphyxia—This is asphyxiation caused by the body’s position that constricts either the airway or the lungs ability to get air or both. This is often believed to be the result of a subject being “held down”, usually on their stomach. It can also occur without restraint being applied. e.g. the drunk who falls asleep sitting in a chair, slides part way down (slumps), head rolls forward, airway is constricted, he is too drunk to realize it (let alone move). Death then results.

Restraint Asphyxia—This is essentially a “catch all” phrase covering, most usually, positional asphyxia resulting from the subject being held in a position that resulted in their suffocation.

It also includes persons with psychotic episodes that are not drug related or medical difficulties (such as lethal heart murmurs) that a civilian or police officer cannot be expected to be aware of, or necessarily even recognize until the situation goes critical. In a sense, this is a bit of a misnomer or a “chicken and the egg” question. Was the death actually a result of the restraint? Or was it a result of a pre-existing condition?

Recognition And Response Are Critical

All three “sudden death” scenarios need to be recognized and dealt with as the medical emergency they truly are. Follow proper first aid procedures, beginning with initiating emergency medical services response, and render appropriate first aid to the subject until emergency medical services arrive.

What it comes down to with Sudden Custody Death Syndrome occurrences, for me, is that Excited Delerium and those pre-exsisting medical conditions that may result in death, I view as suicides who picked my truck to jump out in front of. There is just nothing I can do about them except to follow up appropriately. Meanwhile Positional and 'true' Restraint Asphyxia can be safe guarded against by building simple preventative measures into our Use of Force training and then always following these steps.

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