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Preparing for "Sudden Death!"

by Michael A. Brave and John G. Peters, Jr.
(© Copyright 1994 All rights reserved.)

[Author's Note: Before we discuss "Custody Death Syndrome" (CDS), we encourage you to call the IACP [(800) THE-IACP] and request Training Key # 429 - "Custody Death Syndrome," and the IACP Executive Brief for March 1994, "Pepper Spray and In-Custody Deaths." The IACP documents are excellent and provide an overview and reference list for CDS.]

A suspect under your officers' control has suddenly died. In addition to your concern for the involved officers' well-being, you immediately cringe at the thought of the critical scrutiny you will soon be facing by the media, by council officials, and by special interest groups.

As you review the incident, you are confident of your officers' proper actions and are relieved that you had recently instituted a policy and provided training to your officers on the "Custody Death Syndrome" (CDS).

What Is The "Custody Death Syndrome" (CDS)?

CDS is a category of deaths which has no apparent detectable anatomical cause, which occurs while, or shortly after, a person is taken into custody . Generally, CDS has been associated with positional asphyxia, drug-induced excited delirium, cocaine psychosis, and/or neuroleptic malignant syndrome.

In the past several years there have been numerous deaths which have occurred during custody or shortly after a police encounter. In the majority of these cases the autopsies did not reveal any basis for anatomical death - a "negative au- topsy." Since there was no anatomical cause of death, many of the deaths were listed as being a result of police practices (e.g., oleoresin capsicum (OC) aerosol exposure, carotid restraint, and/or positional asphyxia).

Fortunately the autopsies, and the concurrent investigations, did identify several signs which preceded the rapid demise of the individual. Some of these warning signs are:

Bizarre Behaviors include paranoia (e.g., hiding behind bushes, trees, or cars), hallucinations, hearing voices, extreme aggression toward objects (particularly glass), violent resistance/struggling, inappropriate nudity, hyperactivity prior to police contact, and self-inflicted injuries.

Bizarre Communications include talking incoherently, screaming, and yelling.

Physical Symptoms include hyperthermia (excessive body temperature), profuse sweating, seizures, foaming at the mouth, dilated pupils, uncontrollable shaking, inability to breath, and extraordinary strength.

Officers' Actions in encountering a CDS person often required several officers and usually involved a strenuous confrontation. Several of these encounters have resulted in officers using carotid restraints, OC, and/or hogtying.

What Do We Do?

Knowing that the above-listed CDS warning signs will probably precede a sudden custody death proactive administrative guidance can be provided. Certain officer actions will also raise "red flags" to our critics (positional asphyxia, OC exposure, and carotid restraint). Implementing a policy and providing officer training which can minimize the potential for death, and the resulting liability exposures include:

1. Educate offices on the CDS warning signs.
2. Educate officers to attempt to calm the individual and to gain control of the person as soon as practicable.
3. Provide realistic procedures for officers to summon emergency backup/support personnel to assist in controlling the CDS suspect.
4. Educate the officers to summon medical assistance as soon as practicable after detecting a sufficient number of the CDS warning signs.
5. Instruct officers to carefully observe the CDS person prior to the arrival of medical personnel.
6. Instruct officers to advise the responding medical personnel of their observations and their CDS suspicions.
7. Prohibit hogtying and warn of other suspect positioning which may enhance the possibility of death (e.g., a person with a large belly being placed flat on that belly, or placing the person over the vehicle's drive-shaft hump). Of course, if an action is prohibited, such as hogtying, officers must be provided with legitimate alternatives, such as alternative restraint equipment and procedures.

   Informing Your Medical Examiner:

   Even if you live in a major metropolitan area you cannot assume that your medical examiner is familiar with CDS. Therefore, you may wish to provide your medical examiner with copies of any articles you acquire for your reference file and a copy of your CDS policy and training documents.

   Sample Policy

   The authors have a sample CDS Policy available. If you would like to receive a copy of the sample policy call Mike Brave at (715) 833-1125 or fax at (715) 833- 1413.

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   1. Brave, Michael A., and Peters, John G., Jr., "Liability Constraints on Human Restraints," Police Chief, March 1993, Volume LX, Number 3, pages 28-35.
      
      Custody Death Task Force, Final Report, San Diego (CA) Police Department, June 1992
      
      Mittleman, R.E. and Wetli, C.V., "Cocaine and Sudden 'Natural' Death," Journal of Forensic Sciences, JFSCA, Vol. 32, No. 1, Jan. 1987, pp. 11-19.
      
      O'Halloran, M.D., Ronald L., and Lewman, M.D., Larry V., "Restraint Asphyxiation in Excited Delirium," The American Journal of Forensic Medicine and Pathology, 14(4):289-295, 1993.
      
      Reay, Donald T., M.D., Fligner, Corinne L., M.D., Shilwell, Allan D., M.D., Arnold, Judy. "Positional Asphyxia During Law Enforcement Transport," The American Journal of Medicine and Pathology, 12(2):pp 90-97, 1992.
      
      Wetli, C.V. and Fishbain, D.A., "Cocaine-Induced Psychosis and Sudden Death in Recreational Cocaine Users," Journal of Forensic Sciences, JFSCA Vol. 30, No. 3, July 1985, pp. 873-880