Fla. FD Official: Be on Alert for Excited Delirium

Davie Fire-Rescue Medical Director Dr. Peter Antevy told attendees at Firehouse Expo last week that responders need to know the signs and symptoms of excited delirium.

Instead of answering the agitation with force, such as hog ties and physical struggling, sedation is the answer when possible, Antevy said, noting that while many police officers might recognize the physiology of the emergency, they have to take the necessary steps to protect themselves and the public. That might include physical restraints and even use of a Taser on the patient/suspect.

“They want to get home to their families and I can understand that,” Antevy said. The more EMS and police work together, and are educated about the signs and symptoms, the more likely a patient will experience a good outcome, he said.

After the patient has been sedated, Antevy recommends IV saline and, if necessary bicarbonate to reduce the acidosis found in most excited delirium patients. If bicarbonate is administered, the provider must monitor the patient closely, paying particular attention to end tidal readings. Ice packs to cool the body are also highly recommended, he said.

And any time sedatives are administered, he said “good medic common sense” is needed to make sure the patient’s compensatory body functions are maintained.

It’s very likely that an excited delirium patient will be experiencing tachycardia as the body tries to react to the additional simulation and physiological reactions taking place. Rapid pulse rates are common in excited delirium patients.

Antevy said providers need to be watchful of excited delirium patients because they decompensate quickly, often going into bradycardia and even asystole without much warning.  That’s why rapid transport is always indicated with patients suspected of having excited delirium, he said.

And the hospital should be alerted to suspected cases of excited delirium so they know what to expect. It’s not uncommon for people exhibiting symptoms to be sent off to the psychiatric ward for evaluation when they should be headed to the emergency room, or intensive care unit for treatment of life-threatening conditions.

Even basic life support providers can make a big difference in the outcome, Antevy said. By being an advocate for the patient, and not letting the hospital ship them to a psych ward, and making sure police officers have a good understanding what they are dealing with and perhaps suggesting better ways to restrain the patient which might allow them to breath more effectively.

Not all patients will survive this life-threatening condition and that’s why Antevy said it’s important to “document, document, document” all findings and observations with these patients.

“That way, when you come under scrutiny, and you will, you’ll have the documentation to indicate what was going on,” Antevy said. High temperature, with a number, is a good thing to have, along with heart rate and state of agitation, which will all be clues and evidence to help defend one’s self from any accusations of wrongdoing.

“It’s important to recognize excited delirium so that it can be dealt with safely and efficiently,” Antevy said.