CANADA

Province of Alberta

Report to the Minister of Justice and Attorney General Public Fatality Inquiry

Fatality Inquiries Act

WHEREAS a Public Inquiry was held at the in the on the on the before into the death of of City
(City, Town or Village)

The Law Courts Edmonton , in the Province of Alberta, , , 2010
year

of day of day of

(Name of City, Town, Village)

22nd 16th

November September

, (and by adjournment ),

2011
year

The Honourable Frederick Day

, a Provincial Court Judge, 38
(Age)

Trevor A. Grimolfson
(Name in Full)

12224 - 41 Street, Edmonton, Alberta
(Residence)

and the following findings were made:

Date and Time of Death: Place: Medical Cause of Death:

October 29, 2008 at 12:05 p.m. Royal Alexandra Hospital, Edmonton, Alberta

(“cause of death” means the medical cause of death according to the International Statistical Classification of Diseases, Injuries and Causes of Death as last revised by the International Conference assembled for that purpose and published by the World Health Organization – The Fatality Inquiries Act, Section 1(d)).

Excited Delirium due to multiple drug toxicity.

Manner of Death:
(“manner of death” means the mode or method of death whether natural, homicidal, suicidal, accidental, unclassifiable or undeterminable – The Fatality Inquiries Act, Section 1(h)).

“Unclassified”

J0338 (2007/03)

Report – Page 2 of 2

Circumstances under which Death occurred: Mr. Grimolfson displayed aggressive, assaultive and violent behaviour the morning of October 29, 2008. He assaulted a store owner and was destroying store property. Pepper spray was used to attempt to subdue him to no avail. Police were called. Two attempts to use tasers (conductive energy devices) in dart mode showed no effect. A physical struggle ensued with two police officers. A further use of the taser in stun mode to the neck again showed no effect. The two police officers eventually restrained Mr. Grimolfson placing handcuffs on his wrists behind his back and placing a spit mask over his face. Mr. Grimolfson was conscious and continued to struggle briefly after being restrained. Within minutes of being restrained he was unresponsive. Attempts at resuscitation by the police officers and paramedics were unsuccessful. The autopsy found the immediate cause of death to be Excited Delirium due to multiple drug toxicity. Excited Delirium is a condition or state first described in 1849, where one is delirious, not in touch with one's surroundings and unable to respond to them. "Excited" describes a state or condition of agitation often displaying aggressive and/or violent behaviour. Excited Delirium is a medical emergency. There are two major causes: one, psychiatric illness, and two, influence of drugs, though it is not known with certainty in the medical community, why drugs cause Excited Delirium. The Toxicology report found very high levels of MDMA (commonly called "exstacy") as well as very high levels of Ketamine. There were trace amounts of cocaine and an over-the-counter antihistamine. The level of MDMA ("exstacy") was sufficient to cause death by itself as was the level of Ketamine. That is, either drug, on its own, at the levels found, could cause death. Thus, while Excited Delirium is the immediate cause of death he would not be in Excited Delirium but for the presence of these levels of drugs. Taser use continues to be a subject of considerable interest, if not controversy. Electrical devices, from a medical perspective, all function in the same way; that is, they can channel electrical energy through the heart causing an abnormal rhythm called ventricular fibrillation. In this state the heart is not beating normally, has no ability to push blood thus there is no blood flow and one can remain conscious for only 6 to 15 seconds. What is critical to assess, therefore, is the time of last use of the taser and the time of unconsciousness: i.e. if it is within 15 seconds then taser use could be a contributor to cause of death, but, if it is outside 15 seconds then the probability that taser use was a contributor to cause of death is negligible. Here, a few minutes passed, not seconds, from the time of last taser use to time of unconsciousness; therefore, the taser use is not a relevant factor. Recommendations for the prevention of similar deaths:

None.

DATED at

May 18, 2012 Edmonton

, , Alberta. The Honourable Frederick Day A Judge of the Provincial Court of Alberta

J0338 (2007/03)

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