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SM-PGN-15

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust SM-PGN-15 – Guidance-Aftercare - Use of Taser and CS Incapacitant Spray (CS)–V02-Iss 2 – Oct 2019 Part of CNTW(O)21 – Security Management Policy

Security Management Policy Practice Guidance Note

Guidance on the aftercare with the use of Taser , CS Incapacitant Spray (CS) and PAVA Incapacitant Spray (PAVA) V02

Date issued

Issue 1 – Mar 2018

Issue 2 – Oct 2019

Planned review

Mar 2021

SM-PGN-15 Part of CNTW(O)21 – Security Management Policy

Author/Designation Claire Andre – Clinical Police Liaison Lead, CNTW Safer Care Group Michael Fairs – Ward Manager (Walkergate Park)

Responsible Officer/ Designation

Tony Gray – Head of Safety, Security and Resilience

Contents

Section Description Page No

1 Introduction 1

2 Purpose 1

3 Use of Taser / CS Incapacitant Spray (CS) on Cumbria Northumberland, Tyne and Wear NHS Foundation Trust premises?

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4 What is a Taser and Taser x2? 2

5 What are the normal effects of Taser? 2

6 Taser Probe Penetration 3

7 Medical staff and Nursing Responsibilities 5

8 What is CS? 7

9 What are the effects of CS? 7

10 Medical implications following the use of CS 9

11 Medical and Nursing Staff Responsibilities 9

12 What is PAVA (Referred to as Captor 2)? 10

13 What are the effects of Captor 2? 10

14 Medical Implications following use of Captor 2? 11

15 Medical and Nursing Responsibilities 11

16 Documentation and Reporting 12

17 Post incident de-brief/review 13

18 Associated documentation 13

SM-PGN-15

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust SM-PGN-15 – Guidance-Aftercare - Use of Taser and CS Incapacitant Spray (CS)–V02-Iss 2 – Oct 2019 Part of CNTW(O)21 – Security Management Policy

Appendices attached to this PGN

Document No:

Description

Appendix 1 Taser/ CS/Captor2 – Monitoring Chart

Appendix 2 Aftercare of Taser – Northumbria Police information

Appendix 3 Aftercare of CS – Northumbria Police information

Appendix 4 British Transport Police Guidance on PAVA (Captor 2)

SM-PGN-15

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust SM-PGN-15 – Guidance - Aftercare - Use of Taser and CS Incapacitant Spray (CS)– V02-Iss 2 – Oct 19 Part of CNTW(O)21 – Security Management Policy

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1 Introduction

1.1 This practice note details guidance in the event of post deployed of a ‘Taser’ device or CS within Cumbria Northumberland, Tyne and Wear Foundation NHS Trust (the Trust/CNTW).

1.2 This guidance has been established through liaising with Northumbria Police and British Transport Police and following their guidance and input. The language used within this is Police Language to ensure staff can be clear what is being discussed. This is Practice Guidance, and follows Police National Guidance on CS, Taser and PAVA (Captor2).

2 Purpose

2.1 The information within this practice guidance note is intended to assist professionals in the aftercare of individuals who have been exposed to CS Incapacitant Spray (known throughout this document as CS), PAVA Incapacitant Spray (known throughout this document at Captor2) or have had a Taser device issued against them.

2.2. The use of Taser/CS may be prior to a person being under the care of the Trust (a person may have been admitted to the ward/136 suite after use of the equipment) or whilst the person is an in-patient in our Trust. Under both circumstance the trust has a duty of care to the individual and must ensure they receive the appropriate aftercare.

2.3 Northumbria Police are now transitioning to use Taser x2 as the newer type of

Taser. This will be explained further in point 4. Taser will be used throughout this document to reference the device however for ease and understanding.

2.4 Captor2 would only be have been used on a person prior to being brought to

the 136 Suite or on rarer occasions used in the S136 suite. This is only used by British Transport Police (BTP) in our region. Durham Police also use this but it is rare that they will be within our trust areas. The same advice would be followed if there were those rare occasions.

3 Use of Taser/CS on Trust premises

3.1 The use of Taser/CS on in-patient units would only be used by the necessary Police force, in extreme circumstances. In this situation, it would where possible be following discussion with the mental health professionals involved in the patient’s care.

3.2. It is recognised however that once the Police are requested to attend CNTW premises and to safely manage an incident, it is the decision of the Police to how this will be conducted and this may include the use of Taser or CS. They will be supported throughout their attendance by CNTW staff members who know the patient. The Associate Director and Medical Staff responsible for the person’s care should also be informed immediately.

3.3 In all situations, the Trust expects that, wherever possible, staff will work closely with the Police to ensure they have the most up to date information regarding the person’s health and risk management, thus enabling any

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situation to be brought to an end with the least force necessary. This will include where a risk is predictable that a care plan is in place for use of Taser/CS, including any physical health conditions and how they should be managed if Taser or CS is required.

4 What is a Taser? 4.1 A Taser is a hand-held device that carries a single cartridge which 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.

Taser x2 differs only in that its caries two cartridges, instead of one. Meaning that there is an immediate back up should the first set of probes not make contact or fail in some way. With this model if both cartridge are fired, as long as an upper and lower cartridge from either cartridge are intact a cross connect will occur and it will be a successful discharge.

4.2 It works as a sequence of very short duration, high voltage electrical current pulses pass through wires delivering an electrical charge. 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.

Taser is described by National Police Guidance as a ‘less lethal option’ in the options available to Police in high risk situations. The decision to use a Taser will always be for the police service following a risk assessment. Taser is classed as deployed should it be drawn from holster, red dot pointed at individual (red dotted), or if fired/arced. When red dotted and fired/arced this requires an automatic police review. When drawn from holster this is dependable upon circumstances.

5 What are the normal effects of Taser? 5.1 During or shortly after the use of the Taser, individuals may experience the following:

Feeling dazed for several minutes

Muscle twitches

Unsteadiness, and a spinning sensation

Temporary tingling

Weakness in the limbs

Local aches and pains, and tissue swelling

‘Bee like’ sting pain 5. 2. These sensations are normal effects of the Taser, but if any of these are still

present after the Taser charge has ended, appropriate medical advice must be sought.

5. 3. Close monitoring of the individual throughout the period following application of the Taser is of the utmost importance.

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5. 4. Therefore the attendance of appropriate medical personnel (e.g. paramedics) should be routinely requested at the earliest opportunity.

6 Taser Probes Penetrating the Skin

6.1 Taser probes are 8mm in length and have a 1mm high barb about 3mm from the tip. They are not “fish-hooked” in shape. They are attached to wire that is approximately 25 foot/7.6 metre in length. They are designed to stick in the skin or in the clothing and not dislodge. The depth is not deep enough to threaten internal organs.

6.2 There will be two small puncture wounds from the short needles used to direct the electricity directly into the skin. There may be small burns similar to sunburn around the marks. These should return to normal in a few days. If they do not and there is pain and swelling, there may be a local infection. If this is the case ensure the person seeks appropriate medical attention.

6.3 If the probes only stick in clothing, there still may be two small areas of skin underneath that look sunburned, as described by the guidance.

6.3.1 Medical Implications following the use of Taser

Skin is the primary resistor to flow of the electrical current delivered into the human body via the Taser. Skin resistance and effects of Taser vary widely depending on any individual

Taser is used by the Police only after a risk assessment is undertaken considering all information the officers have available to them at that time. They will usually have authority from senior officers for the Taser to be brought to a scene and then based on all information they have available to them, the risks in the on going situation and the other options available a decision would be made

There are certain situations where a Taser use would require further consideration of all options by police and the potential implications. As well as other factors that can be put in place to minimise risk associated:

o If a person was high up and the fall would cause

significant injury (e.g. on a roof)

o Used with CS ( due to this being flammable)

o When someone is known to have covered themselves in flammable liquids (e.g. petrol)

6.3.2 Other possible medical affects of Taser:

Burns

o There is the possibility of minor burns in association with Taser probe strikes. These have likely to be superficial and unlikely to result in permanent scarring. Anything that looks worse than mild

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sunburn should be considered abnormal and seen by a doctor / Emergency Department

6.4 Indirect Injury

6.4.1 In most cases, the application of a Taser will be sufficient to render an individual incapable of continuing an attack and is likely to result in the individual collapsing to the ground, often in a rigid ‘plywood’ like state. The effect is not intended, nor is likely, to render the individual into a state of unconsciousness. The recovery from the effects of the Taser should be almost instantaneous once the current has been turned off.

6.4.2 The individual may be at risk of serious head injury from an uncontrolled

collapse although it is more likely individuals collapse in a semi controlled manner.

6.5 Pregnancy

6.5.1 Although there is no conclusive link with Taser and miscarriage, caution must be exercised in pregnant individuals. If a patient is pregnant, this information must be given to the Police on arrival a priority and they must be seen by a doctor (or Emergency Department) immediately after when safe to do so.

6.6 Other Medical Conditions 6.6.1 We must ensure that any information regarding a person’s physical health is

given to the Police at the earliest opportunity to assist in the risk assessment – e.g. epilepsy or heart conditions. The officers will be the most up to date with any contraindication and Taser use.

6.7 Language/Communication Difficulties

6.7.1 Police officer attending must be given any vital information that may affect the person’s ability to interact with them during situations of negotiation. This may include communication difficulties (e.g. blindness or deafness). It may also include difficulties in communication and language with someone with autism or a learning disability, considering if someone is nonverbal. Also ensuring that if the person does not speak good English police are aware translators may be required or this may affect the management of an unpredictable situation.

6.8 Pacemakers 6.8.1 The evidence for the damage or disturbance to implanted electrical

equipment such as pacemakers is limited and equivocal – be aware of the potential risk of damage to the device.

6.8.2 A doctor/paramedic must immediately review the patient if it is indicated or

known that the person has a pacemaker. A full medical review is required, including an ECG and all vital signs monitoring. Staff must ensure the Police are aware if a person is known to have a pacemaker.

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6.8.3 A full medical review should be undertaken at the soonest opportunity after use of Taser with anyone, looking at the physical health condition of the person and any injury to the body from the Taser probe. Compliance will be required from the patient to undertake this. If this is not possible it must be documented within the notes and revisited at the soonest opportunity until completed.

6.9 Emergency situation 6.9.1 If the following are present the person must be taken to the Emergency

Department urgently:

Persistent abnormal vital signs

Altered level of consciousness

Evidence of hypothermia

Abnormal, subjective complaints, including chest pain, shortness of breath, nausea or prolonged or severe headache

This would be dealt with like any other medical emergency and an ambulance contacted. Who would accompany the person to hospital would depend upon situation and risk. Where the person is an in-patient nursing staff would be expected to support the person during the course of this. The level of support would depend upon the risk assessment and clinical team decision.

6.9.2 If there is a history of cardiac problems, the patient should be placed on eyesight observation (as per Trust policy CNTW(C) 19 - Observation). With a staff member trained in Immediate Life support (ILS). This will assist in identifying any early signs of further cardiac symptoms which may require referral to the Emergency Department 7 Medical and Nursing Staff Responsibilities 7. 1. Probes that have penetrated the skin may be contaminated with blood or other

bodily fluids. Suitable regimes should be in place to deal with the biohazard this presents including suitable personal protective equipment (PPE). Probes which have penetrated the skin should normally be removed by a medical professional either at the scene, at a hospital or in the custody suite. This is principally because of the:

o requirement for infection control o potential for additional trauma to the skin and superficial tissues of the

subject o risk of additional trauma to underlying tissues, organs or body cavities

from probes that have penetrated deeply o risk of self-injury.

In the best interest and wellbeing of the subject or in the event of operational necessity, police officers trained in probe removal, minimum standards of forensic recovery and the associated risks may carry out this procedure.

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7.2 Probes in particularly vulnerable areas (e.g., the eyes, head, neck or genitalia) should always be removed by medical professionals only, ideally in an Emergency Department. If the officer considers there to be any additional risks associated with the removal of a probe, the matter should be referred to a medical professional. In these circumstances, the Police would be required to attend for security purposes and also to retrieve the Taser probe. If the person is under the care of CNTW staff will also support.

7.3 If probes are removed by a Police Officer or Paramedic, they must be examined to ensure that they are complete. If the probes are not intact consider referral to the Emergency Department. If successfully removed by an appropriate person, the area must be cleaned and a small dry dressing applied until any bleeding has stopped.

7.4 The injuries noted should be recorded in the individual’s healthcare record and CNTW online incident report by the Nurse in Charge and attending Doctor.

7.5 The removed probes must be handed over and exhibited by a Police Officer as the component parts of the Taser cartridge, including the wires and probes will be retained by the Police. A Police internal investigation occurs after every Taser use.

7.6 It is the nurse’s responsibility to ensure close monitoring of the individual throughout the period following application of the Taser. This is of the utmost importance. All patients should be placed upon eyesight observations for at least 24 hours afterwards to ensure vigorous monitoring and the person reviewed by a doctor after the 24 hours and a decision made on any further required monitoring.

7.7 All patients will have the vital signs (pulse, respirations, oxygen saturation levels and blood pressure) monitored for at least every ten minutes for the first hour and every 30 minutes until they are fully conscious and mobile. It may be more frequent depending upon clinical presentation. Complete Appendix 1 - Taser/ CS/Captor2 – Monitoring Chart, as a record of this. Thereafter, a decision will be made by the assessing doctor and nurse on the appropriate interval of physical observations. These will be documented within the patient’s notes on each occasion and a care plan will be in place.

7.8 Taser probes to the face, eye, throat, groin or an implant, especially in the

female breast area, should be referred to the Emergency Department. 7.9 If the patients are taken from the ward and under the care of the Police, then

the aftercare responsibility will pass to the Police. The patients care team will remain in contact with the Police Station for updates and providing any necessary information required.

7.10 Once the patient is returned to the ward from Police Custody. The doctor/

nursing responsibilities will resume. The patient will be assessed on arrival by the doctor and assessed regarding if any physical observation monitoring is required. As the affects of Taser are short lived, but the monitoring will depend upon any known physical health condition, and presenting problems.

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7.11 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:

The patient will monitored on ‘within eyesight’ observations by a staff member whom is at the least trained in observation policy and Immediate Life Support (ILS)

Consideration given on how physical health is going to be monitored and as detailed above

If the patient is not conscious and staff are unable to assess physical health appropriately through engagement and visual checks, seclusion should be terminated immediately

8 What is CS? 8.1 It is an irritant dispensed from a hand-held aerosol canister in a liquid stream

that contains 5% solution of CS (2- chlorobenzylidene malonontrile) in a solvent Methyl Isobutyl Ketone (MIBK). The propellant is often Nitrogen but can be other chemicals which are often flammable. It is described in layman’s terms as crystals in a propellant that will be attracted to warm areas of the body (eyes, mouth, nose, underarms, groin etc)

8.2 It is used to minimise the person’s capacity for resistance without

unnecessarily prolonging their discomfort. It affects people in different ways and is only used after a risk assessment is undertaken by the Police Officer.

9 What are the effects of CS? 9.1 CS crystals irritate the eyes (hence ‘tear gas’ is a term often used) and the

respiratory tract; symptoms normally settle spontaneously within 15 minutes. The symptoms will persist until the crystals are removed from the person and the person should be treated as contaminated until done so.

Staff members should take precautions to ensure they are not contaminated by either the person or by handling their clothing or objects contaminated. If staff members are contaminated they should follow the same guidance in this procedure.

9.2 Once the patient has been restrained and the risk minimised they should be

given full reassurance that the affects will wear off, this will lessen the risk of hyperventilation. They should be removed to an uncontaminated area where they can be exposed to fresh air and encouraged to open their eyes. As the tears will assist in the removal of the spray from their eyes. They should not rub their eyes as this increase the affects of the spray. Exposure to fresh air should result normally in a significant recovery in 15-20 minutes.

9.3 Other guidance that should be followed is:

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The exposed skin/eyes washed with cold running water. Do not splash face with water in a sink

The head should be tilted and cold water should be run from the corner of each eye off the face until the affects have ceased

Clothes should be removed and put in a bag (staff should use gloves when dealing with a contaminated person) after removal of contaminated clothing the person should shower

Contact lenses should be removed and rigid ones washed (soft ones should be discarded)

A room used by the person whilst contaminated will need to be specially cleaned to ensure no crystals are still in the area before being used again. Ensure the domestic supervisor is aware of the contaminated area and the need to cleaning, with the following advice.

Prevent others from coming into the area where CS has been used for about 45 minutes.

If a room in Trust premises is contaminated, the doors and windows should be left open to allow air to blow through. A well ventilated room should clear of CS in 45 minutes

If this is not possible, all surfaces within the contaminated area should be washed down using hot soapy water or a detergent and then thoroughly rinsed to remove any CS residue. The cloth should be disposed of when the wash down is complete. It is safe for the dirty water to be disposed of down the drains

The person carrying out the cleaning should be advised of the risks by the person in charge

The person carrying out the cleaning should wear Personal Protective Equipment (PPE) such as rubber gloves, tight fitting glasses (safety goggles) and a face mask. Once the cleanse is complete, these items should be disposed of in a labelled sealed bag. An overall should also be worn which should be washed immediately after use or put in a labelled sealed plastic/polythene bag until this can be carried out

See advice for general cleaning below, and speak to the domestic supervisor

Under no circumstances should warm water be used as this is known to increase the effects of the CS

9.4 Where CS is used with persons suffering from mental disorder/illness the

Police will seek advice from a mental health professional prior to its use where

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possible. However the final decision to use the CS will rest with the Police officer.

10 Medical implications following the use of CS? 10.1 Close monitoring during the recovery period is essential. The expected

recovery period for breathing is around 5 minutes. If a patient has difficulty breathing than a doctor/ paramedic must be sought immediately.

10.2 If Prevention of Management of Violence and Aggression (PMVA) physical

techniques have been utilised by either the Police or staff then the risk of breathing difficulties may be higher and rigorous monitoring must take place. Affects of excited delirium and positional asphyxia should be considered. Staff should attach a pulse oximeter to the person if able to do so and must ensure someone is monitoring the patient at all times.

10.3 If an individual suffers redness or blistering to the skin they must be seen by a

doctor/medical personnel urgently. The blisters are very distinctive and obvious to all.

11 Medical and Nursing Staff Responsibilities 11.1 A full medical review should be undertaken at the earliest opportunity looking

at the physical health condition of the person and any injury to the face/eyes from the CS. Compliance will be required from the patient to undertake this. If this is not possible it must be documented with the notes and revisited at the soonest opportunity until completed.

11.2 Close monitoring of the individual throughout the period following of use of CS is of the utmost importance. All patients should be placed upon eyesight observations (and segregated from other patients until crystals have been removed from the person and clothing) for at least 24 hours afterwards. This will then ensure vigorous monitoring. Following this the patient will be reviewed by a doctor and a decision made on any further monitoring.

11.3 All patients will have their vital signs (pulse, respirations, oxygen saturation levels, and blood pressure) monitored at least every 10 minutes for the first hour and every 30 minutes until they are fully conscious and mobile. This may be more frequent depending upon the clinical presentation. Appendix 1 - Taser/CS/Captor2 – Monitoring Chart will be completed. Thereafter a decision will be made by the assessing doctor and nurse on the appropriate interval of physical observations. These will be documented within the patient’s notes on each occasion by the doctor and a care plan will be in place. The patient must have their physical observations taken.

11.4 If the patients are taken from the ward and under the care of the Police, then the aftercare responsibility will pass to the Police. The patients team will remain in contact with the Police station for updates and providing any necessary information required.

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11.5 Once the patient is returned to the ward from the Police custody. The doctor/ nursing responsibilities will resume. The patient will be assessed on arrival by the doctor and assessed regarding if any physical observation monitoring is required. As the affects of CS are short lived, but the monitoring will depend upon any known physical health condition, and presenting problems.

11.6 Although Seclusion and Rapid Tranquilisation after the use of CS is not

contraindicated extra precautions should be taken. Consideration should be given to how monitoring will take place in seclusion and what extra monitoring may need to be in place and should be included with the care plan:

The patient will monitored on ‘within eyesight’ observations by a staff member whom is at the least trained in observation policy and ILS


If the patient is unconscious/asleep and staff are unable to assess physical health appropriately through engagement and visual checks, seclusion should be terminated immediately

12 What Is Captor2?

12.1 Pelargonic Acid Vanillylamide (PAVA/Nonivamide) - CAS No 244 - 46 – 4 at a concentration of 0.3% in a 50 / 50 solvent of Ethanol and Water with a Nitrogen propellant.

12.2 PAVA is referred to be British Transport Police (BTP) as Captor2, and hence

that is how it is referred to throughout this document. It’s different in its component parts from CS. It discharges as a liquid stream directly at person, hence only affecting the person it is aimed at. As opposed to CS which effects everyone in the vicinity.

12.3 It is also, unlike CS, non-flammable. Captor2 was chosen as the best

alternative by BTP due to the presence of high voltage electrical equipment in the areas they work.

13. What are the effects of Captor2? 13.1 Once discharged at the person, this will cause discomfort to the eyes and a

burning sensation to the skin. If any has been swallowed, patients should not experience any internal discomfort at all although their mouth will feel as though they have eaten very spicy food such as curry.

13.2 Most symptoms will subside of their own accord within 30 to 45 minutes of

being exposed. It may cause skin to go red and feel hot and remain so for up to 1 hour, when normal colour will start to return. This is normal as Captor2 stimulates blood circulation giving similar effects to the use of muscle pain relief cream.

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13.3 If the symptoms continue, then washing / bathing the face and eyes in cool, clean running water should bring rapid relief. If Captor2 has got into the eyebrows, hair or beard it is possible that it could re-activate the first time that it comes into contact with water. For example; taking a shower the next day.

13.4 The effect will not be as strong and can be avoided by keeping the eyes tightly

closed and washing and rinsing the area thoroughly. If symptoms persist patients should be seen by medical staff.

13.5 Captor2 may cause damage to certain types of contact lens. If patients

report having problems with your lenses, they should consult an optician. 13.6 Clothing - Clothing that has been sprayed with Captor2 should be

washed separate to other clothing. Clothing can be cleaned in the conventional way using normal washing powder or liquid.

13.7 Captor2 is a 50 \ 50 mixture of Ethanol and Water. There should be no

other reactions to the skin as a result of this solvent. If patients are concerned for any reason they should be seen by a doctor.

14 Medical Implications following the use of Captor2? 14.1 Captor2 has been well researched from a toxicological standpoint and

whilst there are short-term effects detailed below, there is no evidence of harmful long-term effects.

14.2 The only medical implication that has been identified is that when used within

a short range of 3ft or less there is a very small risk of retinal damage. It is a small risk and BTP were not aware of any reported cases.

15 Medical and Nursing Responsibilities 15.1 A full medical review should be undertaken at the earliest opportunity looking

at the physical health condition of the person and any injury to the face/eyes from the Captor2. Compliance will be required from the patient to undertake this. If this is not possible it must be documented with the notes and revisited at the soonest opportunity until completed.

15.2 Close monitoring of the individual throughout the period following of use of

Captor2 is of the utmost importance. As the risks are low in relation to this compared to CS, then the monitoring of a person will be decided by the clinical team following an assessment by a doctor. This will depend upon any underlying health problems, and clinical presentation.

15.3 Appendix 1 - Taser/CS/Captor2 – Monitoring Chart will be completed. Once a

decision is made by the assessing doctor and nurse on the appropriate interval of physical observations, this will be documented within the patient’s notes. The nurse in charge will ensure a care plan will be in place.

15.4 If the patients are taken from the ward and under the care of the Police

service, then the aftercare responsibility will pass to the Police. The patients

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care team will remain in contact with the Police station for updates and providing any necessary information required.

15.5 Once the patient is returned to the ward from the Police custody, the doctor/

nursing responsibilities will resume. The patient will be assessed on arrival by the doctor and assessed regarding if any physical observation monitoring is required. As the effects of Captor2 are short lived, but the monitoring will depend upon any known physical health condition, and presenting problems.

15.6 Although Seclusion and Rapid Tranquilisation after the use of Captor2 is not

contraindicated extra precautions should be taken. Consideration should be given to how monitoring will take place in seclusion and what extra monitoring may need to be in place and should be included with the care plan:

The patient will monitored on ‘within eyesight’ observations by a staff member whom is at the least trained in observation policy and ILS


If the patient is unconscious/asleep and staff are unable to assess physical health appropriately through engagement and visual checks, seclusion should be terminated immediately

15.7 Captor2 poses very little in the way of contamination problems. The basic

principles of decontamination are as follows:

It is possible that Captor2 residue may remain on a surface or article for a period of time unless decontamination takes place. However, Captor2 is the synthetic equivalent of the active ingredient in chilli pepper extract and it degrades naturally within a relatively short space of time. The ethanol in which Captor2 is dissolved evaporates quickly without leaving a trace

A well ventilated room will normally clear of air borne Captor2 spray droplets within 30 minutes. To enhance decontamination, windows and doors should be left open during this period

Contaminated surfaces should be washed with warm soapy water. There is absolutely no risk to the skin if residue gets on the hands. If this happens avoid touching your face until you have washed your hands with soapy water. Captor2 is a compound found in hot chilli peppers and will cause sensitive skin areas to feel hot

16 Documentation and Reporting

16.1 A care plan of aftercare should be established collaboratively with the doctor, nursing staff and following any advice from the trained staff in the Police force. This will incorporate, any medical condition, special monitoring and if external monitoring has taking place – via Police or Emergency.

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16.2 Any use of CS, Captor2 or Taser on an in-patient unit/136 suite will be reported using the Trust incident reporting system, with consideration by the clinical service of it being classified as a serious incident (SI), based on the impact on the patient.

16.3 The Responsible Clinician (RC), Ward Manager (or POC) should be made aware at the soonest opportunity of the situation and if possible attend the ward/area. They should be kept up to date with any development and plan of aftercare.

16.4 Any potential use of the CS, Captor2 or Taser should be reported to the Clinical Manager, and Associate Director, (or on call equivalents) with outcome specified and plan for aftercare discussed.

16.5 All information prior to, during and after the incident, (including aftercare arrangements) should be carefully documented with the patients notes, including any injures or ill affects suffered. Risk assessment, care plans and physical health assessments should be updated with any new information. 17 Post incident de-brief/review 17.1 Appropriate support should be offered to the individual after the incident.

17.2 Depending on the circumstances of the incident, the individual may be removed in to Police custody.

17.3 Support in the form a de-brief should occur immediately following the events to enable staff to discuss these and air views and emotions. An after action reviews (AAR) would also take place within 72 hours of the incident (as per Trust policy CNTW(O)05 Incidents (including the management of serious incidents).

17.4 Police will automatically review Taser use incidents with scrutiny – CNTW staff may be asked to participate in this.

18 Associated documentation 18.1 Please read this PGN in conjunction with the following Trust Policy documents:

CNTW(C)01 Resuscitation Policy

CNTW(C)02 Rapid Tranquilisation Policy

CNTW(C)10 Seclusion Policy

CNTW(C)16 Prevention and Management of Violence and Aggression Policy

CNTW(C)19 Observation Policy

CNTW(O)05 Incident Policy (including serious incidents)

Northumbria Police Guidance leaflets for CS and Taser

British Transport Police Guidance on PAVA (Captor2)

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Appendix 1

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust Appendix 1 – Monitoring Chart - V02-Iss – XX18 Part of SM-PGN-15 – Tasers - (CNTW(O)21 – Security Management Policy)

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Taser/ CS/PAVA(Captor2) - Monitoring Chart

Please follow the following guidance as detailed in the Practice guidance Note:

Patient must be monitored every 10 minutes for first hour

Every 30 minutes until awake and fully mobile and conscious

Or as detailed by doctor/ MDT upon assessment

Patients Name

Date of Birth:

RIO Number:

Date/ Time:

Details of Taser/ CS/PAVA (Captor2) use:

Time BP Pulse Temp Resp rate

O2 Sats Comments /Signature

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Appendix 2

15 Cumbria Northumberland, Tyne and Wear NHS Foundation Trust Appendix 2 – Northumbria Policy – Operational Use of Taser – V02- Iss1-Mar18 Part of SM-PGN-15 – Tasers – (CNTW(O)21 – Security Management Policy)

NORTHUMBRIA POLICE

Operational Use of Taser

Information leaflet for persons upon whom a Taser has been used

You have been subjected to the effects of a Taser. The Taser passed short pulses of electricity into your body. The electricity made your muscles contract. You may have lost balance and fallen to the ground. The device was used by a specially trained police officer. During, or shortly after the use of the Taser, you may have experienced the following:

Being dazed for several minutes;

Muscle twitches;

Loss of memory of the event;

Unsteadiness, and a spinning sensation;

Temporary tingling;

Weakness in the limbs;

Local aches and pains, and tissue swelling.

These sensations are normal effects of the Taser.

If any of these effects are still present a day later, see a doctor

You may have two small marks (like bee stings) in your skin. These are small puncture wounds from the short needles used to inject the electricity directly into your skin

There may be small burns similar to sunburn around these marks. These should return to normal in a few days. If they do not and there is pain and swelling, you may have a local infection – see a doctor

If the probes only stuck in your clothing, you may still have two small areas of skin underneath that look sunburned

SM-PGN-15

Appendix 3

16 Cumbria Northumberland, Tyne and Wear NHS Foundation Trust Appendix 3 – Northumbria Policy – Operational Use of Taser – V02- Iss1-Mar18 Part of SM-PGN-15 – Tasers – (CNTW(O)21 – Security Management Policy

NORTHUMBRIA POLICE

Information Sheet for Persons Sprayed with CS Incapacitant

You have been sprayed with a 5% concentration of CS in the solvent

Methyl Iso Butyl Ketone (MIBK) with a nitrogen propellant. This may have the following effects: CS This will cause discomfor t to the eyes and a burning sensation on the skin.

You may also have difficulty in breathing and tightness of the chest

accompanied but coughing. Exposure to fresh air will normally result in recovery from most

symptoms within 15 minutes. If symptoms persist you should

consult your doctor. Take this sheet with you. CS may cause damage to cer tain types of contact lens. If you have problems with

your lenses, you should consult an optician. Take this sheet with you. MIBK This may cause your skin to go red after 6-8 hours and you may have flaking

or blistering of the skin which could continue for up to a week. If this happens

you should consult your doctor. Take this sheet with you. If you experience skin reddening, you may wish to avoid shaving and the

use of after-shave which would aggravate the condition. CONTAMINATED CLOTHING Any contaminated items of clothing (including watches and other items of

jewellery) should be washed thoroughly with detergent and water prior to

being re-used. CANISTER RETENTION The CS canister with which you have been sprayed will be retained by Nor thumbria

Police for a period of 28 days. The device will be disposed of the following this

period unless we are notified in writing by you or your legal representative that is

required as evidence. The reason for the requested retention must be specified. Requests for canister retention must be addressed to The Chief Inspector (Operations

Manager) at the Area Command in which you were detained quoting the Custody

Record Number indicated below: Custody Record Number:

CS 6

SM-PGN-15

Appendix 4


Information Sheet for Persons Sprayed

You have been sprayed with: Pelargonic Acid Vanillylamide (PAVA/Nonivamide) - CAS No 244 - 46 - 4 at a concentration of 0.3% in a 50 / 50 solvent of Ethanol and Water with a

Nitrogen propellant

This may have the following effects:

This will cause discomfort to the eyes and a burning sensation to the skin. If you have swallowed any you should not experience any internal discomfort at all although your mouth will feel as though you have eaten very spicy food such as curry

Most symptoms will subside of their own accord within 30 to 45 minutes of being exposed. It may cause your skin to go red and feel hot and remain so for up to 1 hour, when normal colour will start to return. This is normal as PAVA stimulates blood circulation giving similar effects to the use of muscle pain relief cream

If the symptoms continue, then washing / bathing the face and eyes in cool, clean running water should bring rapid relief. If PAVA has got into the eyebrows, hair or beard it is possible that it could re-activate the first time that it comes into contact with water. For example; taking a shower the next day. The effect will not be as strong and can be avoided by keeping the eyes tightly closed and washing and rinsing the area thoroughly

If symptoms persist you should consult your doctor. Take this sheet with you

PAVA may cause damage to certain types of contact lens. If you have problems with your lenses, you should consult an optician. Take this sheet with you Clothing - Clothing that has been sprayed with PAVA should be washed separate to other clothing. Clothing can be cleaned in the conventional way using normal washing powder or liquid. Ethanol and Water mix: This is a 50 \ 50 mixture. There should be no other reactions to your skin as a result of this solvent. If you are concerned for any reason you should consult your doctor.

SM-PGN-15

Appendix 4


Take this sheet with you.

Information Sheet for Owners/Occupiers of premises where PAVA Incapacitant Spray has been used

PAVA incapacitant spray with a 0.3% concentration of PAVA in a solvent

mix of 50% Ethanol and 50% Water has been used within these premises.

Advice on de-contamination of affected areas:

PAVA Incapacitant poses very little in the way of contamination problems. The basic principles of decontamination are as follows:

It is possible that PAVA residue may remain on a surface or article for a period of time unless decontamination takes place. However, PAVA is the synthetic equivalent of the active ingredient in chilli pepper extract and it degrades naturally within a relatively short space of time. The ethanol in which PAVA is dissolved evaporates quickly without leaving a trace

A well ventilated room will normally clear of air borne PAVA spray droplets within 30 minutes. To enhance decontamination, windows and doors should be left open during this period

Contaminated surfaces should be washed with warm soapy water. There is absolutely no risk to the skin if residue gets on the hands. If this happens avoid touching your face until you have washed your hands with soapy water. PAVA is a compound found in hot chilli peppers and will cause sensitive skin areas to feel hot

Clothing that has been sprayed with PAVA should be washed separate to other clothing. PAVA is washed out through normal methods of cleaning

In shop premises, if it is suspected that any product or other article has been contaminated, it is advised that the product be removed from display and shop policy referred to

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