Thursday, April 10, 2008

Sometimes...

Sometimes people die.  Actually, everybody dies- but that's not the point.  Sometimes people die and you go over the situation examining decisions and what-if's and sometimes you find the place where something different might have saved a life.  Sometimes that is valid and sometimes it is NOT.  Sometimes the examination is a serious debriefing, professionals trying to learn lessons and find a better way to do a risky job.  Often it is one or more amateurs with an agenda trying to place blame... (and that's not fair. The real mechanism, often, is that someone who they love brought on his own deaths through his own actions... and that's too much, too much love and anger, too much to feel for one dead person. If they can remove at least the little piece about his responsibility for his own death maybe they will sleep better at night.  Maybe they can forgive the dead for dying if they can remove the need to forgive them for what lead to the death.) The amateurs will go to unbelievable lengths of twisted logic to believe that they have found a way.

There was a recent news article that enraged me, and maybe I will dissect it later- but Dave asked about the comment that sometimes people die no matter how hard you try.  A long time ago I mentioned without following it up that if a threat cannot feel pain, it almost guarantees a serious injury.  Those are all connected.

Dave was concerned that it might be personal to talk about.  Less for me, but I have restrictions based on confidences and other things, so this post will probably seem more oblique than most.

The force is over when the threat decides it is over.  That simple. Humans almost always give up.  Unless every long bone in the body is broken or the Central Nervous System is shut down the human machine is still capable of fighting.  The whole point of pain compliance (joint locks, pressure points and Taser) is to deliver enough pain that the threat decides to quit.  The next step above that does damage, but it takes a truly horrific amount of damage to make it impossible for a human to keep fighting.  It is some damage + a fear of more damage that makes the threat quit fighting.  The threat quits because of the fear. They quit psychologically.

The next step above this is lethal force. If it is imperative to stop the threat and damaging force has failed, that may indicate lethal force (that is not legal advice).

More often than not (and in almost every case that has made the papers lately and locally) though the officers could justify lethal force, they try to handle the situation at a lower level. Often a much lower level.  One example is "the swarm" where as many officers as they can get pile on the threat.  The idea is to tire the threat out. Use friction and body weight to cause an exhaustion that will do what pain and fear failed to do.  It is dangerous as hell. If you are trying to wrestle and the other guy is biting, clawing, blinding and may have a weapon, it sucks... and I know officers who have been permanently injured trying hard NOT to injure a threat.  Even if the threat doesn't have a weapon all the officers do, and the threat could work one out of a holster and turn it into a bloodbath just by chance.  So it is dangerous. It would be far safer and often justifiable to stand back and use firearms, but most officers are so reluctant to kill that they try this technique.

Usually it works.

Sometimes (look for "excited delirium") it doesn't.  Excited delirium is a condition that most officers are familiar with, but it is hard to pin down exactly what it is or what causes it.  It usually follows heavy stimulant use (PCP or cocaine) but sometimes not.  Often the threat has a history of severe psychiatric disorders, but sometimes not.  Sometimes it is just rage taken to a point that is inhuman.  The weirdest part, to me, is that some of the liver temperatures taken at autopsy, well after death have been higher than the body can withstand without brain damage, so there is something physiological going on.

What presents (and none of these are 100%): is someone who often strips naked, sometimes howls like an animal, attacks almost anything that moves and likes to break glass.  They don't respond to pain.  They fight when any normal human would long have collapsed into a heap.  They shrug off bullet wounds that are clearly lethal.  The ones I have dealt with have gone relatively well, but close friends have been involved in instances where a relatively small threat was literally throwing (in one case eight, in another five) officers around.

And that's the thing, Dave.  Because sometimes the threat just suddenly quits and you get handcuffs on and start to take a breath and realize that he isn't breathing.  He didn't give up, his heart gave out.

At great personal risk the officers addressed the threat at a lower level of force than they could have justified and he died anyway.  In the end, to the amateur debriefers, it's all the same.  If they hadn't fought so long and so hard, the poor boy would have lived.  They should have done something else.  What?  Taser?  But all of the cool tools that come under fire- Taser, VNRs (Vascular Neck Restraints, the fancy word for a hadaka jime), ankle to hand restraints, even OC tend to be used more often when you need the edge.  You need the edge most of all with excited delirium.  As seen from the liver temperature, some of the people in ED are on the fast track to death or brain damage anyway. 

 Here's the thing- it's possible that a certain percentage of these cases would die anyway, even if they never came in contact with an officer.  A rough analysis shows that the percentage who die in custody hasn't really changed with the LVNR and when the LVNR was removed from many agencies; when hog-tying was common and when it was discontinued; when the Taser and OC were introduced.

There's an international study working on in-custody deaths right now.  It may be years before they have solid numbers, but then we may have an answer.  Until then, the amateurs with an agenda will blame whatever tool or tactic was used, completely ignoring the fact that the officers had no choice about getting involved and risked their lives trying not to use deadly force.

12 comments:

Formosa Neijia said...

Rory,
Thanks for discussing that. I've had one experience with "excited delirium" and I'll never forget that guy's eyes when he looked at me. He looked through me.

After that I retooled my training to take someone like him into account. But I didn't think that they might die anyway.

Dave

Drew Rinella said...

I'd ask for a link to the article, but I probably don't want to read it anyway.

mistamark said...

"The weirdest part, to me, is that some of the liver temperatures taken at autopsy, well after death have been higher than the body can withstand without brain damage, so there is something physiological going on."

At the risk of sounding like a hippie, TCM postulates that anger comes from the liver.

"If left unchecked, suppressed liver Qi could turn into liver fire, with its attendant violent, unpredictable behaviour."

Mac said...

In a course I am taking now, given by clinical specialists in mental illness, including excited delirium, their consensus (and they are national trainers, physiologists, doctors and 25 year recovering addicts-turned-clinicians), is that "they most often die anyway, no matter what you do, including nothing".

Drew Rinella said...

Our protocols on the coast actually do cover excited delerium as a form of hyperthermia, and we are to treat it as such, including active cooling and rectal core temp.

I guess you slip 'em the thermometer in between punches!

MS said...

"Excited delirium" = berserkergang?

Just wondering.

Rory said...

Mark-
Don't sweat sounding like a hippy. If someone saw a connection and I can make it work, I don't care much about how odd the source sounded. What was the TCM treatment for "Liver Fire?" Anything I could apply in the field.

Mac-
Not sure about the math. I know these guys have suddenly croaked in ERs with a full complement of state of the art medical skill and technology right there. OTOH, we've dealt with what, dozens? And none of my personal ones have died. I can only think of two off hand in the facility and I know I've saved one via Taser. But it is a very real possibility that amount, level and type of force applied is irrelevant and whether the threat dies is based on something biological and completely outside the officer's control.

MS-
Maybe in one direction. If someone were to hit ED in a battle, it would (in that culture) probably be called the 'gang... but if that was the only source of a berserk state, most berserks would suddenly die of what would appear to be a fever at the end of a battle. There are other mindsets I've touched which are closer to the berserksgang without the pathology.

mistamark said...

" Don't sweat sounding like a hippy. If someone saw a connection and I can make it work, I don't care much about how odd the source sounded. What was the TCM treatment for "Liver Fire?" Anything I could apply in the field."

Unfortunately the TCM treatment involves administering Gentian Root (long dan cao) over a few days and needling a few points. Not really the kind of thing you can pull out when the guy's doing his berserker impression...
As a preventative measure though, the 6 healing sounds are indicated... Somehow I can't see the blokes you look after going for that much. It is a deceptively effective practice though.

One thing I did find when looking up the correct spelling of berserker:

http://www.vikingfighting.com/Default.aspx

maybe that's the solution :)

Steve Perry said...

Thing with acronyms and abbreviations is that they can mean different things in different venues.

"ED" can be "excited delirium." If you watch TV and see the commercials for Viagra or Cialis, ED means "erectile disfunction"

Could be a correlation ...

Rory said...

Acronyms! Here I was worried that someone would call me on using ED (the accepted shorthand for 'emotionally disturbed') for excited delirium. What do we get? Erectile dysfunction.

I guess everyone sees whatever problems they dealt with most recently.

;)

Steve Perry said...

Nah, I never used the "ED" term, I prefer "LD," for limp-dick. Of course, given that they make Viagra out of my blood -- one drop makes a thousand pills, it's not something I have to worry about ...

The Moody Minstrel said...

And all this time I thought it meant "Educationally Deprived". I guess that shows what world I'm forced to live in.

Interesting post, as always. Self-destructive combat overload? I wasn't aware that the body could do that. That's scary.

To be honest, Rory, I'm surprised the taser even makes a difference with someone in an ED (as in Excited Delirium) state. I'd imagine it would just pump him up even more.