01-03 Appendix A - Medical Advisory Notes Flashcards
Member Safety
When attending a scene where the risk of contact with blood or body fluids exists, members SHALL_____ These include but are not limited to wearing of ______ Hand washing is the most important infection control measure for the prevention of self and cross contamination.
exercise extreme caution and use universal precautions.
disposable examination gloves (nitrile), using waterless antiseptic wash or hand wipes, and using a disposable one–way air valve for mouth-to-mouth respiration.
Where it is suspected or known that a person is a carrier of an air–borne transmitted disease such as tuberculosis members
- SHALL when at a police station, place the person in an area where adequate ventilation exists. Members SHALL not place a person suspected or known to have tuberculosis or other air–borne transmitted communicable diseases in areas with little or no ventilation, such as interview rooms
- should wear surgical masks when in close contact with the person and when transporting the person to a police station or other location. Where possible, the infected person should also be asked to wear a surgical mask when in close contact with other individuals. If surgical masks are not available or the infected person refuses to wear a mask, members SHALL transport the person as the sole occupant of a compartment of a prisoner transport vehicle, or, if not available, with a window of the police vehicle open.
Persons in Custody Safety
During the booking process, the Officer in Charge is required to evaluate the ______ As part of that evaluation, it is incumbent upon the Officer in Charge to be aware of any medication or drug the persons in custody has taken prior to arrest (legal, prescription or otherwise). Based on the information received, the Officer in Charge should make _______ The decision as to whether to send an individual to the hospital should be made based on the Officer in Charge’s assessment of the circumstances.
mental and physical condition of the individual.
further inquiries regarding the type of drug, time and amount taken, whether the individual is a frequent user, and the physical state of the individual.
Persons in Custody Safety
The Officer in Charge SHALL inform persons in custody of the risk of not disclosing the consumption of prescribed or non–prescribed substances. Where a person in custody appears ill, shows ______ further medical advice SHALL be sought and/or the persons in custody SHALL be transported to the hospital for a medical examination.
symptoms of distress or adverse reaction, or reports any of these symptoms, as a result of drug use, or for any other reason,
Persons in Custody Safety
Officers should consider the possibility that an illness may be
drug related and be mindful that, under certain circumstances, a prisoner may have unknowingly consumed a drug. [e.g. GHB (Gamma Hydroxybutyrate) slipped in a drink]
Persons in Custody Safety
Where a person in custody has or is suspected of having taken a drug or other controlled substance prior to arrest but shows no outward signs or symptoms of distress or adverse reaction, the Officer in Charge SHALL
make further inquiries in order to determine whether further medical treatment is required.
Persons in Custody Safety
When considering the need for further medical attention, the Officer in Charge should be cognisant of some circumstances which may impact on the health of the individual
- where a drug that is not designed to be swallowed has been swallowed by an individual (i.e. for the purpose of concealing or transporting), or held in the mouth in such a way that the drug is exposed (e.g. no wrapper, or damaged wrapper)
- where the individual cannot, declines or fails to recall what substances (whether prescribed or non prescribed), quantity, or when the substances were taken
- where the quantity of drugs taken suggests a possible overdose (i.e. more than prescribed)
- where any drug has been taken in conjunction with alcohol
- where the individual is acting irrationally or aggressively, appears ill, is complaining of pains, nausea, etc., or reports feeling differently than other times when they have taken the same drug
- where cocaine has been used by the person, and the person has had to be physically restrained, or has exerted themself physically (e.g. foot pursuit, struggle, etc.)
- where the prisoner exhibits an unexplained change in behaviour (e.g. becomes aggressive, lethargic, sleepy, etc.)
Persons in Custody Safety
The following services are available at no cost to assist the Officer in Charge in making a determination as to whether a person in custody is in need of further medical treatment. These services may be used where the Officer in Charge requires further information (e.g. effects of drug interaction) to complete their assessment of the individual
- Telehealth Ontario (1–866–797–0000, TTY 1–866–797–0007) – provides quick easy access to a qualified health professional (registered nurse) who can assess the symptoms of the persons in custody and offer advice as to whether the individual is in need of immediate hospital care. Depending on the number of people making use of this service, a representative may have to return your call. When leaving a message, for faster service, ensure you identify yourself as a police officer seeking advice regarding a person in custody who has taken a drug prior to arrest.
- Ontario Regional Poison Information Centre – SickKids Hospital (416–813–5900 or 1–800–268–9017, TTY 416–597–0215 or 1–877–750–2233) – can provide information regarding drug interactions, and potential overdose information. If the concern to be addressed deals only with an interaction or potential overdose, call this service directly; otherwise contact Telehealth Ontario first.
- When there is a delay in receiving the required information from the above-mentioned services, the persons in custody SHALL be continuously monitored until the information requested is received and the Officer in Charge has made a final determination whether to accept the individual at the police facility.
Persons in Custody Safety
Any person who has or is suspected of having taken a drug prior to being arrested and is accepted at a police facility SHALL be ____ Individuals who have taken hard drugs such as cocaine, heroin, etc., SHALL be monitored more closely for at least ____
monitored more closely, and the results of those checks recorded, until such time as the Officer in Charge is satisfied that the individual is not at risk.
three (3) hours from the time when the drug was taken.
Persons in Custody Safety
If at any time, the persons in custody’s condition changes, or there is a concern regarding the health of the person, members SHALL notify
the Officer in Charge who SHALL re–evaluate their condition.
Persons in Custody Safety
Individuals with violent or suicidal tendencies SHALL be
lodged in a separate cell whenever practicable and their behaviour closely monitored.
Persons in custody housed in divisional cells or lockups should be placed
opposite each other where possible. This can provide an opportunity for one person in custody to give early warning of illness, suicide, or self–injury involving another person in custody
Persons in Custody Safety
If a person in custody becomes unconscious, or is in distress from illness, injury, intoxication, or reaction to drugs, the person SHALL be
removed to the nearest hospital for examination and treatment. Under no circumstances will an unconscious person be admitted to a police cell or lock–up.
Persons in Custody Safety
Unexpected deaths of intoxicated individuals may occur as a result of a condition called _____. The consumption of alcohol or alcohol in combination with central nervous system depressants (e.g. narcotics, barbiturates, etc.) can frequently produce a _____ Individuals who are intoxicated or who exhibit very loud or disrupted snoring must be __________
obstructive sleep apnea
deep sleep accompanied by loud snoring. Snoring is not an indicator of consciousness. It indicates only that a person is breathing.
closely monitored and awakened frequently in order to determine if their state of sobriety is improving over time.
- Alcohol Withdrawal Syndrome (AWS) is characterized by
by physical and mental symptoms that can occur after a person discontinues consuming high doses of alcohol. Symptoms of AWS may appear within six (6) to twelve (12) hours after a person’s last consumption of alcohol. AWS more commonly affects those with a history of alcoholism and/or those who have experienced problems with alcohol withdrawal in the past. Symptoms can depend upon the amount of alcohol consumed, frequency of consumption, and the duration of consumption prior to discontinuance. Determining a “timestamp” as to a person’s last consumption of alcohol is important in assessing the onset of AWS.
Symptoms can range from mild to severe and include:
Mild Symptoms
- tremors (trembling or quivering)
- anxiety
- sleep disturbance (insomnia)
- sweating (diaphoresis)
- over responsive reflexes (hyperreflexia)
- nausea/vomiting
Mild symptoms can occur within twenty-four (24) hours after discontinuance and should subside within forty-eight (48) hours.
Moderate Symptoms
- intensified Mild Symptoms
- rapid breathing (tachypnea)
- racing heart rate (tachycardia)
- agitation
Moderate symptoms can occur within twenty-four (24) to thirty-six (36) hours after discontinuance and should subside within forty-eight (48) hours.
Severe Symptoms
- severely intensified Mild and/or Moderate Symptoms
- hallucinations
- seizures
- disorientation
- abnormally high fever (hyperthermia)
Severe symptoms can occur within
forty-eight (48) hours after discontinuance and/or after a decrease in consumption of alcohol and can cause a person’s condition to deteriorate to a very serious condition known as delirium tremens (DTs).
Symptoms of DTs usually occur
forty-eight (48) to seventy-two (72) hours after discontinuance and include:
* profoundly intensified Mild, Moderate, and/or Severe Symptoms
If left untreated, DTs can result in death.
The time frames for the onset of AWS symptoms have been generalized. Symptoms occurring outside of the time frames (before and after) must still be
considered (e.g. Seizures may present between twelve (12) to sixty (60) hours after a person’s last consumption of alcohol).
The decision as to whether to send a person in custody to the hospital should be based upon the Officer in Charge’s assessment of the circumstances and observations made. Where a person in custody displays or reports symptoms of AWS as a result of self–disclosed or suspected alcohol use/abuse,
further medical advice SHALL be sought and/or the persons in custody SHALL be transported to the hospital for a medical examination.
Intoxicated individuals who lapse into sleep should be placed
lying on their side with the head angled forward (recovery position) whenever possible.
Some symptoms make individuals appear as if they are intoxicated when, in fact, they are suffering the
negative effects of a medical condition. Members SHALL arrange for immediate medical attention when this occurs or appears to be occurring.
