Recommendation - College of Policing and National Police Chiefs' Council, August 2019
A young man was found after hanging himself in Greater Manchester after being reported missing from a care facility. Officers attended and noted that there was a ligature around his neck and he was still upright against a fence. They cut him down, leaving the ligature in place and stated that they could not find a pulse. Officers did not attempt CPR and paramedics who arrived a short time later confirmed that the young man was in fact dead. Officers' training was reviewed and it was noted that response officers, while trained in CPR, are not trained in ligature removal. There is also no link in the training that a person who has hanged themselves potentially has gone into cardiac arrest and therefore that CPR should be an option to consider, and that the scenes of crime information to leave the ligature in place should be overruled by the Article two requirement to preserve life.
IOPC reference
Recommendations
Officers attended an incident where a young male was found hanging. They did not detect signs of life and did not administer CPR. Responding officers receive ‘Emergency First Aider at Work’ (EFAW) (Module 2) training, in line with the College of Policing’s (CoP) First Aid Learning Programme (FALP). While Module 2 covers cardiac arrests in simple terms, it does not explain specifically that persons found hanging may be in cardiac arrest and that CPR should be administered in such cases. Officers, when faced with such an incident, should consider the possibility that a person, even if no signs of life are detected, may be in cardiac arrest and must be managed like any other cardiac arrest. The CoP should promptly amend Module 2 to ensure responding officers faced with such an incident factor the possibility of a cardiac arrest into their assessment and respond accordingly, stressing that the preservation of life is the utmost priority, including above the preservation of evidence
Do you accept the recommendation? Yes
I am writing on behalf of the College of Policing in response to your 28A of Schedule 3 to the Police Reform Act 2002 formal recommendation and response notice dated 1st August 2019. The notice arises from an investigation in to the circumstances surrounding the death of Westleigh Lane. The notice sets out the recommendation in the following terms:
Officers attended an incident where a young male was found hanging. They did not detect signs of life and did not administer CPR. Responding officers receive ‘Emergency First Aider at Work’ (EFAW) (Module 2) training, in line with the College of Policing’s (CoP) First Aid Learning Programme (FALP). While Module 2 covers cardiac arrests in simple terms, it does not explain specifically that persons found hanging may be in cardiac arrest and that CPR should be administered in such cases.
Officers, when faced with such an incident, should consider the possibility that a person, even if no signs of life are detected, may be in cardiac arrest and must be managed like any other cardiac arrest. The CoP should promptly amend Module 2 to ensure responding officers faced with such an incident factor the possibility of a cardiac arrest into their assessment and respond accordingly, stressing that the preservation of life is the utmost priority, including above the preservation of evidence
The College of Policing is the independent professional body supporting everyone working in policing to reduce crime and keep people safe. We aim to share knowledge and good practice, set standards, and support professional development.
The College of Policing licences the College’s First Aid Learning Programme (FALP) used by Home Office Forces. The programme is endorsed by the National Police Chiefs Council (NPCC) and the Health and Safety Executive (HSE).
The aim of the FALP is to provide guidance to support first aid learning in a flexible modular programme. The learning standards for each module provide the learning required for specific roles within a policing context. The FALP has five modules and the national recommendation is that police officers receive a minimum of Module 2 training (the equivalent to the qualification of a HSE Emergency First Aider).
The development and maintenance of the FALP 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. Work has already commenced to review and standardise the patient report forms completed after the provision of first aid with the aim of developing a better understanding of training needs and the prevalence of the incidents encountered by officers and staff. Consideration of inquests and investigations is a standing item on the first aid group’s agenda and the issues raised in your letter will be raised at the next scheduled meeting.
The College of Policing is also 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 College has given careful consideration to your recommendation to amend Module 2 of the FALP. None of the high level learning outcomes in any of the FALP modules are situation specific, in that they do not attempt to anticipate or dictate when it is appropriate to administer a particular first aid intervention. Due to the range of incidents that officers and staff attend this would not be possible were it to attempt to do so. We do not therefore think that the FALP is an appropriate location in which to place advice that is specific to responding to incidents where a person has been found hanging. The expectation is always that an officer will follow the basic guidelines in all cases and when presented with a casualty who is not breathing (including hanging) would commence CPR.
The College does provide more relevant and specific guidance to officers who are responding to an attempt at suicide by hanging within the Authorised Policing Practice (APP) advice on Mental Health on Suicide and bereavement response. The current relevant content is as follows:
After a suicide attempt The WHO guidance provides the following advice for Police officers, firefighters and other responders. First interveners are responsible for responding to a crisis in the most adequate and efficient way. In doing so, they need to go through various stages: If the person is unconscious or may be physically unwell:
1. check the person’s vital signs following the suicide attempt and apply resuscitation, as appropriate (they need to remain calm to be able to make the right decisions in a situation dominated by emotional stress and anxiety). In cases of hanging, where there are signs of life, cut and loosen the ligature, call an ambulance and apply first aid 2. contact emergency health care – depending on the nature of the suicide attempt, and mental health care needs (in many situations, it will be important to identify the drugs or toxic substances used in the attempt and determine the amount ingested, it will be helpful to take unused pills and empty bottles to the hospital or mental health unit so that healthcare professionals can verify the substances that have been ingested).
The College proposes to amend this section to contain specific advice to the effect that a person who has been found hanging may be in cardiac arrest and that CPR should be administered in such cases. The College is already considering the appropriate wording and will shortly make an amendment to the APP.
Given the breadth of material that the FALP covers I hope that you find the proposed amendment to APP to be an appropriate and proportionate response to what you are seeking to achieve through this recommendation."