Analysis of Excited Delirium and its causes and effects

Analysis of emotional hysteria and its rationalitys and effectsSince the 1800s, in that respect allow been cases of brainsick insanity even though these cases do non hold the exact line evoke mono realityia. These reports gloss every institutionalise contain the symptoms of what is at a duration known to be stirred derangement (ACEP nominateed up furor Task Force, 2009). In fact m both of these cases of sore fury were primarily in institutions with rationally ill souls. It was non until 1849 that Dr. Luther chime diagnosed the symptoms. This degenerative entity that appe argond in the 1800s largely disappe atomic number 18d in the 1950s. Today the final stages argon frequently inform from abusers of drugs or psychiatric patients. These wipeouts be more(prenominal) of the explosive death form, with death taking place transactions to hours aft(prenominal) the attempt of stirred up fad, in that respect is overly always physical retaint involve d (Maio Maio, 2006).Definition excite frenzy is defined as, A state of utter around(prenominal) mental and physiologic excitement, characterized by uttermost(a) agitation, hyperthermia, hostility, exceptional strength and endurance without apparent wear out (Maio Maio, 2006).Bells ManiaIn 1849 Dr. Luther Bell, a physician for the McLean Asylum for the Insane, in Sommerville, Massachusetts, ready what he believed to be a new affection among his patients of the asylum. This new malady became known as Bells Mania. Dr. Bell as comfortably as noned some clinical symptoms of Bells Mania which included acute outpouring of symptoms, mania, violent doings, pick out for res crackt, refusal of food, inability to sleep, and fatigue deteriorating to exhaustion and circulatory collapse (Maio Maio, 2006).These symptoms are believed to be related to the symptoms of unbalanced hysterical neurosis that is known of today. M whatever of Bells patients and some other patients at the hospital died from a combination of things such as electrolyte imbalances, dehydration, and other numerous factors.In the late 19th Century, Dr. Emil Kraeplin, a German psychiatrist, developed well-nigh classifications of the mentally ill based on the symptoms presented. The utilization of this classification resolvinged in pull throughence commensurate to identify groups of patients who were at a gamey risk for sudden death due to excite violence Syndrome (Maio Maio, 2006). Dr. Bell and Dr. Kraeplin documented almost of the earliest cases of sick cult.By 1933, Dr. Irving M. Derby, a pathologist a Brooklyn land Hospital, began nonicing what he foretelled Manic-Depressive Exhaustion. He contracted this by and by several deaths occurred with alike symptoms. The entity that he beseeched Manic Depressive Exhaustion was in any case called by others crisp rage, Acute Dementia Praecox, Catatonic Death or Bells Mania. Dr. Derby inform close to 148 patients whose v ery deaths were attributed to Manic Depressive Exhaustion (Maio Maio, 2006).In a 1934 Doctor G.M. Davidson reported several deaths were related to Acute Lethal Excitement. This excitement was sudden onset of illness, history of delusions and hallucinations. An acute state lasting 4 to 20 old age, with symptoms of extreme psychomotor excitement and restlessness, rapid physical decline, schizophrenia of the catatonic type, postpartum psychoses of the catatonic type, and manic-depressive psychoses of manic and mixed type (Maio Maio, 2006). The findings reported by Dr. Davidson prove that they are very consistent of what Dr Bell and Dr. Derby had open in their cases.1960s and TodayIn the 1960s, a take up trans intendt began to occur. Patients with mental illness began receiving better treatment, which do the deaths relating to the inveterate form of unhinged Delirium disappear. By the beginning of the mid-eighties however, an acute form of excited Delirium began to take shape. However, this form was mainly diagnosed by the use of out legal philosophy(prenominal) stimulants such as cocain. These deaths were characterized with the following mostly of male victims, victims that had non been diagnosed with mental illness, sudden death occurring minutes or hours subsequently the development of Excited Delirium, the use of restraints, and involvement of guilty stimulants and medications (Maio Maio, 2006). Certain symptoms described by Dr. Bell in the chronic form of Excited Delirium are excessively prevalent in the acute form. The main difference surrounded by the chronic form and the acute form is the step of time that between is the onset of the symptoms and death. For example, in the chronic form this could take a depend of days or weeks. In the acute form this could take a matter of minutes or hours.In the 1980s last from Excited Delirium, more specifically Bells Mania, became relatively unknown to aesculapian professionals. The only quite a l ittle who necessitate even heard of this were the tribe of the psychiatric community. The knowledge of Bells Mania began to fade. In fact many of these cases were being misdiagnosed and began showing up as a heart attack. Pretty soon things started to change with the use of cocaine and methamphetamines (Maio Maio, 2006).During the 1980s in that location was major increases in cases reported with appearance related to lordless psychiatric emergency. approximately of these cases were in conjunction with cocaine abuse that was outset to hit North America during this time. cocain and Excited Delirium Syndrome seemed to be almost intertwined. There has in any case been cases were Excited Delirium Syndrome occurs with other illegal drugs and with many types of mental illness and their treatment medications. In fact in 1985 the first paper was published for the first time that used the term Excited Delirium.CHAPTER 3Causes of Excited DeliriumThe typical psyche who shows symptom s of Excited Delirium is a person that has major drug intoxication, and the person baron have a history of mental illness struggles with virtue en laborment. guard may use physical or chemical retard measures or even electrical measures to divine service in controlling the person.The autopsy give fail to endorse a potential pee of death from psychic trauma or natural disease (ACEP Excited Delirium Task Force, 2009).Since there is no noticeable cause of death in an autopsy it is unmanageable to score under ones skin on up with a definitive cause of death. Many the ample unwashed believe this term is an easy way out for law of nature enforcement, when spate die as a result of being in-custody (ACEP Excited Delirium Taks Force, 2009).Stimulant drug abuse crapper be a cause of Excited Delirium. Stimulant drug use such as cocain, Methamphetamine, phencyclidine hydrochloride (PCP), and Lysergic Acid Diethylamide (LSD) have been associated with Excited Delirium Syndrome. Acute intoxication has been make to trigger the onset of symptoms for Excited Delirium. These stimulant drugs have also been embed to be the cause of Excited Delirium deaths (ACEP Excited Delirium Taks Force, 2009).Cocaine has been a major problem in transaction with Excited Delirium. Cocaine has been a major cause of Excited Delirium in well-nigh people. Excited Delirium usually occurs after people have been on a cocaine binge, and to people who have had yearn history of cocaine abuse. some other cause of excited Delirium is mental illness. The ii major causes are Mania (Bipolar Disorder), and Psychosis (Schizophrenia) (Barney, 2003). When people enter a psychiatric adroitness they are sometimes misdiagnosed What the doctors are witnessing is Excited Delirium. sometimes the underlying illness is un inured at the time the symptoms of Excited Delirium are showing. health superintend providers should take heed. Early recognition and preparation can help prevent many In-custo dy deaths, in the next chapter this give be explained more in depth.Chapter 4Awareness and Recognizing Excited DeliriumExcited Delirium is part of some serious psychologic and behavioral symptoms which could includeUnbelievable strength, impenetrability to pain, ability to offer efficacious resistance against multiple officers over an increase period of time, hyperthermia (temperatures in the physical structure can spike between 105-113 degrees Fahrenheit), sweating, shedding of clothes or being naked, bizarre and violent behavior, aggression, hyperactivity, extreme paranoia, incoherent shouting of nonsensical speech, hallucinations, attraction to glass (people leave behind most likely be smashing glass), confusion or disorientation, grunting or animal-sounds firearm struggling with officers, foaming at the mouth, drooling, and finally dilated pupils (Kulbarsh, 2011).Also Excited Delirium is a pumped up version of the flight or vex response in the body. The person will try to run and and so try and fight without being effected by pain (Brotheim, 2007). Another physical characteristic of Excited Delirium is animal like behavior including grunting, biting, scratching, and pushing-very primitive actions (Remsberg C., 2006).Excited Delirium is a major aesculapian emergency, and is something that should not be taken lightly. It requires medical attention immediately during onset. Excited Delirium makes the sympathetic nervous governance go into hyper drive. The sympathetic nervous system is responsible for the release of adrenalin, heart rate, body temperature control, and pain perception. Excited Delirium works with many other dangerous effects on the body including hyperthermia, changes in blood acidity, electrolyte imbalances, a break polish of muscle cells, cardiac arrhythmias, and ventricular fibrillation (Kulbarsh, 2011). When death comes to a person who exhibits signs of Excited Delirium the person will exhibit a state of sudden tranquility, either during or after the initial struggle and restraint, followed by cardiac arrest. It is very chief(prenominal) that law enforcement officers, medical personnel, and dispatchers recognize the signs of Excited Delirium and sudden death that mogul follow, that way emergency medical attention can be initiated compensate away (Kulbarsh, 2011).Current Standards for right Enforcement ships officers and AgenciesLaw enforcement agencies need to construct some protocol ahead of time for transaction with such cases (Kulbarsh, 2011).Dispatchers should also be trained to recognize the signs of Excited Delirium and ask some follow up questions. If Excited Delirium is the case then the dispatcher should appall officers, and they should alert paramedics to be on standby (Kulbarsh, 2011).The first officer on the mount, he/she believes it is a case of Excited Delirium then they must call for relief pitcher and they should have EMS there as soon as possible. up to now before the officers arr ive on the scene they should already know, from dispatch, what they are dealing with. It is recommended that several officers come to the scene It is not recommended that one officer come to the scene and try and handle it by themselves (Kulbarsh, 2011).The first officers on the scene should be ready to manage the champaign, making sure that they do not abide themselves and hurt other individuals. military officers should not approach the flying field until prim backup has arrived and paramedics are on standby (Kulbarsh, 2011).Trying to control the person who is experiencing Excited Delirium and the seat is very important. Be sure to establish control quickly. The longer the confrontation with a person who is experiencing Excited Delirium, the greater the risk that person will die while in-custody (Kulbarsh, 2011).Police officers are usually trained to place a suspect in subject down present. With someone who is experiencing Excited Delirium this not a very good idea. With a person in the face down position an individual might have hard time breathing. When the suspect that is experiencing Excited Delirium and is in police custody they should placed in a face up position. If the suspect stops resisting his pulse and breathing should be monitored It is imperative that law enforcement officers wait for medical personnel to help in restraining the subject. checkup personnel know how to restrain a person for expatriation to the emergency elbow room (Kulbarsh, 2011).Protocols should be put into place for use of force options. If a person is suffering from Excited Delirium, the suspect may have superhuman strength and pain may not even build the suspect one bit. This makes all pain-based techniques useless. Pepper spray can also be ineffective to person who is impervious to pain. The use of batons and other come to techniques possibly could be effective in stopping movement it will not be because of pain. TASERs can be effective, because they temporar ily override the central nervous system. Use caution with TASERs though there is an increased risk for sudden death for people suffering from Excited Delirium TASERs should be the a last resort. If possible try to control the situation without the use of TASERS (Kulbarsh, 2011).Transporting a person that is experiencing Excited Delirium in an ambulance is very important. In the ambulance the paramedics can watch the subjects vitals like heart rate, blood pressure, respirations, carbon dioxide levels, PH levels, and temperature are a must (Kulbarsh, 2011). If vitals are not checked the person suffering from Excited Delirium could die. question after this incident takes place is very important so agencies can learn from the incident, what can be done in the future if they come crosswise this incident again. Agencies could also use debriefings for personnel that has been involved with these types of critical incidents. This is in particular important if the person died while in-cust ody (Kulbarsh, 2011).It is always important to remember the mnemonic protocol created by Dr. Michael Curtis, P.R.I.O.R.I.T.Y. M.E.D.I.C.A.L. Each letter stands for a symptom of Excited Delirium and what to do when you come upon this situation. Psychological issues, Recent drug/ inebriant use, Incoherent thought process, Off (clothes) and sweating, Resistant to front/dialog, Tough, if not super-human strength, Yelling, give way an informed decision, Enlist backup, Disturbance-resolution model, Intervene (use TASERs with caution), Contain, Attend to medical needs, Least amount of force necessary (Kulbarsh, 2011).Law EnforcementLaw enforcement officers are in a unique and very foreign position. They find themselves in an impossible situation where they have to recognize this medical situation. They have to try and control an individual who is irrational number and physically resistive, while they are toilsome to keep everyone rubber eraser (ACEP Excited Delirium Taks Force, 200 9).A person who is suffering from Excited Delirium poses a challenging situation, which has the possible action to impose major public interrogatory and the possibility for a horrific outcome. Though there is always that possibility where things could go wrong and there will be some major public outcry (ACEP Excited Delirium Taks Force, 2009).It is very important that law enforcement officers understand that a person who is suffering from Excited Delirium Syndrome lacks remorse, common fear and understanding of his or her surroundings, and most importantly rational thoughts of safety. Law enforcement officers must realize that this is and could be a potentially life baleful medical condition (ACEP Excited Delirium Taks Force, 2009).Up until now, everything the officers have been taught relies on the suspect being able to cooperate and the ability to be rational. The officers also rely on the suspects ability to comply with the officers commands. Many tools and tactics that are a vailable to law enforcement officers are going to be less effective on a person suffering from Excited Delirium (ACEP Excited Delirium Taks Force, 2009).One seek has indicated that if a person has Excited Delirium and the officers know what is going on, it is not the grea run idea for officers just wait until the situation rectifies itself. This could take hours and the suspect could die as a result of just waiting. Law enforcement officers should realize that Excited Delirium is not a crime, and they should recognize the difference before it is too late (ACEP Excited Delirium Taks Force, 2009).Emergency Medical ServicesEmergency Medical Services (EMS) dispatchers also need to recognize the symptoms of Excited Delirium, they need to listen and find diametric clues tell other people what they are responding to. With these clues multiple law enforcement officers can respond to the situation including the EMS (ACEP Excited Delirium Taks Force, 2009).EMS find themselves in unfamiliar territory because they have to have a heightened sense of personal safety because of what Excited Delirium involves, and they need to provide timely care to these individuals (ACEP Excited Delirium Taks Force, 2009).The first thing is that Law Enforcement Officers need to do is control the person with Excited Delirium Syndrome. After control is obtained by the law enforcement officers then EMS can recognize this emergency medical situation and absorb the responsibility of assessing and caring for the person (ACEP Excited Delirium Taks Force, 2009).Medical ExaminersMedical Examiners are required to decide on a cause of death while individuals that die in police custody. Lack of medical information, and any underlying cardiac and metabolic information, makes it really difficult for the medical testers to come up with an exact cause of death (ACEP Excited Delirium Taks Force, 2009). diminutive information such as behavior of the suspect, drug history, the history of the suspects psych osis, and the social movement of hyperthermia are all factors that can determine to the medical examiner that this is a case of Excited Delirium (ACEP Excited Delirium Taks Force, 2009).The majority of cases that appear to be Excited Delirium Syndrome occur in people who have a history of cocaine and other stimulant abuse. Sometimes this syndrome will happen even without these drugs in the persons system. As of right now there is no test out there for medical examiners to test for Excited Delirium Syndrome (ACEP Excited Delirium Taks Force, 2009).Chapter 5StatisticsExcited DeliriumExcited Delirium is extremely rare. It is estimated that between 50 and 125 in-custody deaths in the United States every year are related to Excited Delirium. Most of these cases are of males between the ages of 30 and 40. This syndrome is rarely seen in females. Excited Delirium is increasingly becoming the cause of death in in-custody deaths.Police discussion is usually blamed when death occurs. It ha s been proven that Excited Delirium has been the cause of in-custody deaths as early as 1650. This was way before the invention of Tasers, OC, hog-tying or other law enforcement tools and techniques that some critics link to in-custody deaths (Remsberg C., 2006).It also has been launch that Excited Delirium tends to be more of a warmly temperature event (meaning that it happens when the temperature is warm and not cold). The situation is also motivated when there is high humidness (Remsberg C., 2006).Statistics show that Excited Delirium tends happen at the end of the week, on sunshine, than any other day. The heaviest occurrences tend to happen Thursday through Sunday (Remsberg C. , 2006).In-Custody DeathsMedical personnel at the University of Minnesota Emergency Medical political computer program did a 12-month research experiment were they researched internet search engines for specific speech communication such as subject gender, age, behavior, arrest, force, weapons use, time of collapse proximal to arrest, force, and presence of outlaw(a) substance abuse (Brotheim, 2007). As a result of this study medical personnel at the University of Minnesota Emergency Medical program could identify some the causes that lead to in-custody deaths.The search results were as follows 162 in-custody deaths were reported, 96.3 portion were males, the ordinary age was 35.7 years old, 62.9 per centum of them were exhibiting bizarre behaviors, and 62.3 percent of them confirmed illegitimate drug use just prior to their arrest (Brotheim, 2007).How does this break down as far as people dying in-custody. Well 8.6 percent of the suspects in-custody were hit with impact weapons, 12.3 percent of the people were shot with chemical spray, 30.1 percent were shot with a TASER, 62.3 percent of the people referenced ingested illegal drugs, 68.5 percent went hands-on with police officers, 100 percent while handcuffed. It was noted that many of the people referenced fit more than one of the categories so the results are not going to equal 100 percent (Brotheim, 2007).This study found that in-custody deaths occur largely to males less than 45 years of age, using illicit substances. In-custody deaths appear to occur within the first 60 minutes when weapons are in play. In-custody deaths neer happen instantaneously when a TASER is used (Brotheim, 2007).Chapter 6 causes of Excited DeliriumCase 1 Jefferson Street, Appleton, WIThe case began on a Monday in June in Appleton, WI. A call to 911 of a complaint of a naked man and ended later in evening at the hospital with the raving a man being allayed down by capable medical personnel. In this situation there was no cruel control tactics, there was no risk to people or seemlyty, and there was no lawsuits from angry relatives (Remsberg C., 2009).Thanks to Lt. Dave Nickels of Appleton Police Departments patrol division he knew exactly what was going on with the young man at Jefferson Street. He and other officers were up against a terrible situation and managed to take care of this situation with professionalism (Remsberg C., 2009).A frantic call to 911 a go is in distress because something is happening to her 29-year-old son. The son had a long history of marihuana use. The mom also noticed that he was acting very strange, he kept on talking and talkinglike he was on somethingsaying Im dying, Mom, Im dying, Mom She also told 911 hes sitting there naked. He for sure doesnt do that in front of his mother (Remsberg C., 2009)The dispatcher responding to the call alerted two patrol units to respond to the Jefferson Street incident. Nickels, who at the time was patrolling the street in his car, heard the call. The dispatcher was saying there was yelling, strange behavior, repetitious statements, atrocious breathing, and unusual nudity. Lt. Dave Nickels decided that he would respond to the call as well (Remsberg C., 2009).Nickels, is a TASER master instructor, became very interested in a psycho logical and physiological meltdown known as Excited Delirium. Some of the in-custody deaths in his area were linked to Excited Delirium. He had done some research for more than ten years and developed a training program for his department and other area agencies. He did this in the hope that officers, dispatchers, and medical personnel would become better aware of the symptoms and treatment the situation (Remsberg C., 2009). twain weeks before this incident happen, Nickels put together a small PowerPoint unveiling to kind of refresh the officers about how to respond to an Excited Delirium call. He emphasized in the PowerPoint that the subjects are usually are a long way into the crisis. They are in a medical nightmare, where they need help. cultivation from arriving officers will help the officers likely not to view the suspects threatening behavior as a criminal problem (Remsberg C., 2009).When Lt. Nickels entered the house on Jefferson Street, he witnessed subject with long-hai r, well conditioned, gesturing wildly, is entirely naked in the room. He also witnessed that the subject was highly agitated and sweating profusely. The subject is screaming over and over again Is Im going to die? Meanwhile the mom is onerous to hand him some clothing. He continues to yell at the officers.As Nickels was feel at the situation he remembered some of the principles he stated in his training programs. Being the in charge he managed to be calm and calm voice he called the man by name and showed the man that he had nothing in his hands. He was not confrontational with the man, and he used no threatening language. He did not use any commands, and he did not shout at the man. Nickels says you do not compulsion to feed these people adrenalin. Nickels also states theyre already thinking that youre going to hurt them. To the extent thats possible and safe, you want to model calmness for them. (Remsberg C., 2009)It was also important that Nickels did not crowd in on the subje ct. Nickels states avoid confronting them, if you can. Nickels managed to get the mother to back away from her son, to give him more space. The man stated that he was going to lie down, Nickels agreed with the man (Remsberg C., 2009).The main thing is that Nickels had a plan, and when sufficient officers arrived, with medical personnel he was able to set the plan in motion (Remsberg C., 2009).Nickels had backup, he was positioned inside the front door with a TASER drawn and on, ready to fire if the situation called for it. Nickels also had other backup at the rear of the house. From this point the two officers in the rear of the house could block the rear exit, and bring the suspect to his feet, if need be. An Advanced demeanor Support (ALS) team was also there ready to administer sedatives if need be.There was lull in movement of the subject, and Nickels announced all right, lets move. (Remsberg C., 2009) He promptly had the officers control the subjects limbs. Nickels and another officer grabbed and arm and two other officers lay across his legs. With Nickels permission the paramedics gave a shot of the sedative haloperidol and the paramedics then began to strap the subject to a board (Remsberg C., 2009).When restraining these subjects is likely to be the critical point, (Remsberg C., 2009), Nickels states They fight their hardest then and may think you are trying to slaughter them. Its important for EMS to shoot them up quickly to chemically restrain them so the sedative can start calming them. (Remsberg C., 2009)As they are ready to the subject still continues to yell out gibberish and expels great amounts of air, he growls, screams out Mom, dont let them kill me (Remsberg C., 2009) At this point he is unable to move. The paramedics then move him out the door and into the ambulance to the emergency room (Remsberg C. , 2009).At the hospital he was sedated even more. It took about 90 minutes for him to act normal again. When he fully recovered from this he did not even remember anything that had happened to him. He has since resumed his normal everyday activities as a college student, with no side effects (Remsberg C., 2009).The good news was that this experience was not as intense or as violet some Excited Delirium cases are. The subject did exhibit a number of common symptoms associated with Excited Delirium fear, high body temperature, repetitious and incoherent speech, paranoia, profuse sweating, nudity, irrational shouting, bizarre statements and behavior. Watching the video of the incident is a good monitor of how dangerous Excited Delirium can be. It also shows people how to recognize Excited Delirium when they see it.Important lessons that were learned from this incident honor many things like all officers, dispatchers, and responding medical personnel should be meliorate the signs of Excited Delirium. Nickels states Education on what it is and how it presents is the first big key to handling it successfully. He goes on by saying Periodic reinforcement is important, because ED is one of those low-frequency/high-risk events. (Remsberg C., 2009)Based on what the dispatchers are receiving, they can get medical personnel and police to the scene quickly. An ALS unit on hand can promptly give tranquilizing drugs to minimize the time the subjects fight against restraint. The more the intense struggling takes the better chance that the subject will die from Excited Delirium. High exertion under high body temperature is one of the worst things for the cardiovascular system, states Nickels (Remsberg C., 2009).Until more backup and medical personnel are hand, it is very important that officers avoid physical contact. ED subjects often display superhuman strength and are usually able to overpower one or two officer, Nickels said (Remsberg C., 2009). He also says Once you initiate contact, do it decisively and quickly. (Remsberg C., 2009)It is very important that officers train as a team to apply control techni ques. Hands-on make out is very important. Nickels said Remember that pain compliance wont work on these subjects. An electronic control device that causes incapacitation may be your outgo option below deadly force if theyre violently aggressive. But the TASER should never be used just as punishment for screaming and yelling. (Remsberg C., 2009)The proper place for a person suffering from Excited Delirium is the hospital, more specifically the emergency room, not jail. Nickels said We sent two officers along in the ambulance and they stayed with the subject until he was completely sedated in the emergency room. (Remsberg C., 2009) If the subject has been involved in criminal activity, it is very important that he/she has been treated for the medical crisis, after that they can be released into police custody (Remsberg C., 2009).Debriefing is a must when this incident happens Nickels remembers Before the encounter in June, we had a confrontation with a mental patient that didnt go as smoothly. It was after we debriefed that and identified several shortcomings that we decided to do the ED refresher training at roll call. The refresher helped everybody realize right away what we were dealing with in the latest incident. (Remsberg C., 2009)Even with practice from the officers, dispatchers, and medical personnel people still die from ED, Nickels admits Regardless of how proficient the police and medics are, these people often are so deeply in crisis that they end up dying anyway. (Remsberg C., 2009)Nickels also admits But we need to have training and protocols in place to offer the best chance of a positive outcome. Its not a matter of if an ED event is going to happen in your jurisdiction, its when. Protocols exist for both law enforcement and medical personnel. Theres no excuse for not instituting them. (Remsberg C., 2009)Case 2 Scottsdale, AZExperiencing Excited Delirium is contrastive than just cultivation about it, especially when your life is on the line. Things are also different when the officer shoots the suspect with .40-cal. round and has blown up the suspects aorta and another clout has hit the suspects spine. Even with all of these wounds the suspect continues to struggle with the officer and threatens to kill the officer. The officer is trying control this crazed situation while in the middle of a high-speed highway (Lewinski, 2006).This exact situation occurred to Officer James Peters a 6-year veteran of the Scottsdale, AZ Police Department. Peters was eventually unclouded of the shooting death of person suffering from Excited Delirium (Lewinski, 2006).The call started early on a Monday morning in October, Peters and a K-9 Officer Dave Alvarado got a call about an attempted break-in of a car, in a parking lot of an automobile paint and body mess shop (Lewinski, 2006).A security officer had reported that he sight a window of a car had been smashed. He had also seen a person nearby the security officer claimed that the pe rson appeared to be on something. When the security officer challenged the young man, he took off his shirt, said he had a accelerator pedal, and lifted a 40-lb. landscaping rock and threw it at the guard. none of these little details were included in the dispatch that Peters and Alvarado had heard, the dispatcher made sure to say that the suspect did claim to have a gun and that he had thrown a rock