Recommendations - Thames Valley Police, December 2024

The IOPC recommends that Thames Valley Police (TVP) review its training material on handcuffing from prone (subject lying on their front) and the use of ground pin. The review should consider whether training is sufficiently clear regarding: 

• How a subject’s arms ought to be restrained during and after the application of handcuffs.
• When it might be necessary and proportionate to elevate a subject’s arms during restraint to the ‘natural point of resistance’ to gain compliance, including when a subject’s arms should be lowered.
• The difficulties in determining another person’s ‘natural point of resistance’. For example, if a subject is in distress, is non-verbal, or intoxicated, then they may not be able to properly communicate, display resistance, or show indicators of pain. 

This follows an IOPC investigation where a man was arrested and taken to hospital after swallowing a large quantity of tablets. After being discharged from hospital, he was physically restrained by police officers in the prone position, handcuffed and placed in limb restraints. 

During the course of the restraint, the man’s arms, following the application of handcuffs, were pulled at and beyond a 90-degree angle for a prolonged period of time. This resulted in significant injuries to the man’s shoulders. The man appeared distressed but did not verbally communicate with the officers. However, following his death it was established that he sustained a serious injury to his shoulders.

While the TVP training material on the ground pin is clear that elevating a subject’s arms should be done to gain compliance and be removed once this has been achieved, the training material on handcuffing from prone is not as clear. It appears that the matter of how a subject’s arms should be restrained after the application of handcuffs is not currently covered in the training material on handcuffing from prone.

The training material reviewed during our investigation is not clear on when it might be proportionate to use this tactic. Currently, the training only talks about lowering the arms once compliance has been achieved.

Accepted

Thames Valley Police (TVP) use a series of resources to guide Public and Personal Safety Training (PPST) instructors through training content. A timetable provides guidance regarding the order of training days for a particular course, a session plan provides the content to be delivered on any training day, and trainer notes provide the detail of how a technique is to be taught / the method of demonstration. 

Trainer notes cover key points to support any depiction in the College of Policing’s Personal Safety Manual of Guidance.

Scenario based training allows for officers to utilise appropriate skills to control varying behaviours in an operational context. Competence is addressed and developed when necessary. This delivery style is in line with the College of Policing’s mandated programme for PPST. 

TVP have reviewed the training material associated with handcuffing from a prone position (subject lying on their front). TVP accepts that training may be clarified further and are taking the following actions to ensure necessary change:

How a subject’s arms ought to be restrained during and after the application of handcuffs.

Following review, TVP have made changes to their Handcuffing from Prone Trainer Notes (Strong Side and Support Side) and their Ground Pin Trainer Notes. This provides further clarity on how a subject’s arms are to be restrained during and after the application of handcuffs.

When it might be necessary and proportionate to elevate a subject’s arms during restraint to the ‘natural point of resistance’ to gain compliance, including when a subject’s arms should be lowered.

Following review, TVP have made changes to their Handcuffing from Prone Trainer Notes (Strong Side and Support Side) and their Ground Pin Trainer Notes. This provides further clarity on how a subject’s arms are to be restrained during and after the application of handcuffs. 

This includes the method in which the arms are elevated prior to the application of handcuffs, how each arm is managed during application, and what position they are placed in after the handcuffs have been applied. 

TVP’s trainer notes do not reference elevating arms to gain compliance. This is done to gain (mechanical) control (this is without the use of handcuffs). This material review is centred on handcuffing from prone. TVP do not teach the elevation or lowering of arms whilst handcuffed to achieve compliance or control. 

The difficulties in determining another person’s ‘natural point of resistance’. For example, if a subject is in distress, is non-verbal, or intoxicated, then they may not be able to properly communicate, display resistance, or show indicators of pain. 

Following review, TVP have made changes to their Handcuffing from Prone Trainer Notes (Strong Side and Support Side) and their Ground Pin Trainer Notes. This provides further clarity on the difficulty in determining another person’s natural point of resistance / tension. Specifically, the following teaching point has been added:

‘It may be difficult to determine another person’s natural point of tension, for example if they are in distress, non-verbal or intoxicated. These subjects may not be able to properly communicate, display resistance or show indicators of pain’.

TVP’s trainer notes provide more detail than the College of Policing Personal Safety Manual of Guidance. This is to support instructors’ understanding of techniques and how they should be taught. Minimal requirement would be to refer to the illustrations and brief descriptions in the personal safety manual. TVP go ‘over and above’ national requirement to ensure diligence and support to their training team.

The IOPC recommends that Thames Valley Police (TVP) ensure that its training and guidance on restraint and positional asphyxia clearly states the role and responsibilities of the safety officer. This includes when a safety officer should be used, the safety officer identifying themselves to those present, monitoring the subject’s signs of life and any deterioration, and verbally encouraging those present to raise any concerns they may have about the subject’s welfare as early as possible.

This follows an IOPC investigation where a man was arrested and taken to hospital after swallowing a large quantity of tablets. After being discharged from hospital, he was physically restrained by police officers in the prone position (lying on his front) for a prolonged period of time. 

During the course of the restraint, there were five police officers present. The man’s breathing and airway were not closely observed. The signs and symptoms of positional asphyxia and cardiac arrest were present. The man later became unresponsive, and he was re-admitted to hospital where he subsequently died.

The TVP training material reviewed during our investigation does not appear to cover the role and responsibilities of a safety officer.

Accepted

TVP have introduced a PowerPoint presentation on positional asphyxia into their Foundation Delivery for student officers. This presentation covers the definition of positional asphyxia, its likelihood and the positions it may occur in, including the increased risk around prone restraint, signs and symptoms and officer response. Officer response is centred on situational awareness, communication and decision making. These areas promote the use of a safety officer where numbers permit.

Referenced in the presentation itself but supported by trainer notes, instructors are to educate student officers in the essential use of a safety officer where viable. 

When a safety officer should be used

The positional asphyxia PowerPoint states: 

‘In any circumstances where a subject is restrained by multiple officers, consideration should be made towards the nomination of a safety officer.’

Monitoring the subject’s signs of life and any deterioration

Verbally encouraging those present to raise any concerns they may have about the subject’s welfare as early as possible.

The positional asphyxia PowerPoint states:

‘The responsibility of this nominated person should be focused on the subject’s wellbeing, signs of life and any deterioration of the subject whilst supporting colleagues’ actions.’

‘If one or more members of a group are fixated on their own method of control, it may be helpful for a safety officer to direct the scenario. They may inform the team collectively and individually of their responsibilities, or identify when they are doing something which may be improved. The safety officer will also prioritise the wellbeing of the subject throughout’.

An extensive amount of trainer notes focus on the requirement for communication as a collective group, officers involved, and safety officer. This includes maintaining communication to formulate a plan, communicating as a team, communicating with the subject to convey professionalism and provide a duty of care, challenging colleagues actions and providing regular updates.

The safety officer identifying themselves to those present

The positional asphyxia PowerPoint states:

‘If any additional officers arrive to assist, the safety officer should make themselves known and brief and direct the officers’.

In addition to the positional asphyxia PowerPoint, TVP also deliver the College of Policing mandated PowerPoint presentation on Acute Behavioural Disturbance. This contains information specifically related to positional asphyxia and the increased risk of cases of actual bodily harm. Areas covered are response options, restraint concerns (including long periods of restraint), restraint considerations (including nomination of a safety officer, avoiding certain positions and aftercare positioning), monitoring detainees under restraint, duty of care and aftercare.

TVP’s trainer notes provide more detail than the College of Policing Personal Safety Manual of Guidance. This is to support instructors’ understanding of techniques and how they should be taught. Minimal requirement would be to refer to the illustrations and brief descriptions in the Personal Safety Manual. TVP go ‘over and above’ the national requirement to ensure diligence and support to their training team. 

In addition to the support provided by the College of Policing, TVP have created trainer notes to assist instructors in the delivery of the Acute Behavioural Disturbance PowerPoint. These trainer notes include the following:

Nominating a safety officer means that one officer can orchestrate proceedings whilst others are concerned with the restraint or containment of the subject. The safety officer will take responsibility for a number of things:

• Remain in contact with supervisors and the control room, request an ambulance (if not done already). 
• Ensure the control of all members of the public in the surrounding area. 
• Request any medical equipment, such as a defibrillator. 
• Observe officers’ technique, ensuring skills are performed correctly with the welfare of the subject paramount. 
• Support officers should they struggle to control the subject or become vulnerable themselves. 
• Maintain communication with the subject to explain what is happening, give instructions and check on their welfare.
• Monitor the subject as a medical concern.

In addition to Foundation Learning, a number of changes have been implemented by TVP to assist officers during annual re-certification training and whilst working operationally

• TVP deliver Scenario Based Training, as mandated by the College of Policing from April 2024 (TVP commenced delivery from November 2023). Within this training, positional asphyxia (knowledge, understanding and response options) are integrated into a series of scenarios to evoke learning. 
• These scenarios fall under the headings vulnerable person, night time economy, public order, custody, house disturbance and suspicious person. 
• In varying environments with differing impact factors known as layers, officers are expected to demonstrate subject management of prone restraint and multi-officer control, which includes the use of a safety officer. 
• Instructors review competence and address skill fade utilising ‘breakouts’ and periods of development, for which the TVP trainer notes are used (details in 2021/148339/07). 
• Knowledge and understanding is further reviewed during Time on Tasks between physical rounds of training. TVP have introduced their own mandatory topics for Time on Tasks to ensure officer knowledge is adequate in specific areas, and development is provided when lacking. These mandated topic areas include:
  -    List the Priorities of Managing a Subject being restrained in the prone position.
  -    What are your options to gain compliance/control when a subject is restrained, prone, and in handcuffs?
  -    List your individual considerations around the National Decision Model during long periods of control/prone restraint.
  -    When someone is prone, face down, list your concerns and control measures.
  -    What signs of deterioration may be observed during control and restrain?
  -    Describe best practice when putting a subject in Ground Pin - describe all elements of the technique.
  -    In each case, the trainer will ensure all group members have completed the mandated Time on Tasks. If an officer lacks the appropriate level of knowledge, this will be developed on a case-by-case basis – re-integration into scenarios is used to compound theory knowledge and learning.
• If an officer continues to demonstrate a lack of understanding, they will fall short of the required standard (GC10) and booked on to a future session for development and re-assessment.
• Beyond training, TVP officers have further access to operational guidance through the use of Snap Guides. Snap Guides are accessed via phones, tablets or computer systems, to either upskill or respond dynamically. Pre-existing Snap Guides, and those recently created, cover the following topic areas:
  -    acute behavioural disturbance
  -    prone restraint ground pin
  -    prone restraint alternative ground restraint
  -    safety officer
  -    safety officer when spit guard use
• Operational Guidance on Mental Health, which covers the use of a safety officer, has also been updated.

Future schemes of work

• To enhance force wide knowledge and understanding of prone restraint and the use of a safety officer, the Public and Personal Safety Team are currently producing an e-learning package in conjunction with training design.
• This will also incorporate learning points from the IOPC investigation in relation to situational awareness, communication and subject positioning.
• The target audience for this learning will be all officers and staff who undertake Public and Personal Safety Training.