Forensic Pathology for Police - Brainshare Public Online Library

560 21 Miscellaneous Topics
amphetamines, LSD and PCP. Conversely, it can also occur in various psychiatric
conditions. In excited delirium, the victim experiences major cardiovascular
manifestations (increased heart rate and blood pressure and an increased risk for
arrhythmias, or abnormal heart rhythms, some of which may be lethal), paranoid
behavior, marked agitation, superhuman strength, and hyperthermia, among
other symptoms. This condition can result in death even without police or other
intervention; however, when police intervention does occur, certain interventional
maneuvers and/or devices can, depending on the timing and circumstances, be
considered contributory to death. It can be tempting to single out a particular
device or maneuver to include on the death certificate, and it may occasionally be
appropriate to do so; however, if an exact mechanism cannot be attributed to the
device or maneuver, it is probably best to use a more general description of the
restraint/subdual, thus implicating the stress involved with the police intervention.
An example of a cause of death ruling in such a case might be: I – Cocaine-induced
excited delirium; II – Physical restraint by police. If police action does contribute
to death, it is appropriate to rule such deaths as homicides. It should be emphasized
that such a ruling is a medical ruling, not a legal ruling, and in many such instances,
the police action is subsequently determined to be reasonable and justified, especially
considering the alternatives (not apprehending an individual who is likely to
harm someone else, or simply shooting the individual, which is far more likely to
end in death). Others prefer to rule the MOD as “accident” or “undetermined.” A
final note is that some do not prefer to use the term “excited delirium;” instead, they
prefer the term “sympathomimetic poisoning syndrome” or “sympathomimetic toxicity
syndrome” or some similar terminology to describe the massive neurologic
reaction that occurs in these people.
Mass Fatality Incidents
Mass fatality incidents, sometimes referred to as “multiple fatality incidents,” can
range from relatively small incidents, with a relatively small number of victims,
to major catastrophic events, such as occurred with the Indian Ocean tsunami in
December 2004. Mass fatality incidents may involve natural disasters or man-made
events. Examples include weather-related and other environmental disasters (heat,
cold, tornadoes, floods, conflagrations (fires), mudslides, hurricanes, volcanic eruptions,
and earthquakes), infectious diseases, toxic environmental conditions (natural
or man-made), transportation events (motor vehicles, trains, planes, ships), fires and
explosions, mass shootings, and acts of terrorism or war. In any mass fatality incident,
multiple different agencies and institutions, including many from all different
levels of government, will be involved, including police, fire and rescue, healthcare,
etc. Usually, the local death investigation agency will have jurisdiction over the dead
bodies. Cooperation between all of the groups involved is an absolute necessity in
these cases, as is involving local funeral directors.
Planning is the key to being adequately prepared for a mass fatality incident. Each
death investigation office/jurisdiction should have a detailed mass disaster plan, with