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Chief officers have a responsibility to establish a local protocol with social services, local authorities and health trusts for dealing with potentially violent individuals.

The following areas should be considered when developing such policies:

• A proactive approach to gathering information; • Conducting intelligence systems checks;

• Sharing information with partners for safer detainee care; • Observing the detainee during and after arrest for potential

dangers;

• Identifying any impact factors;

• Effective allocation and use of resources;

• Extent of searching to be justified on an individual basis; • Effective transport;

• Procedures for informing custody officers of the grounds for arrest, risks, intelligence, observation and other relevant information on persons detained in custody.

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3.3.3 ACUTE BEHAVIOURAL DISTURBANCE

People who are violent and agitated pose an increased risk to the safety and welfare of themselves and those dealing with them. There may be an underlying medical reason for the behaviour. If there is any suspicion that the violence stems from a medical condition, the person must be treated as a medical emergency. Whenever possible, the person should be contained rather than restrained until medical assistance can be obtained.

The following medical conditions may cause violent, aggressive or changing behaviour and confusion:

• Diabetes; • Epilepsy; • Stroke; • Infections;

• Angina and other heart problems; • Excited delirium;

• Head injury;

• Dehydration (and salt imbalance); • Sickle Cell Anaemia;

• Acute mental illness such as paranoia, hearing voices; • Neurological diseases such as dementia and brain injury; • Learning difficulties.

Note: Where an individual is well known or familiar to police officers and staff, there is an increased risk that symptoms of serious illness or injury may go unnoticed, eg, regular detainees associated with alcoholism or drug addiction.

Custody managers should ensure that:

• All custody staff are trained and competent in first aid and have completed the First Aid Skills for Custody (FASC) training according to the requirements of their role;

• All custody staff are trained and competent in the completion and management of risk assessment and understand the importance of this task;

•

A local policy exists that sets the criteria for custody suite closure and contingency arrangements for that closure. It may also be necessary to plan for the need to access additional custody capacity if the risks associated with a detainee cannot be adequately managed within existing resources.

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3.3.4 DEALING WITH DIABETES

When a diabetic person is detained, it should be established whether they are insulin dependent or not. If the detainee is insulin dependent, staff should ask whether the detainee has insulin with them or if it can be collected from home.

A diabetic detainee should be checked at least every thirty minutes throughout the duration of their stay. Custody officers should, during the initial risk assessment, decide if they feel that further assessment of the detainee by a health care professional is required. Custody staff should be aware that any individual with diabetes mellitus or ‘sugar diabetes’ can develop hypoglycaemia (low blood sugar).

In assessing the individual, should take into consideration whether they are displaying any symptoms that may indicate illness, eg, altered consciousness level, unusual thirst, visual disturbances, difficulty in speech and understanding, asking for something sweet or vomiting. This is a medical emergency; if a healthcare professional is not immediately available then the detainee should be transferred to hospital by ambulance.

If the detention of an insulin dependent diabetic person is likely to extend beyond the time in which they will need their next dose of medication, a healthcare professional should assess that individual and make the appropriate prescription as necessary.

The custody officer should discuss management of the detainee’s health, and fitness of the detainee for interview with the healthcare professional. Information about any possible complications should be obtained from the detainee and the healthcare professional along with details of the appropriate dosage and type of insulin medication.

Once insulin has been prescribed, persons with diabetes may, subject to risk assessment, inject themselves. This should be after having food and under the supervision of custody staff. Doses of insulin taken by the detainee and times that it is taken should be recorded. Custody staff should establish in consultation with the healthcare professional when the next dose is due.

Where the detainee has an insulin infusion pump in situ, this should be left as it is and advice from a healthcare professional sought urgently.

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Detailed guidance on ACPO approved first-aid procedure and practices in response to diabetes can be found in the ACPO Police First Aid Learning Programme, and the Faculty of Forensic and Legal Medicine (FFLM) Guidance for the Management of Detainees with Diabetes in Police Custody.

If a detainee refuses insulin, a healthcare professional should be informed immediately. The detainee may use their diabetes as a means to delay the investigative process. Insulin refusal alone, however, is not a medical emergency as deterioration in health may take hours or days.

In document Libro Morata (página 85-87)