Police Custody

 

History:

 

  • Traumatic Injury
  • Drug Abuse
  • Cardiac History
  • History of Asthma
  • Psychiatric History

 

Signs and Symptoms:

 

  • External signs or trauma
  • Palpitations
  • Shortness of breath
  • Wheezing
  • Altered Mental Status
  • Intoxication/Substance Abuse

 

Differential:

 

  • Agitated Delirium Secondary to Psychiatric Illness
  • Agitated Delirium Secondary to Substance Abuse
  • Traumatic Injury
  • Closed Head Injury
  • Asthma Exacerbation
  • Cardiac Dysrhythmia

 

Treatment:

 

 

Evidence of Traumatic Injury or Medical Illness ?

 

  • Yes

 

    • Appropriate Protocol and Transport

 

  • No

 

Use of Pepper Spray ?

 

  • Yes

 

    • Irrigate face/eyes
    • Remove contaminated clothing

 

Wheezing ?

 

  • Yes

 

 

  • No

 

History of Asthma ?

 

  • Yes

 

    • Observe 20 min

 

Wheezing ?

 

  • Yes

 

 

History of Asthma ?

 

  • No

 

Agitated Delirium ?

 

  • Yes

 

 

  • No

 

    • Coordinate disposition with patient, law enforcement personnel, and if necessary Medical Control

 

Use of Taser ?

 

  • Yes

 

Significant Injury from Entry Point of Taser or from Fall after Taser Use ?

 

  • Yes

 

    • Appropriate Protocol and Transport

 

  • No

 

 

Cardiac History with Pacemaker, Chest Pain, or Palpitations ?

 

  • Yes

 

    • Appropriate Protocol and Transport

 

  • No

 

Agitated Delirium ?

 

  • Yes

 

 

  • No

 

    • Coordinate disposition with patient, law enforcement personnel, and if necessary Medical Control.

 

Pearls:

 

  • For this protocol to be used, the patient does not have to be under police custody.
  • Agitated delirium is characterized by marked restlessness, irritability, and/or high fever. Patients exhibiting these signs are at high risk for sudden death and should be transported to hospital by ALS personnel.
  • Patients restrained by law enforcement devices cannot be transported in the ambulance without a law enforcement officer in the patient compartment who is capable of removing the devices.
  • If there is any doubt about the cause of a patient’s alteration in mental status, transport the patient to the hospital for evaluation.
  • If an asthmatic patient is exposed to pepper spray and released to law enforcement, all parties should be advised to immediately recontact EMS if wheezing/difficulty breathing occurs.
  • All patients in police custody retain the right to request transport. This should be coordinated with law enforcement.
  • If extremity/chemical/law enforcement restraints are applied, complete Restraint procedure in call reporting system.