Never again: a hard lesson from a tragic, predictable death
Abstract
The recent tragic death of a young man experiencing hyperactive delirium with severe agitation in Bologna (Italy), on July 19, 2026,1 should serve as a crucial reminder of the importance of effective management of this challenging emergency. While it is a tragic event, the shock of such an episode forces us to draw a core lesson for clinical practice, system design, and medical culture.
Hyperactive delirium with severe agitation is indeed a true medical emergency.2 Individuals usually experience extreme agitation characterized by unexpected strength, panic, violence, disorientation, hallucinations, hyperthermia, and an accelerated autonomic nervous system. These symptoms can quickly escalate and lead to cardiopulmonary arrest, often resulting in the patient's death, frequently occurring in a pre-hospital care setting. [...]
Ethics Approval
Not applicable.
Data Availability Statement
All data underlying the findings are fully available upon reasonable request to Erika Poggiali, E.Poggiali@ausl.pc.it
References
- 1) The Guardian. Video shows death of man in Italy while under police restraint – video. Available from: https://www.theguardian.com/world/video/2026/jul/22/video-shows-death-of-man-in-italy-while-under-police-restraint-video
- 2) American College of Emergency Physicians. ACEP reaffirms positions on hyperactive delirium. ACEP website. Published October 10, 2023. Available from: https://www.acep.org/news/acep-newsroom-articles/aceps-position-on-hyperactive-delirium
- 3) DeBard ML, Adler J, Bozeman W, et al. White Paper Report on Excited Delirium Syndrome. 2009. Accessed August 14, 2026. Available from: https://www.prisonlegalnews.org/news/publications/acep-report-on-excited-delirium-syndrome-sept-2009/
- 4) McGuinness T, Lipsedge M. 'Excited delirium', acute behavioural disturbance, death and diagnosis. Psychol Med 2022;52:1601-11. DOI: https://doi.org/10.1017/S0033291722001076
- 5) Takeuchi A, Ahern TL, Henderson SO. Excited delirium. West J Emerg Med 2011;12:77-83.
- 6) American College of Emergency Physicians Hyperactive Delirium Task Force. ACEP task force report on hyperactive delirium with severe agitation in emergency settings. Available from: https://www.acep.org/siteassets/new-pdfs/education/acep-task-force-report-on-hyperactive-delirium-final.pdf
- 7) Curato M, Shah K, Reisig C. Urban emergency medicine. Cambridge University Press. 2023. DOI: https://doi.org/10.1017/9781009181570
- 8) Isoardi KZ, Cole JB, Hoffman RS, Isbister GK. What is the best approach for parenteral sedation to manage severe acute behavioral disturbance in the emergency department? Clin Toxicol (Phila) 2026;64:79-85. DOI: https://doi.org/10.1080/15563650.2025.2591356
- 9) Lee C. ACEP rejects “excited delirium”. Available from: https://www.acepnow.com/article/acep-rejects-excited-delirium/4/
Metrics
Citations and online attention from Dimensions, Altmetric and PlumX.
License
Copyright (c) 2026 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.