Correspondence With Dr. Deborah Mash of the University of Miami Brain Trust

 Dr. Mash,

    I have studied your research regarding Excited Delirium Syndrome (EDS) as a brain disease and possibly linked to one gene. I commend you and your staff for your commitment to the truth and how it helps remove the negative perceptions associated with in-custody death. As we discussed in late November, I am hoping to assist you in validating your research, as I believe the signs and symptoms of EDS and Porcine Stress Syndrome (PSS) are strikingly similar: easily excitable, hyperthermia, abnormal breathing, skin discoloration, muscle tremors, abnormal vocalization and death in the presence of “rough handling” and stressors. In swine they have isolated one gene, known as a stress gene (officially trademarked as Hal-1843 by University of Toronto Innovations Foundation due to Halothane sensitivity), that has historically been a high frequency finding in non ambulatory and/or DOA swine post transport to slaughter. 

    Due to aggressive identification and eradication practices, the occurrence of this gene is on a decline. It still makes up a major percentage of non ambulatory and DOA swine on arrival at the slaughter facility and was found in roughly 11% of swine producing farms that participated in a 2006 study. Not only is there similarities in how EDS and PSS physiologically manifest as a response to stress, there is also a possible link with Halothane sensitivity. A small percentage of human test subjects presented with hyperthermia after being anesthetized with halothane. Though I was not able to determine any other side effects  that were observed during this particular study, it deserves further research. Halothane anesthesia in stress gene identified swine also present with signs and symptoms of PSS (hence, the naming of that gene).

    I have communicated with the owner of a lab that specializes in identifying the Hal-1843 gene in swine (this person also owns a company that does forensics testing for the FBI and other Law Enforcement agencies). The lab does not store samples, it merely tests and returns the results to the respective client. The owner stated that they can test human samples for this gene, their fee is $500.00. For further information on the Hal-1843 gene, he has referred me to the University of Illinois. While I attempt to learn more about what the Hal-1843 gene looks like and the cellular affects it has on the carrier,  I must defer some of my questions to you;

1. Is it possible that the stress gene in humans and swine interferes or is triggered by dopamine and excess epi and causes the massive breakdown at the cellular level?

2. With this line of reasoning, could CNS stimulants be simply facilitating an “animal” response in humans, i.e.; super strength, animal noises, reaction to reflections…?

3. Could this same gene impact the uptake and use of selenium and vitamin D which help protect cell wall integrity? 

4. Has there been any finding of accelerated rigor in subjects dying  from EDS? This has been one of the observations of death in PSS.

 

    I believe there is a high probability of a match of the gene you have isolated in humans and the Hal-1483 gene in swine. If there is not a match, there is still a wealth of information on PSS that can substantiate your findings and help develop policy that will be more successful in the field management of individuals presenting with agitated and/or combative behavior. The irony is that swine have also been used in an attempt to discredit Taser and the agencies and officers that deploy them on out of control suspects. I would be honored to be part of your research team. Please let me know if you would like me to continue this “leg work” and arrange for testing of any samples you have at the University.

Sincerely,

Michael W. Weaver

Team Tactics For The Combative Patient 

Alternative Transport For Federal and State DSHS Dependents

 Proposal for the alternative transport for ambulatory non emergent patients by local EMS and Fire Administrations

   I propose an alternative transport of a specific population of Federal and State DSHS dependents. I have communicated (phone and email) with representatives of Washington State DSHS and Local Para Transit and both were receptive to this concept. Municipal Para Transit fulfills a critical role as they will have to be available and willing to respond to the location of Fire/EMS crews. Once on scene, they will provide transport to non-emergent patients that cannot provide their own transportation or individuals that have mobility issues and require the assistance provided by ADA equipped vehicles (wheelchair access). For transport costs to be reimbursed by DSHS, patients must be delivered to a 24 hour urgent care clinic. To be considered for alternate transport, patients can be screened that meet certain criteria after initial Fire/EMS evaluation.

Two that stand out are;

1. Individuals that are ambulatory and do not have a need to be seen at the Emergency Room (prescription refill, cold symptoms, bandage removal etc.).

2. Abusers of the 911 system that are seen multiple times a week without a diagnosis of illness (typically a mental or behavioral health issue). There will be others in the system that qualify for alternate transport and this will be a huge cost savings to DSHS. The representatives of Washington State DSHS have stated that there is currently a program that is funded for transport of DSHS dependent families to Seattle Children’s hospital. The program pays a transport company $35.00 each way and the representative said that would work for my proposal as well. Also, it was discussed that whichever Fire/EMS agency that participates in this program will receive a “kickback” on a portion of the savings realized by the alternative transport and the 24 hour urgent care clinic vs. the private ambulance and ER visit. I am unsure of what could be agreed upon but the individual I discussed this possibility with seemed unaffected by the suggestion.

                Currently, the hold-up is finding an agency that fits the demographics to participate in the pilot program and meeting the transportation needs of enough individuals to make this cost effective; At least ten individuals under the management of DSHS a day that fit the parameters for alternative transport. My best guess is an agency that uses private ambulance for at least twenty BLS transports a day and has a high client ratio of DSHS dependents. This would possibly provide the needed number of transports via Para Transit and be an income of at least $700.00 a day. The municipality already has the expense of the Para Transit bus and Fire/EMS is already providing evaluation and arranging transport to this target group

Porcine Stress Syndrome and Excited Delirium Syndrome

My focus is on helping Law Enforcement and First Responders. There has been a ton of negativity directed at Law Enforcement even before the BLM movement. I believe it is a direct result of their training involving TASER use. They are trained to believe the TASER works 100% of the time. They even have a video of it dropping a large bovine bull. This has led to the TASER being used as a tool of compliance instead of a tool of incapacitation. When a subject does not comply, they simply apply it again and again. Now there is such negativity directed towards TASER use they are using lethal force, another publicly perceived negative. I would like to implore Law Enforcement to have another look at how they deal with non-compliant subjects. 

I have done significant research into Excited Delirium Syndrome (EDS) and have found what I believe to be a direct link between Porcine Stress Syndrome (PSS) and EDS.

 I have studied and researched Excited Delirium Syndrome (EDS), Porcine Stress Syndrome, Capture Myopathy and PTSD. It has been asserted by Dr. Deborah Mash of the University of Miami that Excited Delirium is a brain disease and possibly linked to one gene. My theory is that all of the above listed conditions are either related or similar enough in presentation to warrant a change in negative practices that are in place to deal with agitated and/or violent behavior with unknown etiology. The signs and symptoms of EDS, Capture Myopathy and Porcine Stress Syndrome (PSS) are strikingly similar: easily excitable, hyperthermia, abnormal breathing, skin discoloration, muscle tremors, abnormal vocalization and death in the presence of “rough handling” and stressors. Based on what I have been able to look up, those individuals afflicted with extreme cases of PTSD have what is termed psychotic events. I am currently researching through an acquaintance with a background in neurological sciences in the military if these extreme cases of PTSD also have other physical manifestations that are similar to the other models I have found that are representative of humans, domesticated livestock and wild animal populations.

In swine they have isolated one gene, known as a stress gene (officially trademarked as Hal-1843 by* **University of Toronto Innovations Foundation* due to Halothane sensitivity), that has historically been a high frequency finding in non ambulatory and/or DOA swine post transport to slaughter. Dueto aggressive identification and eradication practices, the occurrence of this gene is on a decline. It still makes up a major percentage of non-ambulatory and DOA swine on arrival at the slaughter facility and was found in roughly 11% of swine producing farms that participated in a 2006 study. Not only is there similarities in how EDS and PSS physiologically manifest as a response to stress, there is also a possible link with Halothane sensitivity. A small percentage of human test subjects presented with hyperthermia after being anesthetized with halothane. Though I was not able to determine any other side effects  that were observed during this particular study, it deserves further research. Halothane anesthesia in stress gene identified swine also present with signs and symptoms of PSS (hence, the naming of that gene).

  In wild animal populations, it has been discovered that in certain geographic locales that there is a much higher incidence of death when attempting to relocate the animals. Efforts to reduce death have included changing relocation attempts to cooler seasons, nutrient and vitamin supplements and the aggressive use of sedatives post capture.

   All of this brings reason to ponder:   

1.  Is it possible that the stress gene in found humans and swine interferes or is triggered by dopamine and excess epinephrine causing the massive breakdown at the cellular level that is similar to the cascade of events caused by sepsis in the fatal stages.  

 2.   With this line of reasoning, could CNS stimulants be simply be facilitating an “animal” response in humans, i.e.; super strength, animal noises, reaction to reflections…?   

3. Could this same gene impact the uptake and use of selenium and vitamin D which help protect cell wall integrity?   

4. Has there been any finding of accelerated rigor in subjects dying from EDS or PTSD? This has been one of the observations of death in PSS.   

5. What if the two genes are one and the same?  

First Responders and the Violent Subject

This author uses the terms combative patient and/or violent subject in place of any references to Excited Delirium Syndrome (EDS). This is mostly due to the volume of physically violent individuals encountered by First responders that have other etiology besides EDS. Regardless of the cause, violence is something the First Responder must deal with every day. Before evaluation, treatment and transport can begin, the out of control individual must be subdued and restrained. It would be well advised for agencies to define exactly when a suspect becomes a patient and how to transition from Law Enforcement custody to Fire/EMS care. The “patient” must have cuffs removed, soft restraints applied, secured to a backboard and moved to the medic unit for further evaluation, treatment and transport. In the field, Law Enforcement tries to help, but unfamiliarity of equipment and lack of standards to orchestrate such chaos only increases stress to the officers, crew and the patient. It also takes time; extended on-scene time has been a finding in a number of sudden in-custody deaths. The risk of lawsuit is not eliminated if the suspect dies in a medic unit versus a patrol car. The goal is to foster a safe environment for everyone and help remove the risk of liability to the municipality and the employees that must deal with the physically violent individual.