RED FLAGS to A&E

Once upon a time, there was a s136 policy which contained the throw-away sentence, “If the person detained has physical healthcare requirements, they should be taken to Accident & Emergency first.”  I’ve also seen similar sentiment expressed “Where there are injuries or medical problems.”

What does this mean?  How injured is injured; what are ‘physical healthcare requirements’ and ‘medical problems’ and who is judging it? 

This is not splitting hairs: the police service have been accused of neglect and human rights violations for ignoring presentations which may or may not have fit into the above broad statements and where it was later argued that the individual should have been regarded from the start as a medical emergency.  We need to give police officers a clue.

Of course, the history of s136 with A&E has not been great.  Many to this day will argue, “We’re not a place of safety.”  I’ll deal with this one very quickly:  a place of safety defined by s135(6) as “a hospital, a police station or any other suitable place the occupier of which is willing temporarily to receive the patient”.  There are two clues in there for me, about A&Es who agree that someone should be in their care.  For the period prior to being transferred to the ‘preferred’ location they are acting as a place of safety for the purposes of the Mental Health Act, even if just for an hour or so.

Some area’s A&Es won’t even discuss this – I once went to a major department at the earliest stages of work on this to ask for their help in understanding what should come to them and what should not.  I was asked to leave the building before being allowed to explain properly why I was there.  I could not get my breath, if I’m honest.  Surely if you work with your local police force to help them understand the medical issues, it will reduce the number of inappropriate removals to A&E that you have to suffer?  They weren’t prepared to listen.

Another A&E was far more helpful – so we invited them to list for the police what should be taken to A&E.  I thought you’d like to see what they said?  They became termed as RED FLAGS and were made subject of formal training:

• Dangerous Mechanisms
• Blows to the body
• Falls > 4 Feet
• Injury from edged weapon or projectile
• Throttling / strangulation
• Hit by vehicle
• Occupant of vehicle in a collision
• Ejected from a moving vehicle
• Evidence of drug ingestion or overdose (inc alcohol)

• Serious Physical Injuries
• Noisy Breathing
• Not rousable to verbal command
• Head Injuries
• Loss of consciousness at any time
• Facial swelling
• Bleeding from nose or ears
• Deep cuts
• Suspected broken bones

• Attempting Self-Harm (persistent except when under restraint)
• Head banging
• Use of edged weapon (to self-harm)
• Ligatures
• Especially where above accompanied by a history of overdose or poisoning

• Psychiatric Crisis
• Delusions / Hallucinations / Mania

• Possible Excited Delirium – two or more from
• Serious physical resistance / abnormal strength
• High body temperature
• Removal of clothing
• Profuse sweating or hot skin
• Behavioural confusion / coherence
• Bizarre behaviour

To assist in assessing the above, many police forces are now calling ambulances to the scene of the arrest, in order to ask, “Is there a RED FLAG that necessitates removal to A&E?”  Rule out any possible medical emergency or physical healthcare requirement BEFORE deciding to remove a person to a psychiatric unit and especially before removal to a police cell.

This approach has been circulated nationally and I was pleased to get a chance to go back to the A&E that threw me out 3yrs previously and discuss this with them.  They breathed a deep sigh of relief and signed up to it within 15minutes as a having the very real potential to minimise the impact of s136 upon their department, particularly inappropriate impact.

It’s good to talk

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Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

 

All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2011

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Government legislation website – www.legislation.gov.uk