You may have read about the tragic death of Elijah McClain, a 25 year old Denver-area massage therapist who died after receiving an injection of ketamine from emergency personnel. That was in 2019. Now the State has decided to open its own investigation into that incident and others involving ketamine.
Excited delirium is a term widely recognized in emergency medicine, yet lacking a single accepted definition. It’s not to be found in the DSM5, nor does it have official status with the WHO or the AMA. That makes it something of an orphan, medically-speaking. Many practitioners believe in it. Others remain skeptical.
Closest description I found: a state of delirium (extreme confusion) marked by psychomotor agitation (restlessness, hyperactivity, constant motion, hypervigilance) and autonomic dysfunction (effects on heart rate, bladder function, body temperature, etc). Causes can and do vary.
I’ve witnessed something that fit that description on three separate occasions. Once in an ER waiting room, another time on an acute psych ward, and finally, on a San Francisco street. Each time it was managed by police and paramedics, and each time the response included sedation plus a lot of physical restraint.
Having been involved in similar situations, I came away feeling there’s no way that even three strong males could have coped, without the medication. And the risk of injury had still been quite high – mostly to the patient.
That’s the real challenge: restraining someone who’s agitated without injuring them. There’s an extensive medical and psychiatric literature on the subject.
I hadn’t been aware that ketamine was commonly used in such situations. When injected, it takes effect quickly, lasts maybe half an hour. There’s less stress on heart rate and breathing — that’s a good thing. I understand there are some behavioral effects that can be troublesome – hallucinations, or renewed agitation as the drug wears off.
In the addictions field, we know ketamine as Special K, a popular club drug along with Molly (MDMA) and GHB (the ‘date rape’ drug). It’s made by outlaw chemists or perhaps stolen from veterinary practices, where it’s been referred to as ‘kitty valium’. Dried to powder form, it can be snorted to create a trance-like state that I guess people find desirable?
I can see both sides of the delirium issue. First, why it could cause major problems for cops and EMTs on the street. I can also understand how some officers and emergency personnel could fall into the habit of overreacting to signs of agitation. “You want to get out ahead of it,” a patrol sergeant advised me. He meant medicate aggressively. “Because the longer we wait, the more difficult things will get.”
I don’t know if that’s technically accurate. He swore by it.
In the Colorado case, the dosage administered to McClain seems to have been excessive. He stood 5’6” and weighed 140, yet received a dose suited to a much larger man.
I’m sure that issue will be at the center of the coming investigation.