BOSTON 鈥� The IACP executive board approved the 鈥淢anagement of Behavioral Health Emergencies鈥� resolution, submitted by the , at the 2024 IACP conference and exhibition. Behavioral emergencies represent a broad spectrum of disorders including severe agitation.
The resolution resulted from several years of effort by the IACP Police Physicians Section to clarify and advocate for collaboration between law enforcement and EMS. That work was spurred by the death of Elijiah McClain and the investigation and and , as well as other high-profile incidents, which also has led to legislation that seeks to criminalize ketamine administration and communication between police officers and EMS personnel.
At the 2024 IACP conference, Scott Coyne, MD, Suffolk County (New York) Police Department, discussed the process to develop the 鈥淢anagement of Behavioral Health Emergencies鈥� resolution and the importance of treating patients experiencing a behavioral health emergency as a medical emergency.
鈥淭his is now the position of the IACP,鈥� Coyne said.
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Coyne also mentioned the recently released 鈥�.鈥�
|More: Managing the acutely agitated behavioral health emergency
Metabolic acidosis contribution to in-custody death
David McArdle, a reserve officer with the Denver (Colorado) Police Department, continued the IACP presentation on behavioral emergencies by reviewing several in-custody deaths attended by paramedics. McArdle emphasized the importance of paramedics doing a hands-on physical exam as hyperthermia was present in these incidents, but it wasn鈥檛 observed by paramedics who failed to touch the patient鈥檚 skin during their assessment and before administering medication.
鈥淚t doesn鈥檛 matter why the fight started 鈥� criminal act or psychiatric emergency,鈥� McArdle said. 鈥淪truggling, along with underlying drug intoxication, ramps up the metabolic impact on the body. The need to blow off (exhale) carbon dioxide is under-appreciated by public safety personnel.鈥�
McArdle shared these highlights from case reviews and relevant research:
- Prone restraint deaths result from metabolic acidosis, no hypoxic asphyxia
- Metabolic demand is increased by stimulant drugs, physical exertion and stress
- Metabolic acidosis requires hyperventilation to 鈥渂low off鈥� carbon dioxide
- Prolonged restraint in the prone position may prevent adequate elimination of carbon dioxide
- An initial ECG rhythm of pulseless electrical activity (PEA) or asystole after cardiac arrest is generally inconsistent with primary cardiac etiology
He concluded his discussion of cases by sharing a video demonstration of tarp-assisted cooling 鈥� immersing a patient in a tarp filled with ice water 鈥� to assist in rapid cooling of a patient experiencing hyperthermia.
鈥淚t is incumbent on you as police chiefs to collaborate with other responders to train together as a team of police, fire and EMS. Anyone who is fighting with police is at risk of sudden death of custody,鈥� McCardle said. 鈥淚t is key that we stress to EMS personnel to put hands on these folks.鈥�
