cs incapacitant and taser - bcpft.nhs.uk

Version 1.0 January 2017

CS Incapacitant and Taser

Target Audience

Who Should Read This Policy

Inpatient Staff

CS Incapacitant and Taser Policy


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Ref. Contents Page

1.0 Introduction 4

2.0 Purpose 4

3.0 Objectives 4

4.0 Process for CS Incapacitant Management 4

4.1 Effects and Health Risks 4

4.2 The use of CS Incapacitant prior to Admission 5

4.3 The use of CS Incapacitant on Trust Property 5

4.4 Aftercare and Management following CS Incapacitant 6

5.0 Process for Taser Management 7

5.1 Aftercare and Management following the use of Taser 7

6.0 Procedures connected to this Policy 8

7.0 Links to Relevant Legislation 8

7.1 Links to Relevant National Standards 9

7.2 Links to other Key Policies 10

8.0 Roles and Responsibilities for this Policy 11

9.0 Training 12

10.0 Equality Impact Assessment 12

11.0 Data Protection and Freedom of Information 12

12.0 Monitoring this Policy is Working in Practice 13

Appendices

1.0 Removal of Taser barbs 14



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Explanation of terms used in this policy CS Incapacitant - is an irritant spray that is expelled from a hand held canister. The effective

‘ingredient’ (2-chlorobenzylidene malononitrile) is expelled within crystal form alongside a propellant. It is attracted to warm areas of the body (eyes, mouth, nose, groin) and due to its irritant properties

will temporarily minimize an individual’s capacity for resistance. It is discharged by trained police

officers following an immediate risk assessment of the threat posed by the individual

Taser - A Taser is a hand-held device that fires two probes (or barbs) at an individual. The probes are intended to attach to the skin or clothing on the torso and/or lower limbs. The probes are attached to

the Taser handset by thin wires.

It works by administrating very quick pulses of high electrical current through the wires.

The current flows into the body and results in a loss of muscular control and pain. The effects are instantaneous but only last as long as the charge is applied.

It is discharged by trained police officers following an immediate risk assessment of the threat posed

by the individual

Procedural Documents - the collective term for policies, procedures or guidelines Policy - sets out the aims and principles under which services, divisions, or units will operate. A policy outlines roles and responsibilities, defines the scope of the subject covered, and provides a high level

description of the controls that must be in place to ensure compliance



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1.0 Introduction The Black Country Partnership NHS Foundation Trust does not expect that patients will ordinarily be exposed to CS incapacitant or a Taser. The Trust would prefer that CS incapacitant or a Taser is not used on patients, and that its use to manage difficult situations will always be exceptional. However, the Trust also recognises that despite some reservations about the use of either pieces of equipment, once the Police are requested to attend and safely manage an incident it is their decision as to whether the incident is so serious that the use of either equipment is justified. CS incapacitant is not a gas, it is a crystalline solid. The importance of this distinction is that it crystallises on the person who is sprayed and possibly on the local environment i.e. the room where it has been used, clothing etc. Consequently, it is possible that when a contaminated area or object is touched the crystalline can be reactivated. CS incapacitant will react in any area where there is the slightest amount of moisture. Tasers have been used operationally by the Police since 2003 and are only deployed by specially trained officers who have assessed the level of risk high enough to warrant deployment of the Taser. They have been introduced as a ‘less lethal’ weapon to fill a police operational gap between batons and firearms. In all situations staff will work closely with the police at these times to disclose and discuss relevant information about the individual who is potentially liable to be sprayed with CS incapacitant or those that may have Taser used against them. This dialogue should include information that might be helpful to defuse the situation and / or prevent the use of CS incapacitant or Taser and any underlying physical health concerns that may influence the police decision to use

2.0 Purpose The purpose of this policy is to provide information and support for staff to enable them to reduce and manage the effects of a CS incapacitant or Taser exposure.

3.0 Objectives The policy will support staff to:

Identify the health risks that an individual may experience after being exposed to a CS incapacitant/Taser

Manage an individual who have been exposed to a CS incapacitant /Taser

Manage the aftercare for an individual and the environment

4.0 Process for CS Incapacitant Management

4.1 Effects and Health Risks

The effect of CS incapacitant on the individual occurs within 10-15 seconds but can take up to 20 seconds. The effects are temporary and usually last for approximately 15 minutes, although they can last up to 45 minutes. (NB. Third parties who are either in the immediate vicinity or have to make contact with the individual who has been sprayed shortly after the use of CS incapacitant can also experience these effects).



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Eyes Discomfort, pain, intense tear production (lachrymation) and spasm of the eyelids

Respiratory

Sneezing, coughing and increased secretions with chest tightness or burning, in severe cases respiration may be irregular with periods of apnoea (temporary cessation of breathing). Rarely, secondary pneumonia may develop 24-36 hours after exposure. Gross exposure may cause pulmonary oedema (excessive accumulation of fluid on the lungs) and death from hypoxia (oxygen deprivation in the tissues)

Cardio-vascular

This is not directly affected but the irritation and distress caused by CS incapacitant may cause a rise in blood pressure (which is usually slight and short lived) and possible complications from pre-existing cardio-vascular abnormalities. In particular pre-existing hypertension caused by medication may be exacerbated

Skin Stinging or burning and possible redness, flaking or blistering. Delayed skin irritation (onset 8-16 hours after exposure) has been observed in a significant number of cases. Symptoms gradually settle but can take as long as a week to disappear. This is thought to be a result of the solvent used to carry the CS incapacitant. Continued symptoms should be treated by medical staff or a GP

4.2 The use of CS Incapacitant prior to Admission

Where CS incapacitant has been used on an individual prior to admission, it is important that the time lapse between the application of the spray and the arrival for admission is identified – this will give an indication as to what effects the patient may be suffering and the likely duration. This information should be elicited from the relevant police officer. On arrival the patient should be escorted to a quiet room well away from other patients. Room air conditioning systems must be turned off to prevent circulation. Any individual exposed to CS incapacitant should be seen by the duty doctor as soon as possible.

4.3 The use of CS Incapacitant on Trust Property

Staff should be aware that when the police are called to assist in a violent incident that the police will assume control of the situation and use whatever means they consider appropriate given the risks and level of aggression. This could well include the use of CS incapacitant. It is the responding police officers decision whether to utilise CS incapacitant. However, staff must liaise closely with the police officers and provide them with full details of the situation and any specific information about the identified individual, for example:

Does the patient suffer from any known condition that may be adversely affected by the use of CS incapacitant e.g. respiratory complaints, heart condition, mental state?

Is there any evidence of intoxication or substance misuse by the patient? This might aid the patient’s resistance to the effects of CS incapacitant but should not cause medical problems

Does the patient wear contact lenses?



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4.4 Aftercare and Management following CS Incapacitant

Move the person to an uncontaminated area that is well ventilated – an area outside is ideal but if this is not possible / appropriate a well-ventilated room with as many windows open as possible is adequate. Beware of standing a person in front of an open window that will blow the crystals back into the room and risk contaminating others who are present. Allowing cool air to contact the person’s skin will help the CS crystals to be blown off the skin. All other people not involved in the incident should be moved away

Staff must always wear gloves and protective clothing, when in contact with the person

Staff should approach the person as soon as it is safe to do so

The person’s hearing might be impaired by the CS incapacitant and therefore, communication should be established by using clear and loud instructions

The patient must be discouraged from rubbing their eyes, as this will reactivate the spray. Encourage the patient to blink as this may naturally expel the irritant from the eyes. Where possible, access to fresh air or free flowing ventilation should be provided to minimise effects, the use of a fan may be helpful as long as the direction of the fan points away to an outside space or an open window

It is highly likely that the patient’s clothing may have become contaminated therefore it is necessary to encourage the patient to remove their clothing so that it can be aired for at least 45 minutes. Suitable alternative clothing must be made available

After clothing has been aired it should be washed on a normal wash cycle, independently of other non-contaminated washing. Wherever there is heavy contamination of clothing, it may be necessary to wash it 2 – 3 times. Staff are advised to wear disposable gloves and wear protective aprons when handling contaminated clothing. All protective clothing worn by staff should be appropriately disposed of after use

Alternating staff who are in direct contact with a patient who has been sprayed with CS incapacitant might help to reduce the risk and effects of third party contamination. Wherever possible staff with a history of respiratory problems or skin complaints should avoid primary contact with the individual concerned until such times as the effects of the CS incapacitant have diminished

Ask the person to sit upright and breathe normally. Staff should monitor the person’s breathing

If the person wears contact lenses, ask them to wash their hands and area of their face immediately around the eyes thoroughly before removing the lenses

If necessary, the person can be encouraged to wash their face with copious amounts of running tap water over a sustained period of 3 – 5 minutes. Try to discourage ‘excessive splashing’ as the water may spread the irritant crystals further

The person should wash their hands thoroughly before using the toilet to avoid further contamination risks

Any chemical burn should be treated as a thermal burn

Constant monitoring of the individuals physical and mental health should be undertaken until a medical examination is carried out and prescribes otherwise. In particular, respiration, pulse, oxygen saturation levels and blood pressure should be monitored for abnormalities

Comprehensive record keeping is vital including the rationale for police attendance, patients response to CS incapacitant and the management of after affects



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If an area has been contaminated by CS incapacitant it is important that it remains out of use until such time that it is deemed safe to reuse. The affected area will need to be well ventilated and the use of extractor and portable fans will help in this process. It would be anticipated that a room in which CS incapacitant has been used may need to remain out of commission for 2 – 3 hours, dependant on the quality of ventilation, possibly longer where air through-flow is poor. If staff are unsure or concerned about an area remaining contaminated, they should seek further advice from the manager and / or Police. It may be necessary to consider professional cleaning of a room / furniture where after a period of ventilation the after-effects are still present.

5.0 Process for Taser Management

Any event that may warrant the use of Taser will be orchestrated by the police officers in attendance. Staff must work with officers to facilitate the continued provision of a safe environment which also increases the protection of others and that of the patients’ privacy and dignity. Ideally all others not directly involved in the incident, including other patients must be removed from the area due the incident likely to be of a fluid aggressive nature. Staff should inform the police of the following:

Any physical health concerns, i.e. cardiac problems, pregnancy, epilepsy

If the patients have recently been exposed to CS incapacitant and may still be wearing contaminated clothing

If the patient is wearing any clothing that has been covered in a flammable liquid

A brief summary of why police were summoned in the first instance

If the patient may be under the influence of illicit drugs or alcohol

Has any communication issues

If the patient has a weapon

If the patient has been physically aggressive and to what extent Pay close attention to patients with a cardiac history, including coronary artery disease, myocardial infarction and congestive heart failure. Although the Taser current poses no direct threat to the conductivity of the heart, the strain of a prolonged physical contact with police officers could precipitate a cardiac event. Following the Taser being employed, the patient may have poor recollection of the Taser event. Clear information and reassurance, if appropriate, must be given to the patient alongside the police officers present.

5.1 Aftercare and Management following the use of Taser

The police will take immediate control of the situation following Taser deployment. Staff must be guided by the police

The recovery from the effects of the Taser should be almost instantaneous, once the current has been turned off

Due to the loss of muscle control it is highly likely that the person will fall, and will not have the natural ability/response to outstretch their arms to break their fall. Staff need to be mindful of the environment of the fall as this may result in secondary injuries which should be dealt with appropriately. For example, a patient may fall onto soft furnishings, or fall onto the floor or blunt surfaces and strike their head



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The Taser barbs are likely to be embedded into clothing or skin if they haven’t come detached during the fall. It is principally the police responsibility to remove these barbs. The police retain the Taser, wires and barbs for their own internal processes and investigations

If, however the rare situation arises where nursing staff are expected to remove the barbs details of how to complete this can be found in Appendix 1

Typical injuries from Taser include mild sunburn type burns in the immediate area where the barb attached itself or even between the two barb sites. Anything that looks more mild sunburn should be assessed by a medic. Injuries to skin will vary due to thickness, vascularity, hydration, callosity, and the area of the body to which the electricity is delivered

There is likely to be two small puncture wounds. These should be cleaned and dressed appropriately when the situation allows

Patients may report feeling momentarily dazed, muscle twitches, unsteadiness, temporary tingling in limbs and local aches and pains which may be secondary to the fall

Close monitoring, and physiological observations of a patient throughout the period following application of the Taser must be completed if possible as well as the patient being seen by medical staff. Patients with a cardiac history, pregnant or under the influence of alcohol or drugs must be seen by a medic as soon as possible. Whitehead (2005) suggests seven clinical risk factors that should be referred to A&E: 1. Evidence of excited delirium prior to a Taser being used 2. Persistent abnormal vital signs 3. Cardiac history 4. History or physical findings consistent with amphetamine or hallucinogenic drug

use 5. Altered level of consciousness or aggressive, violent behaviour (due to possible

head injury) 6. Evidence of hypothermia 7. Abnormal, subjective complaints, including chest pain, shortness of breath,

nausea or headache Although Seclusion and Rapid Tranquilisation after the use of Taser is not contraindicated extra precautions should be taken. Consideration should be given to how monitoring will take place in seclusion and what extra monitoring will need to be in place and should be included within the care plan.

6.0 Procedures connected to this Policy There are no standard operating procedures currently connected to this policy.

7.0 Links to Relevant Legislation Police and Criminal Evidence Act 1984 (PACE) This act governs the major part of police powers of investigation including, arrest, detention, interrogation, entry and search of premises, personal search and the taking of samples. Also part of this legislation are the PACE Codes of Practice which police officers should take into consideration and refer to when carrying out various procedures associated with their work. The act attempts to strike a fair balance between the practice of their powers by those in authority and, the rights of members of the public.



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Criminal Justice and Immigration Act (CJIA) 2008 - Sections 119 and 120 The CJIA 2008 introduced new provisions to give staff and police working in the NHS the power to remove and to prosecute individuals causing a nuisance or disturbance on NHS premises. Sections 119 and 120 of the Act created a new offence of causing a nuisance or disturbance on NHS premises and a power for NHS authorised staff to remove a person suspected of committing this offence. The Act only applies to NHS hospitals. Patients or those seeking medical advice, treatment or care cannot commit the offence or be removed under CJIA 2008 powers. 7.1 Links to Relevant National Standards CQC Regulation 12: Safe Care and Treatment The intention of this regulation is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Providers must assess the risks to people's health and safety during any care or treatment and make sure that staff have the qualifications, competence, skills and experience to keep people safe. Providers must make sure that the premises and any equipment used is safe and where applicable, available in sufficient quantities. Medicines must be supplied in sufficient quantities, managed safely and administered appropriately to make sure people are safe. Providers must prevent and control the spread of infection. Where the responsibility for care and treatment is shared, care planning must be timely to maintain people's health, safety and welfare. CQC understands that there may be inherent risks in carrying out care and treatment, and we will not consider it to be unsafe if providers can demonstrate that they have taken all reasonable steps to ensure the health and safety of people using their services and to manage risks that may arise during care and treatment. CQC Regulation 13: Safeguarding Service Users from Abuse and Improper Treatment The intention of this regulation is to safeguard people who use services from suffering any form of abuse or improper treatment while receiving care and treatment. Improper treatment includes discrimination or unlawful restraint, which includes inappropriate deprivation of liberty under the terms of the Mental Capacity Act 2005. To meet the requirements of this regulation, providers must have a zero tolerance approach to abuse, unlawful discrimination and restraint. This includes:

Neglect

Subjecting people to degrading treatment

Unnecessary or disproportionate restraint

Deprivation of liberty

Providers must have robust procedures and processes to prevent people using the service from being abused by staff or other people they may have contact with when using the service, including visitors. Abuse and improper treatment includes care or treatment that is degrading for people and care or treatment that significantly disregards their needs or that involves inappropriate recourse to restraint. For these



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purposes, 'restraint' includes the use or threat of force, and physical, chemical or mechanical methods of restricting liberty to overcome a person's resistance to the treatment in question. Where any form of abuse is suspected, occurs, is discovered, or reported by a third party, the provider must take appropriate action without delay. The action they must take includes investigation and/or referral to the appropriate body. This applies whether the third party reporting an occurrence is internal or external to the provider

7.2 Links to other Key Policies Clinical Risk Management Policy This policy is intended to guide practitioners who work with service users to manage the risk of harm. It sets out the principles and standards required that should underpin best practice across all health settings. Incident Reporting Policy The purpose of this policy is to make clear the system used for reporting incidents involving patients, staff and others undertaking activities on behalf of the Trust. Violence and Aggression Policy The purpose of this policy is to detail the Trust’s strategy and legislative compliance in tackling violence and aggression against patients and staff. Restrictive Physical Interventions Policy The purpose of this policy will be to detail the Trust’s strategy in managing physical and non-physical assaults against NHS staff and others by the use of restrictive physical interventions.



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8.0 Roles and Responsibilities for this Policy

Title Role Key Responsibilities

All Staff Adherence - Familiarise themselves with this policy - Take reasonable care of their own and others safety following an incident - Ensure that patients are given relevant information to help them to adhere to standards of behaviour, which include not

abusing others, either verbally or physically - Identify underlying problems and needs through an assessment resulting with the development of a person centred care

plan - Provide opportunities to enable carers to communicate any concerns to the Key worker/Care co-ordinator and/or Multi-

Disciplinary Team and contribute to patient reviews, such as Care Programme Approach meetings

- Raise concerns from User/Advocacy Groups if systems appear inadequate and support any complaints

Medical Staff Operational - Take immediate action to address the concerns of staff regarding current or potential difficulties in caring for patients

Nurse in Charge Operational - Work closely with the police at these times to disclose and discuss relevant information about the individual who is potentially exposed to CS or Taser

- Report all CS incapacitant/ Taser exposures to Ward Managers, Service Managers and Doctors

Ward Managers Implementation - Ensure systems are in place to ensure a safe service provision - Ensure post incident care and support is afforded to those affected by either CS incapacitant or Taser

Service Managers Monitoring - Ensure statutory Health and Safety requirements are complied with - Monitor and review performance in connection with this policy - Ensure departmental issues are reported to and from the Divisional Managers - Ensure incident reporting is completed

Divisional Directors and Divisional Managers

Oversee - Ensure effective management and organisation of resources to enable effective implementation of this policy - Monitor and review departmental performance in connection with this policy - Report mechanisms on departmental issues to and from the Chief Executive in connection with this policy

Trust Board Strategic - Responsible for the effective implementation of this policy by ensuring the resources and support necessary to adequately implement and maintain the policy are made available

Chief Executive Accountable - Ensure the provision of adequate resources to enable the effective implementation of this policy - Maintain effective reporting mechanisms into the Board in connection with this policy



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9.0 Training

What aspect(s) of this policy will

require staff training?

Which staff groups require this

training?

Is this training covered in the Trust’s Mandatory and Risk

Management Training Needs Analysis document?

If no, how will the training be delivered?

Who will deliver the training?

How often will staff require

training

Who will ensure and monitor that staff have

this training?

n/a n/a n/a n/a n/a n/a n/a

10.0 Equality Impact Assessment

Black Country Partnership NHS Foundation Trust is committed to ensuring that the way we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact Assessment for this policy has been completed and is readily available on the Intranet. If you require this in a different format e.g. larger print, Braille, different languages or audio tape, please contact the Equality & Diversity Team on Ext. 8067 or email [email protected]

11.0 Data Protection and Freedom of Information

This statement reflects legal requirements incorporated within the Data Protection Act and Freedom of Information Act that apply to staff who work within the public sector. All staff have a responsibility to ensure that they do not disclose information about the Trust’s activities in respect of service users in its care to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in certain aspects of your personal life e.g. use of social networking sites etc. The Trust seeks to ensure a high level of transparency in all its business activities but reserves the right not to disclose information where relevant legislation applies.



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12.0 Monitoring this Policy is Working in Practice

What key elements will be monitored?

(measurable policy objectives)

Where described in

policy?

How will they be monitored?

(method + sample size)

Who will undertake this

monitoring?

How Frequently?

Group/Committee that will receive and

review results

Group/Committee to ensure actions

are completed

Evidence this has

happened

Staff compliance with policy guidelines and processes

4.0 Process for CS

Incapacitant Management/

5.0 Process

for Taser Management

CS incapacitant/ Taser exposure: Nursing and

Medical actions recorded in patients notes

Service Managers As required Reducing Restrictive Intervention Group

Reducing Restrictive

Intervention Group

Minutes of meetings/

action plans signed off

Incidents, complaints and

concerns

DATIX monitoring of all

incidents concerning the use of CS incapacitants/

Taser

Governance

Assurance Unit

As required Reducing Restrictive

Intervention Group

Reducing

Restrictive Intervention Group

Minutes of

meetings/ action plans

signed off



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Appendix 1

Removal of Taser barbs

Ordinarily, police officers are trained to remove the barbs that may be embedded into clothing; medical staff must remove barbs that are embedded into skin. However, qualified nursing staff, and any present doctors must liaise with the attending officers to decide how this procedure will be conducted as this may be conditional on the possible aggressive nature of the patient.

Taser barbs to the face, eye, throat, groin or an implant, especially in the female breast area, should be referred to A&E. Most barb injuries can be treated in a similar manner to a simple fishhook injury

Usually the entry site is stunned, leaving it significantly anesthetised

Support (slightly stretch) the skin around the barb. Hold the barb firmly, and not the trailing wires, and then pull straight back in a quick fashion, using the other hand as a brace and counter pressure area on the skin surface. If the barb is resistant to removal with a single, sharp but gentle tug in line with the barb, then leave it in place and refer them to A&E

Clean the area after removal using an aseptic technique and apply a small dry dressing, ensuring that bleeding has stopped

Once the Barbs are removed, they must be examined to ensure that they are complete. Staff must verify with the attending police officers regarding the barb being complete. If the barb is not intact refer to local Accident and Emergency Department

They must be secured as evidence and any injuries or damage noted in the patients notes and on Datix

Barbs removed from the body should be considered as biohazards



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Policy Details

* For more information on the consultation process, implementation plan, equality impact assessment,

or archiving arrangements, please contact Corporate Governance

Review and Amendment History

Version Date Details of Change

1.0 Jan2017 New policy for BCPFT combining previous Taser and Exposure to CS Incapacitant Policy

Title of Policy CS Incapacitant and Taser Policy

Unique Identifier for this policy BCPFT-CB-POL-07

State if policy is New or Revised New

Previous Policy Title where applicable n/a

Policy Category Clinical, HR, H&S, Infection Control etc.

Challenging Behaviour

Executive Director whose portfolio this policy comes under

Executive Director of Nursing

Policy Lead/Author Job titles only

Violence and Aggression Advisor

Committee/Group responsible for the approval of this policy

Reducing Restrictive Intervention Group

Month/year consultation process completed *

November 2016

Month/year policy approved December 2016

Month/year policy ratified and issued January 2017

Next review date January 2020

Implementation Plan completed * Yes

Equality Impact Assessment completed * Yes

Previous version(s) archived * Yes

Disclosure status ‘B’ can be disclosed to patients and the public