I have worked for West Midlands Ambulance Service since 2009, qualifying as a paramedic in 2013. I joined Mitie (Care and Custody), working with Leicestershire Police in 2017, gaining an additional BSc level module in Forensic and Legal Medicine. I now work part-time in both roles, which gives me a good work/life balance, while enjoying the diversity and advantages of a mixed skillset. The varied and challenging role of a forensic healthcare professional (HCP) is ideal for a paramedic, demanding confidence and assertiveness with the ability to make quick, autonomous decisions.
I work in a 36-cell custody block in Leicester, staffed 24/7 with HCPs—a role traditionally undertaken by nurses or doctors, but now with three paramedics on our team.
Our day starts with a 6:45 am handover where any medical concerns for the detained persons (detainees) are highlighted. These can be wide-ranging and may include treatment for opiate or alcohol withdrawal, or administration of a detainee's own prescribed medication which must be verified. Medications can be checked against the individual's Summary Care Record if appropriate, with their consent. Conditions such as insulin-dependent diabetes or epilepsy can be complex to manage in a custodial environment, especially when the individual is non-compliant with medication or is alcohol-dependent.
Alcohol and opiate withdrawal are probably the most common medical issues we deal with in custody. We are fortunate to have recovery workers from the local drug and alcohol team available to identify individuals that require support with addiction or have stopped engaging with services. Certain medication can be administered via Patient Group Directives (PGDs), which allow us to supply and administer licensed, named medicines for symptom relief to this specific group of patients. Part of the examination of a detainee includes the use of a clinical assessment tool for either alcohol or opiate withdrawal (such as GMAWS or COWS) and we can signpost detainees to a drug and alcohol outreach team.
Transport for court usually leaves by 9 am and the daily routine safety tasks are undertaken, while any new arrivals into custody are booked in. Controlled drugs such as Methadone or Espranor that may be required by detainees during the day are arranged to be collected by the custody sergeant.
Requests can range from minor injuries or illness that need assessment and treatment to taking forensic blood samples for drink- or drug-related driving offences. We review detainees subjected to taser discharge, obtain intimate samples and deal with any emergencies that may arise.
Mental health issues affect a large proportion of individuals coming into custody and input from the on-site Mental Health Team helps us to make informed decisions around fitness to detain, fitness to interview and prerelease risk assessment. They also engage with and assess juveniles under 18 years of age by conducting welfare checks. Any young person or detainee thought to be vulnerable is also assigned an appropriate adult to ensure full understanding at all stages of the custody process.
Every contact with a detainee requires detailed documentation, which proves invaluable when a statement request or court appearance is requested. We have extensive training in this area, but court appearances are, thankfully, infrequent.
Detainees may arrive in custody at various stages of intoxication, and we need to determine whether they are safe to detain and establish the level of care they may require. Any intoxicated individual that has sustained a head injury must be seen in hospital before detention and will be reviewed further upon their return to custody.
Female detainees are asked about the possibility of pregnancy. Pregnancy tests are available, and we have an excellent relationship with our team of specialist midwives who look after mothers who are homeless, drug- or alcohol-addicted, seeking asylum or who have complex mental health needs.
There is a wide support network available to detainees at this stage of the justice process and our team is a small part of that. Being able to promote better healthcare access and referring our service users on provides us with satisfaction that we have done all we can to support their health and social care needs—and hopefully do our part to also reduce re-offending rates.