Sudden In-Custody Death Syndrome (SICDS)

Introduction
The narrative is strikingly familiar. Police are called by concerned friends or family to deal with an out of control male. The callers report that the suspect has been acting in a bizarre fashion for a number of hours and has been destroying furniture in the house. They are worried that he will hurt himself and are insistent that he be brought to the hospital for observation. When the police arrive, they find the partially dressed suspect making unintelligible guttural noises while sweating profusely and complaining that some unknown party is trying to kill him. The police agree that the suspect’s behavior presents a danger to himself and decide to detain him for his own safety. While initially compliant, the suspect unpredictably resists efforts to restrain him and continues to fight with seemingly superhuman strength. Officers continue their attempts to subdue the suspect using an increasing array of less-lethal tools and techniques. Officers attempt to hold the suspect on the ground, who, despite being handcuffed,

Sudden In-Custody Death Syndrome (SICDS) is the unexpected death of a suspect proximal to restraint. It is an unexpected death because the less-lethal (as opposed to lethal) force used to subdue the suspect is generally expected to be survivable. Typically, individuals enter a state of combative delirium necessitating a law enforcement response leading to a violent confrontation in which many of the above noted less-lethal techniques are used to subdue the suspect. Death is commonly described as an acute event whereby the suspect becomes suddenly calm before becoming unresponsive and a pathological exam often offers no definitive explanation for the sudden precipitous death. Due to the proximity of death relative to law enforcement intervention, use-of-force tactics and techniques are commonly blamed for the