Clinical placements

What to expect from a nursing student placement in police custody

A police custody suite may not be your first thought when considering clinical placements, but it offers many learning opportunities

A police custody suite may not be your first thought when considering clinical placements, but it offers many learning opportunities


Picture: Charles Milligan

What is a custody suite and what happens after an arrest?

A custody suite is a designated area in a police station containing cells, which vary in number depending on location. Anyone who is arrested is referred to as a ‘detainee’. At this stage they are ‘under suspicion of’ an offence, but have not been found guilty.

The detainee is held in custody to allow the police to obtain further evidence, such as CCTV and witness statements. Time spent in custody varies depending on the specific investigation, the alleged offence and whether an extension to the permitted time is required.

Once the evidence is gathered, the detainee is given an opportunity to provide their side of the story in an interview. The police will then decide whether to charge the person and hold them on remand, or release them under investigation or with no further action.  

Who works in a custody suite?

The police custody sergeant has overall responsibility for the suite and detainees. Their role is to ensure that arrests are legal, that the detainees’ rights are upheld, that investigations are dealt with promptly and decisions are made about whether to charge detainees.

They are supported by civilian staff members, commonly known as detention officers. Their role includes checking detainees regularly, obtaining fingerprints and DNA samples, offering detainees food and drink and assisting them with other needs. 

Why are there nurses and paramedics in custody? 

When detainees are booked into custody they are asked about their health. Many will disclose medical issues – often complex and multiple – and in such cases staff will ask the custody nurse or paramedic to attend.

To ensure the safety of the custody nurse or paramedic, a detention officer will escort them to the cells, or escort the detainee to the medical room. 

The nurse or paramedic then assesses the detainee’s health and medical needs to ensure they are ‘fit to detain’ and ‘fit to interview’, and advises the custody sergeant of any medical requirements the person may have. 

The range of professionals available to support detainees in custody includes doctors (forensic medical examiners), appropriate adults, liaison and diversion workers and drug and alcohol workers. 

Is custody a dangerous environment?

Not every person behind a cell door is violent or aggressive; the vast majority are polite and enjoy the interaction with healthcare staff as they understand that we are there to help them. Physical assaults on nurses and paramedics are fortunately rare.  

In the few cases where aggressive behaviours are exhibited, detention officers ensure the personal safety of nurses or paramedics. They speak to the detainee through the cell door hatch, explaining who we are and our role, before allowing us to enter the cell. They then remain with us throughout the assessment. 

If the risk is perceived as too high, the nurse or paramedic will not enter the cell at that stage. A risk assessment and discussion then takes place with custody staff to rule out possible acute causes of aggression, such as head injury or poorly controlled diabetes, and a care plan is drawn up. This will likely include plans to review the detainee at a later point once they are more calm. 

What will I observe on placement in a custody suite?

No two shifts in custody are the same. Students on placement in a custody suite have an opportunity to observe nurses and paramedics working independently to deliver patient-centred care in a non-clinical area, addressing a broad range of complex conditions. 

You may observe occasional medical emergencies, such as chest pain, seizures, overdoses and head injuries. As the sole person providing emergency care, the nurse or paramedic is required to take the lead in these situations while waiting for an ambulance to attend. 

Detainees may also have poorly controlled long-term conditions, such as diabetes, epilepsy and heart problems, often when medication has not been taken as directed. Assessment of history relating to mental health, self-harm and suicide risk is a large part of our role.

Many detainees will present intoxicated with alcohol and/or drugs; some will have a dependence on these. The nurse or paramedic is instrumental in ensuring they come to no harm while in custody, by providing regular medication and reviews.

Custody nurses and paramedics also obtain blood samples for toxicology from detainees under suspicion of drink and/or drug driving, document any injuries, and obtain a range of forensic samples to confirm or rule out alleged involvement in serious offences.

Custody nurses have to adapt communication techniques according to the situation, and balance the health needs of the detainee with the requirements of the law. Students will observe and have a chance to develop a wide range of nursing skills, including leadership, autonomous practice, accountability and clinical triage. 

 

David Tremlett is a steering group member for the UK Association of Forensic Nurses and Paramedics and a member of the International Association of Forensic Nurses. Read more insights on the custody nurse role on his Twitter account @NurseCustody

 

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