HEALTH POLICY
Reassessing “Excited Delirium”: Aligning Emergency Medicine With Evidence and Equity By Emmanuel Scaife on behalf of the SAEM Social EM & Population Health Interest Group
SAEM PULSE | NOVEMBER-DECEMBER 2025
High-Profile Cases With Restraint Use
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Between August 2019 and May 2020, the deaths of George Floyd and Elijah McClain—both African American men who were restrained by law enforcement—sparked national attention and widespread discussion about law enforcement practices and medical involvement. In both cases, restraint played a central role. Beyond the political and legal debates, a controversial medicalized label repeatedly appeared at the intersection of medicine, law enforcement, and the courts: excited delirium. The continued use of the term excited delirium in clinical and legal
settings has raised significant clinical and ethical concerns. The label has been associated with inappropriate restraint use and increased risk of patient injury and death. Moreover, its application has disproportionately affected Black and Hispanic patients, reflecting systemic inequities in both prehospital care and emergency department settings.
“Excited Delirium” In Historical Context
The concept originated in the late 19th century as “delirious mania,” describing patients with hyperactivity, psychosis, and sudden collapse. Reframed in the 1980s as excited delirium, it became
associated with agitation, paranoia, hyperthermia, and stimulant use. Later, some physicians described it as severe agitation followed by sudden death—often in prehospital settings and frequently in law enforcement custody. In medicine, it has been used as a psychiatric descriptor to explain agitation requiring restraint in the emergency department or prehospital setting. In the legal system, it has been cited to explain deaths in police use-of-force cases. The Harvard Law Review has described excited delirium as a “psychiatric issue characterized by the acute onset of extreme agitation