Acute Behavioral Emergencies: What Every Officer Needs to Know in 2026
- 1 day ago
- 5 min read
Law enforcement officers across the country are increasingly encountering individuals in severe behavioral crises. What was once commonly labeled “excited delirium” has evolved into a broader and more medically grounded understanding now referred to as Acute Behavioral Emergency (ABE). The terminology has changed—but more importantly, so has the science, the legal landscape, and the expectations placed on officers. If your agency has not recently updated its policy or training on ABE response, now is the time.
What Is an Acute Behavioral Emergency?
An Acute Behavioral Emergency (ABE) is a medical crisis that presents through extreme behavioral symptoms. While it may look like criminal resistance or intentional aggression, the underlying cause is often medical, metabolic, psychiatric, or substance-related.
Common signs may include:
Extreme agitation or hyperactivity
Incoherent or nonsensical speech
Paranoia or panicked behavior
Unusual strength disproportionate to body size
Insensitivity to pain
Lack of fatigue despite heavy exertion
Elevated body temperature (hot to the touch)
Irregular breathing (very fast, very slow, or erratic)
Inadequate clothing or nakedness (often an attempt at “self-cooling”)
The most dangerous cases involve a combination of severe agitation, hyperthermia, and abnormal breathing, which can lead to metabolic acidosis, cardiovascular collapse, and sudden death.
The key shift in modern guidance is this: These incidents must be treated primarily as medical emergencies—not simply as criminal events.
Why This Matters to Officers
Two realities define ABE response today:
Medical risk is real and time-sensitive.
Legal scrutiny is intense and evolving.
Courts have increasingly recognized the known risks of positional asphyxia, prolonged prone restraint, and failure to monitor breathing. Agencies have faced liability where officers did not mitigate these risks or lacked adequate training.
In short: If you restrain someone in a prone position and fail to roll them over once controlled—and they stop breathing—you are now operating in well-established constitutional territory.
The weakening of “excited delirium” as a recognized medical diagnosis has also increased legal exposure. Agencies that rely on outdated terminology or incomplete medical understanding may find themselves vulnerable in litigation.
The First Critical Step: Dispatch and Information Gathering
ABE incidents often begin with a chaotic call:
“He’s acting crazy.”
“She’s screaming and ripping her clothes off.”
“He’s fighting everyone and doesn’t feel pain.”
Dispatchers should attempt to gather key information:
Specific abnormal behaviors
Drug or alcohol use history
Mental health history
Access to weapons
Injuries
Prior violence
If ABE is suspected, multiple officers, a supervisor, and EMS should respond whenever possible. This is not a single-officer call.
On Scene: Slow It Down (When You Can)
Once on scene, officers should:
Minimize lights and sirens once safe
Reduce crowd stimulation
Avoid unnecessary yelling or aggressive commands
Designate one officer as the primary communicator
Sensory overload can worsen agitation. The goal is not dominance—it’s stabilization.
That said, de-escalation may not always work in true ABE cases. These individuals may not process commands rationally. They may not respond to pain compliance. Pepper spray, impact tools, or contact-mode electronic control devices may be less effective due to elevated pain thresholds.
Recognize the limits of your tools.
When Physical Control Is Necessary
In some cases, officers must gain physical control quickly to prevent injury to the individual or others. Best practices include:
Develop a coordinated restraint plan before engaging
Use sufficient personnel to control efficiently and quickly
Limit the duration and intensity of the struggle
Avoid prolonged pressure on the chest or neck
Once controlled, immediately reposition to allow free breathing
Time matters. The longer the struggle continues, the greater the risk of metabolic deterioration.
If EMS is present, control efforts should be collaborative. If EMS is delayed and the individual is in medical distress, officers may need to transport to the nearest appropriate medical facility.
But once EMS assumes care, officers transition to a support role.
Tactical Disengagement: A Legitimate Option
Not every ABE incident requires forced custody. Tactical disengagement may be appropriate when:
The individual poses no imminent threat
No serious crime has occurred
Higher levels of force would be unreasonable
This is not abandonment. It is strategic withdrawal. Disengagement decisions should involve supervisory approval and documentation. In many cases, connecting the individual to crisis teams, mental health services, or suicide hotlines may be more appropriate than arrest.
Custody and Transport: The Danger Isn’t Over
Control does not mean safety. After restraint:
Continue active monitoring
Watch for shallow or slow breathing
Address signs of overheating
Avoid leaving the individual prone
Move off asphalt or concrete if possible
EMS transport by ambulance is preferred. If officers must transport, the driver should not be responsible for monitoring the individual. A second officer should observe continuously.
The most tragic outcomes often occur after control has been achieved.
Documentation: Protect the Public and Yourself
ABE incidents require thorough documentation, including:
Timeline of abnormal behavior
Verbal exchanges
Compliance or resistance
Type and duration of restraints
EMS response time and actions
Signs of medical distress
Body camera and in-car footage
This documentation serves multiple purposes:
Post-incident review
Training improvement
Community transparency
Legal defense
Incomplete documentation in ABE incidents is a liability multiplier.
Training Is the Foundation
Agencies should ensure:
Dispatchers can recognize ABE indicators
Officers receive crisis intervention and de-escalation training
Personnel understand restraint risks and positional asphyxia
Joint police–EMS training occurs regularly
Co-responder models are considered where available
ABE management is not a single-skill problem. It requires coordination, communication, and medical awareness.
The Big Takeaway
Acute Behavioral Emergencies sit at the intersection of:
Policing
Medicine
Mental health
Constitutional law
Officers must approach these incidents with urgency—but also with medical awareness and restraint discipline.
The modern expectation is clear:
Treat it as a medical emergency.
De-escalate when possible.
Control quickly when necessary.
Protect breathing at all costs.
Transition to EMS care rapidly.
Document everything.
Handled correctly, ABE responses can reduce fatalities, lower liability, and build public trust. Handled poorly, they can result in tragedy for everyone involved.
The difference lies in preparation, policy, and training.
If your agency hasn’t reviewed its ABE protocols recently, this is the year to do it.
Legal Disclaimer
This article is provided for educational and informational purposes only and is intended for law enforcement training and professional development. It does not constitute legal advice and should not be relied upon as a substitute for consultation with qualified legal counsel. Laws, court decisions, agency policies, and medical standards governing Acute Behavioral Emergencies (ABE) vary by jurisdiction and are continually evolving.
Officers and agencies should consult their department’s legal advisor, medical director, and applicable state and local laws before implementing any policies, procedures, or training practices discussed herein. The author and publisher assume no liability for actions taken or not taken based on the information provided in this article.
This material is designed to support professional awareness and policy development—not to establish mandatory standards of care or operational directives.
