National recommendation - The College of Policing, April 2021

The IOPC recommends that the College of Policing should take steps to ensure that all officers and staff (in particular front line officers) are best supported (for example through training and guidance) to recognise the signs and symptoms of head injuries and understand how to respond to a suspected head injury.

This follows a case where officers were called to a disturbance at a rugby club in Swansea. Upon arrival, officers found a man lying prostrate in the car park and noticed he appeared to have blood on the back of his head and a cut eye. The officers were informed that the man, who was not fully responsive, had been punched. The South Wales Police officers who attended the scene failed to recognise the signs of a serious head injury suffered by this male and appeared to have had contradictory views amongst each other about whether paramedics were required. The officers initially agreed with a decision made by family members to transport the injured party home. After they were unable to manouvere the injured party into the car of a family member, police officers decided to transport him to hospital though this decision could have been made much sooner. Upon arrival at hospital, the individual was assessed as being in a critical condition having suffered a fractured skull and bleeding on the brain.

Our investigation found that frontline officers in South Wales Police are taught module two of the College of Policing's First Aid programme. This module does not include training on how to manage a casualty with a head injury. Training on managing a head injury is provided for in module three, which is designed for officers and staff that are responsible for the care of detainees (eg custody officers and detention staff), and module four which is designed for officers and staff working in medium to high risk areas.

A head injury may result in the rapid deterioration of a person's health which requires prompt medical care. Not all head injuries are visible and complications may occur at any time. Amending module two to include managing a casualty with a head injury would help to ensure that all officers and staff who have direct contact with the public have the necessary knowledge to provide an appropriate response to such injuries. This would reduce the risk to those who might have such an injury from not being provided with suitable medical care.

Do you accept the recommendation?

Yes

Accepted action:

​The College licences the First Aid Learning Programme (FALP) used by Home Office Forces. The College is responsible for ensuring appropriate quality assurance processes are in place to guide forces in the implementation of the HSE guidelines relating to the provision of first aid.

The FALP has five modules and the national recommendation is that police officers who deal with the public (such as the officers whom attended this incident) receive a minimum of Module 2 training (the equivalent to the qualification of a HSE Emergency First Aider). While Module 2 does not seek to provide detailed coverage of all specific medical conditions it does include learning outcomes for officers and staff to make an assessment of the casualty, including the known factors that may present a risk to their health.

Officers and staff are called on to provide first aid in a wide range of incidents during their work. The range of incidents officers attend means it is not possible or viable for all officers to be trained for all types of medical emergencies, or for the FALP to explicitly outline the appropriate medical response in every context.

It is recognised that some areas of policing, such as working in custody environments, firearms operations or public order teams, require additional skills and knowledge. The relevant staff have additional FALP training modules available to ensure they are prepared for situations they are likely to encounter in their specialist roles. Additionally, where local force risk assessments identify a critical need, Chief Officers are able to add additional medical training provisions under the advice of local clinical governance.

The FALP modules are monitored via the College’s own governance and a national NPCC coordination committee. The NPCC portfolio includes the HSE representation, and is supported by a dedicated subject matter expert group of force first aid leads, and a national clinical governance structure, which includes a broad range of independent clinical expertise. The NPCC governance structure considers all relevant recommendations, including sec 28A recommendations, as a standing agenda item.

In addition, a wider review of the high level learning outcomes for the FALP has already started to ensure that they remain fit for purpose. We will ensure that this cause for concern will form a specific part of this review to ensure that officers and staff are able to recognise and respond to the signs and symptoms of injury, including those to the head. The first meeting took place on the 12th April and we expect to complete this work towards the end of 2021 following the publication of updates expected from the UK Resuscitation Council this year.

We note that the recommendation relates to ‘all officers and staff’. However, some officers and staff (non-public facing and at the discretion of the Chief Constable) would only obtain module 1 training, which covers only basic first aid principles and procedures. The College does not consider high level learning outcomes relating to head injuries as recommended would be appropriate for this module and consideration of Module 1 is not forming part of the current review.

The College is committed to continuing our work with forces, the NPCC and other agencies to raise standards of practice in the care of people who come to police attention. We would like to thank you for bringing the circumstances of Mr Jones’ death to our attention so that we can ensure that our immediate and future work is informed by the events that culminated in his death.