Operational partnerships - Management of detained persons following overdose SOP (Q01i)

1. Security protective marking

1.1. Not protectively marked.

2. Summary of changes

2.1 This standard operating procedure (SOP) has been reviewed in August 2024 - paragraph 4.1 updated. 

3. What this procedure is about

3.1. This procedure is introduced to:

1. ensure the safe management and regime of care is implemented when a detainee is suspected to or has actively taken an overdose, either accidentally or deliberately. This overdose may have been taken prior to the detainee’s arrival in custody but not disclosed. If the overdose is disclosed at scene, officers should follow COP APP guidance and attend the Emergency Department before arriving at a custody suite. It must be remembered that certain drugs have a long half-life and may not take effect for several hours after ingestion
2. to ensure that any person detained in custody, which either the Forensic Healthcare Professional (FHP) or Custody Sergeant or both, believe to have a life-threatening illness and/or injury and are refusing clinical treatment, may be transferred to hospital without their consent for preservation of life

3.2.  Note: This policy is designed for use by FHPs, however it can be used by the Custody Sergeant, for decision-making and transfer orders in the absence of an FHP. In these circumstances Custody Sergeants only need consult paragraphs 4.3, 4.4 and 4.5 for guidance.

Compliance with this procedure/SOP and any governing policy is mandatory.

4. Detail the procedure

4.1 First aid 

Shout for help and call 999 asking for an ambulance if the detainee has a reduced level of consciousness.
Administer immediate first aid treatment. If an FHP is available then Oxygen therapy and cardiac monitoring should be applied if required. Obtain baseline observations – blood pressure, pulse, temperature, blood sugar, pulse oximetry and pupils’ size and reaction. If no FHP is available place the patient into the recovery position maintaining their airway.

If it is suspected that the overdose is opiate based then naloxone should be administered by a trained person. Naloxone should be administered intra-nasally, however, Forensic Healthcare Practitioners may administer naloxone by injecting intra-muscularly if required.
Ensure the detainee is not left unattended. Detainee to remain on constant supervision at all times.

4.2 National Poisons Information Service 

Telephone the National Poisons Information Service for further guidance on the management of the detainee on: 03448 920111.

Give National Poisons Information Service as much information as you have regarding the type and quantity of tablets taken, the time they were taken, the detainee’s current symptoms and condition, the detainee’s age, gender and past medical history and if any alcohol or other substance has been consumed.
The National Poisons Information Service will require the following information: your name, where you are calling from, your job title, the detainee's custody number as their reference and the postcode of the police station you are in.

4.3 Transfer to hospital of detainee accepting treatment 

If the National Poisons Information Service suggests further assessment and treatment in hospital and the detainee is accepting this treatment then they are to be transferred to the nearest hospital Emergency Department (ED).

Transfer should be by 999 ambulance in all cases.

The nurse in charge of the ED should be telephoned and informed of the detainee’s attendance and the guidance the National Poisons Information Service has advised.

A copy of the Forensic Healthcare referral note including any history, observations and treatment administered should accompany the detainee to hospital.

4.4 Detainees refusing treatment and care

Follow the guidelines following the refusal of treatment by detained persons whilst in custody:

4.4.1 Detainees with capacity to make informed decisions:

Detainees should always be offered an initial medical assessment, if refused and/or declined against advice the detainee’s capacity to consent to      treatment should be considered and the outcome must be documented clearly in the custody record.

If the detainee refuses to consent, they must be requested to complete the refusal of treatment disclaimer. If the detainee refuses to sign the disclaimer, it must be documented in the custody and healthcare records.

National Poisons Service must be contacted for guidance before a care plan/regime is finalised or agreed.

Constant supervision is advisable, the Custody Sergeant should be made aware of the planned care regime and potential risks. This should be documented on the custody and custody medical records.

4.4.2 Detainees with no capacity or decline in condition - transfer for preservation of life

In the event that the DP loses capacity or becomes unwell the DP should be taken to hospital immediately, dial 999 for an emergency ambulance.

Transfer the patient to A&E using reasonable and appropriate force if necessary, maintaining the security of the detained person at all times. If transfer by ambulance is not acceptable to the patient or the ambulance staff, then the patient must be transferred in a secure police vehicle with the Forensic Healthcare Practitioner and ambulance escorting.

Police are to ensure the safety of the Forensic Healthcare Practitioner during escort.

On arrival at the designated location, notify medical staff of the patient’s refusal to accept treatment and whether they are under arrest. Provide details of the overdose, illness or injury and the reason why treatment is required

If the hospital is willing to initiate treatment, provide details from the PER, hospital transfer note and any medical records supplied.

If the hospital is unwilling to provide treatment, then the FHP must be contacted for guidance before returning to the custody suite and document any reasons on the custody record. A hospital discharge note must be provided by the hospital detailing their findings, treatment.

Note - It may be safer to remain at the hospital rather than return the detainee to Custody until a safe amount of time has elapsed. Each individual case must be discussed with the FHP and treated on its own merit.

The Custody Sergeant must be made aware of the hospital outcome and the care plan.

The Forensic Medical Services Manager must be informed of the incident as soon as possible.

4.5 Detainees not requiring hospital treatment 

In some cases, National Poisons Information Service may advise hospital treatment is not necessary due to non-toxicity of the drug taken. In this situation a care regime is to be implemented with the agreement of the Custody Sergeant and reviewed by the Forensic Healthcare Practitioner as advised by the National Poisons Information Service.

If the overdose was deliberate consider constant supervision care regime, discuss with Custody Sergeant and document on the custody record. A mental health assessment should be carried out by a CPN when available.

4.6 Clinical incident recording 

In all cases of overdose in custody a Successful Intervention e-form must be submitted by the custody sergeant. Remember - detainees may withhold information; always act on the clinical findings and if in doubt consider transfer out.

5. Authorised professional practice

For further information on the management of alcohol and drugs within custody please see APP - Detention and Custody by clicking on the link in section 7.

6. Monitoring and review

This procedure will be monitored by the policy owner who also has oversight of the practical delivery of custody. It will be reviewed every two years with the next review scheduled for August 2026.

A comprehensive performance pack developed and published in force on a monthly basis. It is intended that there should be ACPO and SMT oversight at a local and force level. This data is also made available to the independent custody visitors via the Office of the Police and Crime Commissioner with a briefing.

Each month a Kent Custody Suite is subject of an inspection intended to identify compliance with this policy and areas for continuous improvement.

7. Other source documents, e.g. legislation, APP, force forms, partnership agreements (if applicable)

• Mental Capacity act 2005 – codes of practice 
• Mental Health Act 1983 – codes of practice 
• College of Policing APP – detention and custody 

8. Security

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

9. Retention and disposal of records

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