The American College of Emergency Physicians (ACEP) has disavowed the controversial term “excited delirium,” which some have used to explain how an agitated person could die in custody without attributing it to any force used to subdue them. This term has been a subject of controversy, with links to disproportionate use in the deaths of Black individuals and was cited in high-profile cases, including the death of George Floyd in 2020.
The ACEP’s Board of Directors confirmed that its 2009 white paper on excited delirium syndrome is outdated and doesn’t align with the latest scientific understanding. As a result, the organization has officially withdrawn its approval of the paper. This decision is seen as a pivotal moment, as the paper had been influential in allowing the term to be used in court cases.
Excited delirium was considered a subcategory of delirium and described an individual as being agitated, aggressive, or disoriented, suggesting that this heightened emotional state could lead to their death. However, it was never an official medical diagnosis, as it wasn’t listed in the reference materials used by mental health professionals or in diagnostic codes. A 2022 report by Physicians for Human Rights concluded that the term was “scientifically meaningless.”
The term “excited delirium” has come under scrutiny for its potential links to racial bias and its use to justify excessive force by law enforcement. ACEP’s decision to disavow the term has been welcomed by advocates for racial justice and human rights.
A study found that from 2010 to 2020, there were 166 reported instances where a person died in police custody, and excited delirium was cited as a possible cause of death. Alarmingly, Black individuals accounted for 43% of these deaths, despite making up only 13% of the U.S. population.
The term gained national attention after the death of Elijah McClain in 2019. McClain, a Black massage therapist, died after being subjected to a carotid hold by police and injected with ketamine by paramedics. A jury recently found one of the officers involved guilty of criminally negligent homicide and assault, while another was acquitted. Two paramedics are scheduled to go on trial soon, having pleaded not guilty.
The move to disavow excited delirium is not limited to medical organizations. In 2020, the American Psychiatric Association, the American Medical Association, and the American College of Medical Toxicology all took positions against the diagnosis. These organizations cited the term’s nonspecific nature, the lack of clear diagnostic criteria, and the potential for it to be used to justify excessive police force, especially in cases where Black men die in law enforcement custody.
ACEP’s decision follows years of consideration and deliberation on the issue, with a task force in 2021 concluding that the organization should no longer recognize the term “excited delirium” and that it should be abandoned in clinical settings. The official disavowal of the term is seen as a strong statement that it should no longer be used in court.
While the term “excited delirium” has now been disavowed, ACEP recognizes a similar term, “hyperactive delirium with severe agitation,” as a potentially life-threatening clinical condition. This condition is characterized by vital sign abnormalities, pronounced agitation, altered mental status, and metabolic derangements. The organization advises that when dealing with someone exhibiting hyperactive delirium, first responders should focus on reducing stress, preventing physical harm, and taking the person to a hospital for emergency treatment.
Reference
CNN, “Emergency medical association rejects ‘excited delirium,’ used to describe some deaths in police custody” Emergency medical association rejects ‘excited delirium,’ used to describe some deaths in police custody | CNN.
