The Importance of Redefining Hyperactive Delirium in Emergency Medicine

The American College of Emergency Physicians (ACEP) has recently made a significant decision to discontinue the use of the term “excited delirium” when referring to patients with hyperactive delirium. This move aligns ACEP with other medical societies that have already abandoned the controversial term. This groundbreaking shift in perspective reflects an evolving understanding of hyperactive delirium and its implications in both medical and legal contexts.

The decision by ACEP to reject the term “excited delirium” stemmed from a recognition that the 2009 white paper on the subject no longer reflected current scientific knowledge and contemporary understanding of hyperactive delirium. The term has been misused and, in some cases, retrospectively employed to justify excessive force in law enforcement encounters. By labeling a patient as experiencing “excited delirium,” medical professionals have unintentionally contributed to a narrative that justifies aggressive actions, potentially endangering the lives of those affected.

The reversal of ACEP’s position on “excited delirium” reflects a broader discussion taking place within the fields of law enforcement, emergency medical services (EMS), and psychiatry. Medical professionals now realize that this term has been used to excuse acts of violence and neglect in cases like that of George Floyd and Elijah McClain. By acknowledging this systemic issue and taking a stance against the use of the term, ACEP is joining a growing movement towards accountability and justice in medical and legal contexts.

Medical experts emphasize the importance of redirecting attention from the controversial term “excited delirium” to understanding the best practices for diagnosing and managing agitation in patients. Physicians, paramedics, and emergency medical personnel should prioritize appropriate diagnosis and treatment of various levels of agitation, ranging from mild to severe. By eliminating the distracting concept of “excited delirium,” healthcare professionals can focus on providing effective care and ensuring patient safety.

While ACEP discourages the use of the term “excited delirium,” the college still acknowledges the existence of hyperactive delirium syndrome. This potentially life-threatening condition is characterized by a combination of vital sign abnormalities, pronounced agitation, altered mental status, and metabolic derangements. Emergency physicians and paramedics equipped with the necessary training and supervision regularly encounter patients in severe agitation. Their expertise lies in appropriately recognizing and treating hyperactive delirium syndrome.

ACEP believes in strengthening the training and collaborative efforts between emergency medical services, clinicians, and law enforcement professionals. When encountering patients with signs of hyperactive delirium syndrome, the primary goal should be reducing stress, preventing physical harm, and safely transporting them to an emergency department where they can receive specialized care from emergency physicians.

The decision made by ACEP to no longer support the use of the term “excited delirium” has been applauded by Physicians for Human Rights (PHR). This move signifies a significant win for police accountability, justice, and public safety. PHR emphasizes that the outdated and baseless term should never be used to explain deaths in custody or inform first responder training. California’s recent ban on listing excited delirium as a cause of death further reinforces the need for this shift in medical and legal practices.

The decision by ACEP to stop using the term “excited delirium” marks an important step towards redefining the approach to hyperactive delirium in emergency medicine. By abandoning this controversial term, medical professionals can focus on appropriate diagnosis, treatment, and collaboration with law enforcement to ensure the well-being and safety of patients. This shift aligns with a broader movement towards accountability, justice, and public safety in both medical and legal contexts.

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