"Excited delirium syndrome (ExDS) is a serious and potentially deadly medical condition involving psychotic behavior, elevated temperature, and an extreme fight-or-flight response by the nervous system. Failure to recognize the symptoms and involve emergency medical services (EMS) to provide appropriate medical treatment may lead to death … Law enforcement organizations should take steps to increase officer awareness of ExDS and its symptoms and develop procedures to engage the medical community when identified. Without placing themselves or others at a greater risk for physical harm, officers must be able to rapidly detect symptoms of ExDS and immediately engage EMS for proper diagnosis and medical treatment. Failure to do so may prove fatal" (p. 1). Sections of this article include: historical data and cases reviewed— excited delirium-associated death after handcuffing/hog-tying, after major physical struggle, after TASER use, and with no police presence; medical background to ExDS; clinical presentation—distinct and recognizable features; treatments—control, medical assessment, and the potential for ketamine use; and conclusion.