To see any of the other Paramedic Series blogs, refer to the index:
This afternoon I did a lecture at the University of Worcester to a group of undergraduate, student paramedics. This is one of four universities in the West Midlands for training student paramedics and I’d gone there full of ideas of what we’d discuss – all issues covered on the previous five blogs:
Somehow, and without planning to do so, I ended up involved in talking about self-defence and “reasonable force”, because the issue of personal safety came up in a question and it suddenly struck me that we’re about to send these young people into situations where – let’s be honest – they can face some awful abuse, provocation and violence. In starting to think about the PARAMEDIC SERIES of blogs, I spoke to Ella Shaw who was once hit over the head with a lump of wood and had her hand broken by a person who she continued to care for despite the violence. Let’s not forget: some ambulance services feel it is appropriate to issue “stab-vests” to their staff because of the risks they face. It just makes me hold me head in my hands, on occasions. So I want to make sure they’re as safe as possible especially if the police are not right there to deal with it.
And so – “do you know what you’re entitled to do to defend yourself?” seemed a relevant diversion when the subject came up at Worcester.
SECTION 3 OF THE CRIMINAL LAW ACT 1967
This is the law that allows EVERYONE to protect themselves when faced with an attack or personal violence: this is the law that is debated on the news whenever we get the those stories about what you can do to defend your home against burglars, etc., etc.. It states –
“A person may use such force as is reasonable in the circumstances in the prevention of crime, or in effecting or assisting in the lawful arrest of offenders or suspected offenders or of persons unlawfully at large.”
To paraphrase a judge from a recent court case who was asked what “reasonable doubt” meant, he answered “It is a doubt that is reasonable. These are ordinary English words.” The same applies here. One student said, “If someone was trying to stab you, you’d be entitled to punch them in the face to stop them from getting you and then run away.” << What he said … as long as simply running away was not going to keep you safe.
The force anyone uses to defend themselves is judged in the particular context it was used. I gave the example of a paramedic at an incident who was busy using scissors to cut clothing from a patient to access a wound and assess or apply the correct treatment. If, whilst holding scissors, someone attacked you and your flinch-based, instinctive reaction in pushing out your hands to deflect the blow resulted in scissors hitting someone, it doesn’t mean you’ll be arrested for stabbing your assailant, even if they were injured. Self-defence is judged in its context and if you assault a paramedic holding scissors, whilst they are not allowed to deliberately stab you, any claim to lawful defence of themselves would not be rendered useless because their instinctive reaction happened to involve an aspect which caused a more serious consequence. If pushing someone away from you to keep yourself safe was lawful, pushing them backwards would still be lawful even if they tripped as they went backwards and then hit their head on the floor, fracturing their skull, for example.
On a different, but related issue, it is worth covering some law about the detention of patients under the Mental Health Act where paramedics are often brought into the situation for conveyance purposes. When an Approved Mental Health Professional has ‘sectioned’ a patient under the Mental Health Act, they are obliged to convey that person to the identified hospital for admission. They have a legal authority, under s6(1) of the Act, to “detain and convey” the patient and have “all the powers of a [police] constable” in order to do so. Something of relevance to paramedics and police officers, is the concept of a “delegated authority” to detain and convey; and the legal concept of paramedics assisting police officers in the execution of their duty and vice versa.
Under s6(1) MHA, an AMHP may delegate their authority to detain and convey to anyone else. It is quite frequent that this request will be made of police officers, especially if the AMHP has found that it will be reasonable to use force in order to effect the admission but equally, it could be made of paramedics. There are a few things about this delegated authority that you need to know, whilst reminding you that different ambulance services have different policies about whether or not their staff will accept this legal option.
In some trusts, it is declared that paramedics will not become responsible for legalities around conveyance. They will provide the vehicle, oversee the clinical wellbeing of the patient whilst in transit and support the detaining authority, but they will not detain / convey. In other trust areas, paramedics are allowed to accept delegated authorities for low risk patients who are not resistant to being taken to hospital. So it’s important to understand your area’s procedure. It’s still worth knowing the following things however, to manage your discussions with AMHPs and police officers.
- The AMHP who wishes to delegate their authority to someone else, may not compel anyone else to accept that authority.
- Anyone who does choose to accept it then also assumes “all the powers of a [police] constable” with regard to that patient in that admission process.
- In other words: they have a right to use reasonable force to effect the admission.
- GET THE AUTHORITY IN WRITING: by getting involved in the forcible admission of a patient who is resisting it, you may reasonable anticipate the need to justify anything that you do.
- By virtue of para 11.10 of the MHA Code of Practice, the form of an AMHPs authorisation to detain / convey should be agreed in the joint protocol for your area on conveyance. Usually, in writing.
- By virtue of para 11.17 of the MHA Code of Practice, the AMHP who is requesting the (police or) paramedics to detain and convey should “provide” that authority to do so where the person is unwilling to be moved.
WHO GOES HANDS ON?
This all brings you and us to the question of who goes “hands on” with the unwilling patient? It is commonly thought that this is a matter for the police. After all, we’re trained to use force aren’t we and we’re the ones who are carrying batons, CS spray and occasionally tasers for resistant people. What if the patient is concerned is 83yrs old and has diabetes, blood circulation issues and Alzheimer’s? Are we still in the zone of thinking this is a police responsibility?
Police forces have been known to say things to the effect of “This person is not actively resisting admission” and decline to be the first agent to use force. This could sound like a petulant refusal, couldn’t it? We should remember that police training in personal safety issues is predicated upon verbal communications followed by the use of techniques which involve the deliberate application of pain – justifiable in some situations, but are they really appropriate to the elderly dementia patient? Well, the MHA Code of Practice talks about the restraint of inpatients in hospital and makes as point saying that “pain compliance techniques” should be avoided. We’ve seen police involvement in the restraint ot dementia patients become criticised in the courts and in the media.
This does not amount to the police saying “leave it with you” – but it should involve consideration between the AMHP, the police and any other professionals on hand about how we proceed. There is a very real risk about the use of force by the police on vulnerable people: the use of techniques which involve pain may result in injury and other subsequent psychological problems – it is not to be undertaken casually. That is why a discussion about how things will proceed is always useful and I know senior paramedics who have talked about their potential to do what they call “proactive blanketing” to help in the management of patients who are passively resistant to being detained and conveyed. And the police should support this or other approaches where possible because whatever level of force is used, it has to be the “least restrictive” thing in the circumstances. It’s at least arguable that uniformed, stab-vested police officers using pain compliance techniques on the elderly would fail this test.
Don’t forget three methods of using this blog to find out more:
- There is a full index of over 500 posts on all manner of topics.
- There is a series of “Quick Guides” originally intended for police officers, but some will be of interest to paramedics.
- There is a “search” facility in the top right hand corner: by entering any keywords on policing / mental health will bring up the relevant posts, including entering sections of the MHA like “s136″.
To see any of the other paramedic blogs, refer to the index:
Update on 01st April 2015 – since writing this article, a new Code of Practice has come into effect in England. It doesn’t substantially alter the post but certain reference numbers have changed. My summary post about the new Code of Practice (2015) is here, the new Reference Guide is here and the full document is here. The Code of Practice (Wales) remains unchanged.
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