Man injured during restraint and arrest - Thames Valley Police, March 2018
On 3 March 2018 Thames Valley Police officers attended a shop in Aylesbury, Buckinghamshire, following an allegation that a man was threatening members of the public with a chair. Officers found the man and arrested him. He was taken down to the ground by officers after resisting, and sustained an injury to his nose. The man was transported to custody, where he was assessed by a health care professional (HCP), who determined he was fit for detention. The man remained in custody for some time without issue, but became unwell and was reassessed by the HCP, who decided the man should be taken to hospital for head injury assessment. A scan showed the man had no signs of head injury, but it was thought he may have fractured his nose. The man was released from hospital and returned to custody later that evening and was taken to court the following day.
Our investigators conducted a detailed investigation. They took witness statements from police staff, police officers and members of the public, and from the man who was injured. They logged and analysed CCTV footage, and police officers’ body-worn camera footage, along with radio and telephone transmissions.
Based on the evidence available we found no indication that any person serving with the police may have behaved in a manner that would justify the bringing of disciplinary proceedings, or had committed a criminal offence. We concluded our investigation in November 2018.
IOPC reference
Recommendations
National recommendation
The College of Policing should review the guidance on head injuries in Authorised Professional Practice (APP) to:
- provide greater clarity on what constitutes a head injury, including the difference between a traumatic brain injury, other serious injury to the head and a superficial injury to the head or face
- ensure that officers are provided with clear guidance on how to recognise and respond to each type of actual or suspected injury
- ensure that it refers to the latest version of any other guidance cited (including guidance issued by the Faculty of Forensic and Legal Medicine)
- ensure that any other guidance cited does not conflict with guidance given in the other sections of the APP Any change to APP should not increase the risk to those who might have suffered an injury from not being provided with appropriate medical care.
This follows a case where a man appeared to sustain an injury to his nose after being taken to the ground by police officers. The officers believed the man had suffered a head injury, which according to APP requires a detainee to be taken to hospital immediately. The officers called an ambulance to meet them at the police custody suite. However, the man was seen in the custody suite by a Health Care Professional, who assessed him as having a facial injury and decided that the man did not need an ambulance. The man became unwell 24 hours into his detention and was then taken to hospital for a head injury assessment, where it was determined that he had a possible fracture to his nose. Our investigation found that there had been some confusion about whether the man’s injury should be classified as a head injury. We also identified that the APP signposted officers to other guidance that was not the most recent version and that gave slightly different advice to that given in the APP itself.
Do you accept the recommendation?
N/A
Recommendation to Thames Valley Police
Thames Valley Police should review its training to ensure that it is providing officers with clear advice on what constitutes a head injury and when immediate medical advice must be sought and/or when a detainee must be transferred to hospital.
This follows a case where a man appeared to sustain an injury to his nose after being taken to the ground by police officers. The officers believed the man had suffered a head injury, which according to APP requires a detainee to be taken to hospital immediately. The officers called an ambulance to meet them at the police custody suite. However, the man was seen in the custody suite by a Health Care Professional, who assessed him as having a facial injury and decided that the man did not need an ambulance. The man became unwell 24 hours into his detention and was then taken to hospital for a head injury assessment, where it was determined that he had a possible fracture to his nose. Our investigation found that there had been some confusion about whether the man’s injury should be classified as a head injury. We also identified that the APP signposted officers to other guidance that was not the most recent version and that gave slightly different advice to that given in the APP itself.
Do you accept the recommendation?
Yes
Accepted action:
[The Force Medical Director] and I [First Aid Team Leader] have reviewed the First Aid training for Head Injuries and consequently the training material has been revised in accordance with the recommendation herewith.
PP Slide 1 and notes
Head Injuries
Most head injuries will not be life threatening, but anyone who has lost consciousness for any period of time, whose levels of consciousness deteriorate, or you suspect has a fractured skull - should be treated as a medical emergency and transported to hospital to be assessed by medical staff.
The signs and symptoms vary from person to person and in severity.
There is always a history of a significant blow to the head and the casualty may become unconscious for a short period, after which the levels of response should improve. (Concussion)
They may not be able to remember some of the events either side of the head injury. They will probably have a headache and be dizzy or confused. Frequently they feel nauseous or are sick, breathing and pulse rate could increase and the skin may look shocked – pale, cold and clammy.
If there is traumatic injury to the head, the levels of consciousness become worse as the condition develops (Compression).
There is little you can do about this apart from recognise it and get medical help to you as quickly as possible. The most significant sign is if one pupil is dilated more than the other (unequal pupils).
Other signs of a very serious head injury include a flushed, dry skin, intense headache and nausea; if the skull is fractured there could be swelling or bruising of the head, around one or both eyes, or behind the ears.
Treatment
This is a Medical Emergency – call for an ambulance
In the meantime, maintain airway and breathing.If the casualty is conscious, help them lie down and keep the head, neck and body in line in case there is a spinal injury.If the casualty is unconscious, keep them still and constantly monitor their breathing. If you struggle to keep the airway clear, place them in recovery position using the spinal log roll technique as best as you can.Control any bleeding by applying gentle pressure around the wound. Do not plug any bleeding coming from an ear.Look for and treat any other injuries.
PP Slide 2 and Notes
When dealing with Disorder e.g. incidents outside a pub involving alcohol, drugs and fights, you must be aware of the potential for serious injuries.
These may happen as a result of fighting and/or falling over and it is not uncommon for people in these circumstances to suffer with traumatic head injuries. The most serious causes of a nosebleed could be a fractured skull.
It is essential to be aware that the signs and symptoms of alcohol abuse are similar to those of a traumatic head injury or a stroke.
Gain as much history as possible e.g. fights? falls? and look for signs and symptoms of a head injury.
Remember that a detainee must be transported directly to hospital if they:
are showing any symptoms of head injuriesare, or have been, unconscioushave suffered serious injury
If there is no evidence of a head injury and your casualty is not capable of standing, is semi-conscious or barely responsive:
- place them in a safe Recovery Position.ensure their chin is lifted and forward and their chest is lifted adequately from the ground (beware positional asphyxiation) so that they can continue to breathe adequately.call 999stay with them and closely monitor their airway, breathing and levels of response