Role of FME Custody Medicine

Transcription

1 Role of FME Custody Medicine Dr Kranti Hiremath MBBS, DRCOG, MFFP, DipFM Forensic Medical Examiner

2 Who is an FME / Forensic Physician Forensic Medical Examiner/ Police Surgeon Registered medical practitioner Extra postgraduate qualifications in other fields of medicine Forensic medicine

3 Duties of FME Medical care of detainees Forensic examinations of Adults (victims and accused) Children Road traffic act (section 4 and 5) Liaising with fiscals, labs, other medics social workers

4 Liaison with the Forensic Physician regarding the reason for attendance Ideally the person with the query regarding a detained prisoner should call the FME (Forensic Medical Examiner) The FME will enquire why they are being called e.g. fitness to beb detained / fitness to be interviewed / medication and whether there are any other particular concern in order to asses the urgency of the e call Priorities will be given to head injuries, drunks with head injuries, victims, medical problems, suspicious deaths and drink drive procedures etc

5 Briefing on arrival Discuss reason called physical, mental illness, medication or injury Obtain details from the custody record including reason for arrest Other information from custody sergeant and where appropriate arresting officer regarding circumstances of arrest Whether any force was used such as handcuffs, CS spray, batons etc Whether anything was found in the detained prisoner s s property or when searched (medication, illicit drugs) Police National Computer checks regarding mental illness, violence and drugs Information from General Practitioner, hospital, friends and relatives as appropriate Any concerns regarding detained prisoners behaviour regarding

6 Management Plan Fitness for detention Fitness for interview Medical advice to detained prisoner Medical advice to custody staff Rousing Medical advice to colleagues Need for appropriate adults Information regarding medication

7 Appropriate Adults Juvenile Mentally disordered Learning disabilities Responsibility custody officer s FME may make a recommendation

8 Administration of medication Detained prisoners own medication should be obtained if at all possible (from home) for confirmation The FME should leave clear instructions preferably verbally and in writing Giving medication to a detained prisoner should be witnessed by another officer Detained prisoner should be observed taking medication to prevent hoarding Consideration should be given to supervision of all injections byb y the FME Medication logged in custody record when given Refusal should be logged and the FME informed Unused medication should be disposed of as instructed Medication should be kept in a locked cupboard Private prescriptions will be issued Controlled drugs i.e. Methadone(exceptional cases only) must be administered by an FME

9 Common Problems Epilepsy Asthma Claustrophobia Diabetes Heart disease Sickle cell Injuries Alcohol Drugs Mental health Infectious diseases Fitness for interview,detention,release and court. often combination of above

10 Epilepsy Regular medication Epilepsy or fits associated with alcohol / drug withdrawal Fit in known epileptic / first fit ever

11 Epilepsy Generalised seizures Partial seizure Type of epilepsy and frequency of fits Last fit medication Reliability Last dose Appropriate treatment during custody

12 Epilepsy Signs and symptoms Management of a fit Status epilepticus

13 Asthma

14 Asthma Wheeze and breathlessness Signs of concern Repeated use of inhalers not relieving symptoms Not able to speak easily Use of neck and shoulder muscles Less wheeze but increasing distress

15 Asthma THE SILENT ASTHMATIC IS A SICK ASTHMATIC Inhalers Instructions on other medication if required

16 Panic Attacks Diagnosis on history (avoidance behaviour) Reassurance Rarely medication May affect fitness to interview

17 Insulin

18 Diabetes Types - IDDM and NIDDM Complications Major risks in custody Hypoglycaemia (low blood sugar) Hyperglycaemia (high blood sugar) Treatment

19 Diabetes Using insulin obtain if possible and other medication Access to food Consideration to the supervision of insulin injection. IDDM patients should be seen by the Doctor. Awareness of hypoglycaemia / hyperglycaemia

20 Heart Blood Supply

21 Angina Signs and symptoms Treatment

22 Heart Disease Access to medication such as GTN tablets or spray If chest pain does not settle hospitalisation may be required

23 Angina Heart Attack

24 Sickle cell Disease or trait Access to regular fluids (avoid dehydration) Avoid cold May need painkillers

25 Injuries Use of personal safety equipment CS spray, handcuffs and batons Complete accurate documentation important for medical and legal reasons Dog bites may need hospital treatment, tetanus, antibiotics, follow up

26 Head injury Important to get accurate history from arresting officer before he disappears! Was there loss of consciousness or bleeding from any orifices? Symptoms of concussion (increasingly drowsy, increasing headache, headache, blurred or double vision, vomits, fits, becomes unconscious or other other unusual symptoms) Remember dangerous combinations e.g. head injury and alcohol and or drugs and other medical problems such as diabetes Instructions: - Take the patient to hospital by ambulance

27 Alcohol - Intoxication Consider - use of drugs and other medical problems including a head injury If in doubt call an FME Check and rouse every half an hour Dependent may sober up very quickly and develop withdrawal symptoms

28 Alcohol - Withdrawal May be complicated by fits May need treatment depending on length of detention

29 Drugs Knowledge of drug trends in your area Be aware that substance use and mental illness may coco-exist Problems Hypoglycaemia, dehydration, polydrug misuse, alcohol, nonnon-truthful history and other illnesses

30 Opiates Heroin / Methadone Main problem medical intoxication (drowsy, decreasing level of consciousness, pinpin-point pupils, respiration level falls, snoring) Combination with other drugs and alcohol potentially dangerous Withdrawal less of a problem but can be treated in custody, may affect fitness to be interviewed Intravenous misusers may suffer from abscesses, HIV, Hepatitis B and Hepatitis C Discuss with the FME

31 Benzodiazepines Intoxication similar to alcohol Fits may occur with withdrawal

32 Stimulants Cocaine / Amphetamine Death may occur from cardiac problems, stroke, cocaine agitated delirium Withdrawal risk of selfself-harm

33 Pregnancy Discuss with the FME regarding fitness to be detained especially if on medication and in 3rd trimester of pregnancy

34 Infectious diseases Hepatitis B vaccination for officers Risks mainly needle stick injuries High risk population for HIV, hepatitis B and C (iv drug users) Observe good clinical practice wear gloves, beware when searching Tuberculosis, other infections diseases continue treatment, consider consider hospitalisation Scabies can be treated in custody Cells and bedding cleaned professionally

35 Mental Health Call an FME if concerns regarding mental health Risk of selfself-harm history of previous attempts and past psychiatric history important Remove articles that could be used for deliberate selfself-harm May need constant supervision Liaison with other agencies when detained prisoners transferred

36 Mental Health Abnormal mental state may have a variety of causes: Depression Schizophrenia Bipolar disorder Personality disorder Learning disability Substance misuser

37 Substantial Risk - Temporary Drunkenness Intoxication by drugs Severe drug withdrawal Severe exhaustion or physical pain Severe physical illness Severe mental illness that may be amenable to treatment such as an acute organic reaction or mania A state of fear induced by police contact

38 Significant Risk (Appropriate Adult would be required) Hypomania Schizophrenia and related disorders Depressive illness Mild or moderate learning disability Mild to moderate dementia Inability to handle interrogative pressure Significant anxiety induced by custodial environment and other anxiety anxiety states and phobias, such as fear of being locked in a police cell cell

39 Medical risk factors Sickle cell disease Absent spleen Kidney problems Immunosuppressed Heart condition Lung disease Liver disease Diabetic Drug ingestion(claims overdose and alcohol)

40 When to hospitalise Difficult to give clear guidance for every situation (see below) If in doubt trust your instincts and call an ambulance If not sure call the FME for advice Err on the side of caution

41 Remember (Hospitalisation) Chest pain Breathing difficulties Level of consciousness Severe injuries head injuries with loss of consciousness, deformed limbs, wounds that obviously need suturing

42 Deaths In Police Custody Deliberate self harm single most common cause of death Substance abuse and medical conditions = another half of deaths Police restraint = 6% associated with underlying medical conditions conditions

43 Drugs Anyone Suspected of ingesting substantial amount of drugs needs to be evaluated at a hospital The need is NOT DIMINISHED even if such claims are made to avoid detention Violent, agitated prisoners should be transported to hospital in an ambulance especially due to drugs

44 Clinical well being is the primary concern