Mark Corson

By O. Myxir. University of San Francisco.

General Injuries Detailed documentation of injuries is an important and common request discount 3 ml lumigan otc. The injuries may have occurred before or during the arrest purchase lumigan 3 ml amex, and documenta- tion of such injuries may form part of the investigation to refute counter alle- gations of assault lumigan 3ml. A record of each injury, as outlined in Chapter 4, should be made and basic first aid provided. Certain wounds may be treated with Steri-Strips or Histo- acryl glue in the police station (14), although occasionally transfer to a hospital will be required for further medical assessment (e. Head Injuries Any suspected head injury should receive a detailed assessment (15). The time, place, and nature of the injury should be ascertained from the detainee or from any witnesses who were present. Examination should include measurement of pulse and blood pressure, Glasgow Coma Scale (16), and neurological assessment. The indications for hospital assessment include situations in which there are problems with the assessment of the patient or an increased risk of skull fracture or an intracranial bleed (Table 5) (17). Ingestion of alcohol or drugs and relevant past medical history should be ascertained. Although deaths in police custody are rare, head injuries accounted for 10% and substance abuse, including alcohol and drugs, accounted for 25% in a survey of such deaths between 1990 and 1997 in England and Wales (18). There should be a low threshold for referral to hospitals, especially if a detainee with a head injury is also under the influence of alcohol or drugs. If the detainee is to remain in custody, then instructions regarding the management of patients with head injuries should be left verbally and in writing with the custody staff and given to the patient on release (19). Police 212 Norfolk and Stark Table 6 Brief Mental State Examination • Appearance Self-care, behavior • Speech Rate, volume • Thought Association, content (delusions) • Perception Hallucinations, illusions • Obsessive/compulsive Behaviors • Mood Biological symptoms (sleep, appetite, energy, concentration, memory) • Cognitive function Short-term memory, concentration, long-term memory • Risk behaviors Self harm, harm to others should be advised that when checking a detainee’s conscious level they are required to rouse and speak with the detainee, obtaining a sensible response. Appendix 3 outlines the Glasgow Coma Scale, a head injury warning card for adults, and an observation checklist for custody staff responsible for the health care of detainees. Infectious Diseases The doctor may be called to advise the police regarding infectious dis- eases. Because the popula- tion in police custody is at high risk for blood-borne viruses, such as hepatitis and the human immunodeficiency virus (20), all individuals should be consid- ered a potential risk, and observation of good clinical practice relating to body fluids to avoid contamination risks is essential (21). General Psychiatric Problems When a psychiatric disorder is suspected, an assessment involving back- ground information, full psychiatric history (if known), observation of the detainee, and mental state examination (Table 6) should be performed by the doctor to assess whether there is any evidence of mental illness. The doctor should then consider whether diversion from the criminal justice system is appropriate. If the detainee has committed a minor offense and there is only evidence of minor to moderate mental illness, treatment may be arranged in the community, in outpatients, or in the day hospital. However, if the detainee has an acute major mental illness but has only committed a minor or moderate offense, then admission to the hospital for further assess- Care of Detainees 213 ment and treatment is required either informally or if necessary formally. When the offense is more serious and there is evidence of probable mental illness needing further assessment, then the detainee may need to go before the court for such an assessment to be ordered. Chronic stable mental health problems usually pose no specific problems for police detention but may require specific safeguards when the detainee is to be interviewed by the police (see Subheading 9). Substance Misuse and Mental Illness Concurrent substance misuse and mental illness —“dual diagnosis” or “comorbidity”—is an important consideration. In the Epidemiologic Catch- ment Area study, 29% of individuals with a lifetime history of any mental disorder (other than substance use) had a history of substance use (22% alco- hol disorder and 15% a drug disorder) (22). There are those with a primary diagnosis of a major mental illness who have a secondary diagnosis of substance misuse that further affects their mental health. Such individuals may use drugs to relieve the adverse symp- toms of their mental illness. Conversely, substance misuse may be the pri- mary diagnosis leading to psychiatric complications and mental illness—for example, depression with suicidal ideation may occur among substance abus- ers. On occasions, mental illness and substance misuse may coexist, such as when an underlying traumatic experience results in both substance misuse and posttraumatic stress disorder. When the risk is believed to be high, then referral to a hospital is required, and the detainee should be kept under constant supervision until such transfer is arranged. When the risk is deemed to be low, clear instructions must be given to the police regarding care and supervision. The police may consider removal of the detainee’s cloth- 214 Norfolk and Stark ing and personal effects to prevent self-harm. Claustrophobia Claustrophobia is a common complaint, and a detailed history and examina- tion with an emphasis on the presence or absence of anxiety when faced with the problem in everyday life should be sought. Inquiry regarding behavior at home, such as leaving doors and windows open, avoidance of elevators and underground trains, and a history of the original precipitant for such behavior, should be noted. Often, reassurance is enough, and it is rarely necessary to give any medi- cation. The custody staff should be advised if genuine claustrophobia is sus- pected as this may affect the detainee’s fitness to be interviewed. There are numerous strategies for interviewing a difficult patient (29), which include being fully aware of the person’s history (be prepared) and considering how the person sees you (as uninterested or hostile), being polite and respectful, avoiding confrontation, using appropriate eye contact, keep- ing calm, and showing interest. Finally, be ready to leave if necessary and consider the need to have a chaperone (appropriately trained in restraint techniques) of the same sex as the patient. Accurate assessment regarding the possibility of violence will reduce the danger, but it should never be assumed that there is no risk, and every clinical situation should be categorized as high risk owing to an obvious risk or unknown risk resulting from undiscovered factors (30). Third parties may be employed to act as mules, and a case of body packing using children, two boys aged 6 and 12 years, Care of Detainees 215 who had concealed heroin has been reported (31). A person who is about to be arrested by the police may swallow drugs (“body swallower” or “stuffer”). Doctors may then be called by the police to conduct intimate searches of those arrested (see Chapter 2) (32). Any health care professional who agrees to perform an intimate search should have the required skills and a comprehensive under- standing of the risks involved and their management.

The term “cruel generic lumigan 3ml online, inhuman buy discount lumigan 3ml on line, or degrading treatment or punishment” has not been defined by the General Assembly but should be interpreted to extend the widest possible protection against abuses discount lumigan 3ml amex, whether physical or mental. Although the medical personnel are likely to be attached to the law enforcement operation, law enforcement officials must take into account the judgment of such personnel when they recommend providing the person in custody with appropri- ate treatment through, or in consultation with, medical personnel from outside the law enforcement operation. It is understood that law enforcement officials shall also secure medical attention for victims of violations of law or of accidents occurring in the course of viola- tions of law. Any act of corruption, in the same way as any other abuse of authority, is incom- patible with the profession of law enforcement officials. The law must be enforced fully with respect to any law enforcement official who commits an act of corrup- tion, because governments cannot expect to enforce the law among their citizens if they cannot, or will not, enforce the law against their own agents and within their agencies. Although the definition of corruption must be subject to national law, it should be understood to encompass the commission or omission of an act in the perfor- mance of or in connection with one’s duties; in response to gifts, promises, or incentives demanded or accepted; or the wrongful receipt of these once the act has been committed or omitted. The expression “act of corruption” referred to should be understood to encom- pass attempted corruption. They shall also, to the best of their capability, prevent and rigorously oppose any violations of them. Law enforcement officials who have reason to believe Ethical Documents 393 that a violation of the present Code has occurred or is about to occur shall report the matter to their superior authorities and, where necessary, to other appropriate authorities or organs vested with reviewing or remedial power. This Code shall be observed whenever it has been incorporated into national leg- islation or practice. If legislation or practice contains stricter provisions than those of the present Code, those stricter provisions shall be observed. The article seeks to preserve the balance between the need for internal discipline of the agency on which public safety is largely dependent, on the one hand, and the need for dealing with violations of basic human rights, on the other. Law enforcement officials shall report violations within the chain of command and take other lawful action outside the chain of command only when no other rem- edies are available or effective. It is understood that law enforcement officials shall not suffer administrative or other penalties because they have reported that a violation of this Code has occurred or is about to occur. The term “appropriate authorities or organs vested with reviewing or remedial power” refers to any authority or organ existing under national law, whether internal to the law enforcement agency or independent thereof, with statutory, customary, or other power to review grievances and complaints arising out of violations within the purview of this Code. In some countries, the mass media may be regarded as performing complaint review functions similar to those described in the paragraph above. Law enforce- ment officials may, therefore, be justified if, as a last resort and in accordance with the laws and customs of their own countries and with the provisions of article 4 of the present Code, they bring violations to the attention of public opinion through the mass media. Law enforcement officials who comply with the provisions of this Code deserve the respect, the full support, and the cooperation of the community and of the law enforcement agency in which they serve, as well as the law enforcement profes- sion. Considering that the full exercise of human rights and fundamental freedoms, guaranteed by the European Convention on Human Rights and other national and international instruments, has as a necessary basis the existence of a peaceful society that enjoys the advantages of order and public safety; 394 Appendix 1 2. Considering that, in this respect, police play a vital role in all the member states, that they are frequently called on to intervene in conditions which are dangerous for their members, and that their duties are made yet more difficult if the rules of conduct of their members are not sufficiently precisely defined; 3. Being of the opinion that it is inappropriate for those who have committed vio- lations of human rights while members of police forces, or those who have belonged to any police force that has been disbanded on account of inhumane practices, to be employed as policemen; 4. Being of the opinion that the European system for the protection of human rights would be improved if there were generally accepted rules concerning the profes- sional ethics of the police that take account of the principles of human rights and fundamental freedoms; 5. Considering that it is desirable that police officers have the active moral and physical support of the community they are serving; 6. Considering that police officers should enjoy status and rights comparable to those of members of the civil service; 7. Believing that it may be desirable to lay down guidelines for the behavior of police officers in case of war and other emergency situations and in the event of occupation by a foreign power; 8. Adopts the following Declaration on the Police, which forms an integral part of this resolution; 9. Instructs its Committee on Parliamentary and Public Relations and its Legal Affairs Committee and the Secretary General of the Council of Europe to give maximum publicity to the declaration. A police officer shall fulfill the duties the law imposes upon him by protecting his fellow citizens and the community against violent, predatory, and other harm- ful acts, as defined by law. In particular, he shall refrain from and vigorously oppose all acts of corruption. Summary executions, torture, and other forms of inhuman or degrading treat- ment or punishment remain prohibited in all circumstances. A police officer is under an obligation to disobey or disregard any order or instruction involving such measures. A police officer shall carry out orders properly issued by his hierarchical supe- rior, but he shall refrain from carrying out any order he knows, or ought to know, is unlawful. If immediate or irreparable and serious harm should result from permitting the violation to take place he shall take immediate action, to the best of his ability. If no immediate or irreparable and serious harm is threatened, he must endeavor to avert the consequences of this violation, or its repetition, by reporting the mat- ter to his superiors. No criminal or disciplinary action shall be taken against a police officer who has refused to carry out an unlawful order. A police officer shall not cooperate in the tracing, arresting, guarding, or convey- ing of persons who, while not being suspected of having committed an illegal act, are searched for, detained, or prosecuted because of their race, religion or politi- cal belief. A police officer shall be personally liable for his own acts and for acts of com- mission or omission he has ordered and that are unlawful. It should always be possible to deter- mine which superior may be ultimately responsible for acts or omissions of a police officer. Legislation must provide for a system of legal guarantees and remedies against any damage resulting from police activities. In performing his duties, a police officer shall use all necessary determination to achieve an aim that is legally required or allowed, but he may never use more force than is reasonable.

Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications buy 3ml lumigan with mastercard. Books and Other Individual Titles on the Internet 1393 Box 28 continued from previous page cheap 3 ml lumigan overnight delivery. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications purchase lumigan 3 ml online. Examples: ĉ or ç becomes c ⚬ Do not convert numbers or words for numbers to arabic ordinals as is the practice for English language publications. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Examples: ŏ becomes o ū becomes u ⚬ Do not convert numbers or words for numbers to arabic ordinals as is the practice for English language publications. Books and Other Individual Titles on the Internet 1395 Box 28 continued from previous page. Book on the Internet with an edition and a version Editor and other Secondary Authors for Entire Books on the Internet (optional) General Rules for Editor and other Secondary Authors • A secondary author modifes the work of the author. Examples include editors, translators, and illustrators • Place the names of secondary authors afer the Type of Medium and any edition statement • Use the same rules for the format of names presented in Author/Editor above • Follow the last named editor with a comma and the word editor or editors; the last named illustrator with a comma and the word illustrator or illustrators, etc. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Some books on the Internet do not display a traditional title page that clearly states the place of publication. When there is no title page: • Look at the top, bottom, or sidebar of the frst screen or the bottom of the last screen of the book • If it is not in one of these locations, try to obtain it from a link within the site, usually under a "contact us" or similar link • Look in the source code for the book if it is displayed by the Web browser • If the place cannot be determined from the site itself: ⚬ Place the name in square brackets if the city can be reasonably inferred. For example, Chicago as the place of publication of a book issued by the American Medical Association. Unbinding knowledge: a proposal for providing open access to past research articles, starting with the most important [Internet]. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Books and Other Individual Titles on the Internet 1401 Box 36 continued from previous page. Te use of opioids for the treatment of chronic pain: a consensus statement [Internet]. Unbinding knowledge: a proposal for providing open access to past research articles, starting with the most important [Internet]. Book on the Internet with unknown place of publication Publisher for Entire Books on the Internet (required) General Rules for Publisher • A publisher is defned as the individual or organization issuing the book • Record the name of the publisher as it appears on the title page or opening screens, using whatever capitalization and punctuation is found there • Abbreviate well-known publisher names with caution to avoid confusion. Some books on the Internet do not display a traditional title page that clearly states the name of the publisher. When there is no title page: • Look at the top, bottom, or sidebar of the frst screen or the bottom of the last screen of the book • Look for the name afer a copyright statement, e. Publisher information is required in a citation; distributor information may be included as a note. If you abbreviate a word in one reference in a list of references, abbreviate the same word in all references. Place all translated publisher names in square brackets unless the translation is given in the publication. Tokyo: Medikaru Rebyusha; Beijing (China): [Chinese Academy of Social Sciences, Population Research Institute]; Taiyuan (China): Shanxi ke xue ji she chu ban she; Box 42 continues on next page... Books and Other Individual Titles on the Internet 1405 Box 42 continued from previous page. Terefore in transliterating Chinese publisher names only the frst word and proper nouns are capitalized] • If the name of a division or another part of an organization is included in the publisher information, give the names in hierarchical order from highest to lowest Valencia (Spain): Universidade de Valencia, Instituto de Historia de la Ciencia y Documentacion Lopez Pinero; • Ignore diacritics, accents, and special characters in names. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Aarhus (Denmark): Aarhus-Universitetsforlag [Aarhus University Press]; • As an option, you may translate all publisher names not in English. Place all translated publisher names in square brackets unless the translation is given in the publication. Safe from the start: taking action on children exposed to violence; summary [Internet]. Te use of opioids for the treatment of chronic pain: a consensus statement [Internet]. For those publications with joint or co-publishers, use the name given frst as the publisher and include the name of the second as a note if desired. Te use of opioids for the treatment of chronic pain: a consensus statement [Internet]. Book on the Internet with government agency or other national body as publisher 28. Book on the Internet with joint publication Date of Publication for Entire Books on the Internet (required) General Rules for Date of Publication • Always give the year • Convert roman numerals to arabic numbers. Some books on the Internet do not display a traditional title page that clearly states the date of publication. When there is no title page: • Look for the date at the top, bottom, or sidebar of the frst screen or the bottom of the last screen of the book • Look for the date accompanying a copyright statement. For example: copyright 2006 by the American Chemical Society, © 2006 American Medical Association, c2006 Medical College of Wisconsin • Look in the source code for the book if it can be displayed by the Web browser • If neither a date of publication nor a date of copyright can be found, but a date can be estimated because of material in the book or elsewhere in the site, insert a question mark afer the estimated date and place date information in square brackets Evaluation of health literacy work among libraries and community organizations in the New York City area: report highlights [Internet].