Operational partnerships - Acute behavioural disturbance SOP (O43k)

1. Summary of changes

1.1. This standard operating procedure has been reviewed in June 2021 – no amendments to content have been made.

2. What this procedure is about

2.1. The purpose of this procedure is to ensure that officers and staff recognise the heightened risks associated to acute behavioural disturbance (ABD) formerly referred to as acute behavioural disorder during and post restraint, including the immediate emergency actions that need to be taken. Officers and staff are requested to ensure they familiarise themselves with symptoms and summary of guidelines for restraint and the management of this condition.

2.2. Acute behavioural disorder (ABD) is to be treated as a medical emergency. ABD is a rare form of severe mania, sometimes considered as part of the spectrum of manic-depressive psychosis and chronic schizophrenia. Persons suffering from ABD are highly vulnerable to sudden death from cardiac arrest, during or shortly after a strenuous struggle.

Compliance with this SOP and any governing policy is mandatory.

3. Detail the procedure

3.1. Many of the signs indicating ABD are common to anyone behaving violently. Therefore, it is important for officers and staff to recognise the difference between acute behavioural disturbance and a violent outburst. Attention should be paid to:

• extremely aggressive/violent behaviour
• excessive strength/continued struggle despite restraint
• insensitive to pain - including the effects of PAVA or Taser
• acute psychosis with fear of impending doom
• constant physical activity without fatigue
• hot to touch/profusely sweating/inappropriate state of undress
• hyperthermia
• tachypnoea (abnormally rapid breathing)
• tachycardia (abnormally rapid heart rate)

3.2. Personal struggle, whether handcuffed or not, may lead to the point of exhaustion and the heightened potential of sudden death from cardiac arrest or positional asphyxia (see O43j). This may occur, for example, at the scene of an arrest, in a police vehicle or in a cell. This condition is a medical emergency and the subject needs to be taken to hospital rather than to a police custody suite.

3.4. Officers and staff must consider the following actions:

• suspected ABD is a medical emergency until proved otherwise
• restraint and restrictive interventions need to be seen as a last resort, although they may be unavoidable
• consideration must, if possible, be given to alternative options to restraining a person who is suspected to be suffering from ABD whilst still affording an appropriate measure of protection for the subject, officers and staff present and the public
• there is no minimum safe period of restraint
• it is necessary to take urgent action to end restraint as soon as possible
• the person should, if safe to do so, be permitted comparative freedom of movement within a given area, in what would be regarded a ‘contained’ situation
• monitoring the person’s condition continually whilst being restrained, as death can occur suddenly and develop beyond the point of viable resuscitation within seconds rather than minutes
• whenever possible during team restraint, a ‘safety officer’ is to be identified with the responsibility to monitor the health and welfare of the person during restraint.

3.5. Officers and staff must recognise the heightened risk factors:

• a person is intoxicated with alcohol or drugs
• a person is substantially overweight
• a person is suffering respiratory muscle fatigue (exhaustion)

3.6. Officers and staff must take the following immediate emergency actions in the event that a sufferer of suspected ABD loses consciousness.

• emergency departments have a role to play and so does the ambulance service as rapid treatment with benzodiazepines, antipsychotics or ketamine may be required
• remove all methods of restraint
• place the person in a position that does not impede their breathing
• if consciousness is lost, check airway and breathing
• commence CPR if necessary
• notify a supervisory officer if one is not present. Supervisory officers notified of such incidents must attend the scene immediately
• a full record of the perceived signs of the condition and police response must be made in pocket notebooks or the custody record, as appropriate

4. Equality Impact Assessment (EIA)

4.1. An EIA has been carried out and shows the proposals in this procedure would have no potential or actual differential impact on grounds of race, ethnicity, nationality, gender, transgender, disability, age, religion or belief or sexual orientation.

5. Risk assessment

5.1. This SOP has been assessed as high risk.

6. Consultation

• Staff Safety Training Unit
• Professional Standards
• Human Resources
• IT Security
• Estates
• Finance
• Equality and Diversity
• Health and Safety
• Legal
• Freedom of Information
• Police Federation

7. Monitoring and review

7.1. The SOP will be monitored by the Staff Safety Training Unit. The SOP will be reviewed to ensure compliance with the most recent College of Policing published information and IPCC ‘learning the lessons’ bulletins. Due to the high risk nature of the topic, this SOP will be reviewed every year with the next review scheduled for June 2022.

8. Other source documents

None listed.

9. Security

9.1. Kent Police have measures in place to protect the security of your data in accordance with our Information Management policy.

10. Retention and disposal of records

10.1. Kent Police will hold data in accordance with our Records Review, Retention and Disposal policy.