Contents
1 Introduction
Police forces are using irritant sprays and tasers to subdue and, or control potentially violent individuals and crowds. These non-lethal and basically harmless solutions are becoming more and more common, and the likelihood of healthcare staff managing patients who have been subjected to these methods, and being at risk of contact with sprays or people who have been sprayed is increasing.
Whilst the trust does not advocate the routine use of sprays or tasers by the police on inpatient wards, it recognises that there may be incidents of extreme violence or risk where all other attempts to control the situation have been tried and failed, and as a last resort the police are asked to assist.
Although the overarching responsibility for the health and safety of the patient remains with health care staff, once the police respond, the management of the incident is under police control. The care staff must ensure that the police have all relevant clinical information to aid their decision making. The guidance issued to the police states that the use of a spray or taser is intended solely as a control device to minimise injuries to officers and suspects. Its purpose is to enable the officer to carry out his or her duties in a safe, efficient and most professional manner. Their timely and appropriate use can greatly reduce injuries to both officers and suspects and any escalated use of force may be avoided.
However, an officer is only authorised to use these after he or she has clearly displayed a physical presence and thus identified themselves as a police officer by making identification if they are not in uniform or clearly bearing official title. The officer must also give verbal warning and verbal commands to a resisting subject or arrestee if the situation allows. Verbal warnings and commands would not be necessary if reaction time was of the essence to officer safety or the safety of others. A suspect failing to comply and showing no intention of compliance to an officer’s official, lawful instructions may be incapacitated by the use of the taser.
2 Purpose
The purpose of this guidance is to provide guidance to trust staff in the care of patients following use of an irritant spray or taser and is based on the guidance, which is issued by the association of chief police officers to general practitioners and hospital clinicians.
3 Scope
This policy is applicable to staff who may come into contact with patients who have been in contact with irritant sprays or tasers. This is predominantly admitting in-patient areas and mental health inpatient areas, but may be any area where the police have had to subdue a patient.
It may also be a basis for advice to patients and their carers who have been subjected to police action involving sprays or Taser.
4 Responsibilities, accountabilities and duties
4.1 Board of directors
The trust has a duty under the Health and Safety at Work etc. Act 1974 with regard to the work related risks to employees, and vulnerable people who use our health and social care services. The board of directors has responsibility for having in place suitable arrangements to minimise these risks as far as is reasonable practicable.
4.2 Care group directors
In the event that a situation escalates to the point at which police assistance is required, the care group director is responsible for instigating an internal investigation and identifying any trends which become apparent.
4.3 Managers
The managers are responsible for:
- making sure their staff are aware of and comply with the policy, through local induction, instruction, supervision
- having local procedures in place to maintain compliance with the policy
- monitoring adherence to the policy and taking immediate action where non-adherence is identified
- providing such equipment and supplies required to safely and effectively manage an incident where an irritant spray or taser has been used
- checking that an IR1 has been completed in relation to the incident and use of the spray or taser
- making staff aware of their responsibilities under this guidance
- investigating all incidents where police assistance has been requested and completing the internal report (see appendix A)
- providing a copy of the completed report to the care group director, local security management specialist and trust patient safety lead
4.4 Staff
Whilst the decision to use an irritant spray or taser to gain safe control of a situation is made by the attending police officers, it is the responsibility of the nurse in charge to:
- provide the attending police officers with any relevant clinical information about the patient
- remain within the vicinity (if safe to do so) in order to provide reassurance and support to the patient
- contact the on call doctor and request their attendance if a taser is used, and in any case if the patient remains on the ward
- to arrange a post-incident debrief for the patient if they remain in the care of the trust
- complete an IR1
- risk assess and review patients’ needs with regard to this policy and having in place suitable care plan arrangements
- implementing and complying with the policy
- for patients who remain in the care of the trust, arrange for the patient’s early warning score to be recorded at 15 minute intervals for at least 1 hour post-incident, in line with the early warning score
- provide any information which is requested by the police to assist in their investigation
4.5 On call doctor
Following notification that an irritant spray or taser has been used on an inpatient and the patient remains on the ward, the on call doctor is to attend the ward and, if it is safe to do so, carry out a physical examination of the patient. A review of the patient’s prescribed medication will also be undertaken.
5 Procedure or implementation
5.1 Taser
5.1.1 What is a taser?
They are handheld, electronic incapacitation devices that are designed to fire two barbs at an individual. The device is aimed with the intention of embedding the barbs in the clothing or superficial skin on the torso and, or lower limb, but a barb may occasionally embed in an arm or hand. There is also a risk that a barb may penetrate skin in the head or neck region. Rarely, barbs have penetrated eyes and skull, meninges and underlying brain.
The barbs are attached to the taser handset by thin wires, through which very short duration, high voltage (but low current) pulses pass when the device is actuated. The current flowing into the body is sufficient to induce temporary disruption of voluntary muscle control and intense pain. The taser may also be used in ‘stun’ or ‘probe’ mode, in which the handset’s electrodes are pressed directly against an individual’s skin or clothing. In stun mode, pain (rather than muscle contraction) is the principal local response because of the narrow separation of the electrodes.
Use of the taser in the United Kingdom (UK) is subject to regular review by an independent panel of clinicians, whose role is to evaluate any adverse medical effects of the taser, assess their clinical implications, and to provide advice to Government by way of formal, publicly accessible, statements. The panel also assesses how alterations to the specification of a taser, modifications to officer training, and changes to the way in which the taser is used operationally, may impact on medical outcome.
5.1.2 The medical implications of taser use
Classification of injuries unintended adverse effects from the use of tasers are classed as:
- primary, immediate or delayed consequences of current flow in the body. In addition to the intended effect of painful muscle contraction, there has been speculation that the taser current may exert effects on cardiac rhythm. No fatalities associated with taser use have been unequivocally linked to a direct action of the taser current on the heart
- secondary, physical trauma directly associated with taser use, mainly injuries arising from falls. The head is the region most at risk. Two deaths in the United States have resulted from fatal head injuries sustained during taser-induced falls. Mild rhabdomyolysis has been reported. Thoracic vertebral compression fractures have been documented and such injuries may be primary effects. Pharyngeal perforation, possibly secondary to sudden diaphragm contraction during taser discharge, has been described
- coincidental, injuries not directly attributable to taser (for example, use of baton or irritant spray, self-inflicted wounds or gunshot wounds)
5.1.2.1 Life-threatening and serious injuries
Assessment of taser usage in the United States (US) and UK , indicates that, when operated by trained police officers, the risk of life-threatening and other serious injuries, such as the loss of an eye, is very low. Medically significant head injury resulting from uncontrolled falls is rare; standing subjects generally either freeze on the spot or collapse in a semi-controlled manner. However, there have been two US reports of fatal head injuries incurred by taser-induced falls, and the possibility of head injury should be considered. A number of deaths have been reported in North America during or after exposure of subjects to taser discharge. These deaths have been principally attributed to excess consumption of illicit drugs or to physiological stress imposed by extreme physical activity and restraint, frequently compounded by drug abuse or underlying cardiac disease. No death has yet been unequivocally attributed to the effects of the taser device alone. However, full clinical assessment is essential, particularly in the presence of other factors such as drugs, alcohol, cardiac disease and following violent struggles.
5.1.2.2 Other effects
Falls may result in abrasions, scratches, minor lacerations, swellings and areas of redness on the skin. Minor secondary trauma from barb penetration of the skin will occur. Some barb penetrations will be associated with small, circular, local burns; these are areas of skin where current has entered the body. Where barbs have embedded in clothing, the underlying skin may also exhibit burns. These burns are likely to resolve within a few days without complications.
There is currently no evidence for any long-term clinical effect attributable to the primary effect of the taser. Secondary effects, including cataract from orbital penetration and back pain after vertebral compression fractures, have been reported.
5.1.2.3 Patients where special consideration needs to be given
5.1.2.3.1 Pacemakers and other implanted electronic devices
The evidence concerning damage or disturbance to implanted devices (such as pacemakers) is limited and equivocal so staff need to be aware of the potential risk of damage.
5.1.2.3.2 Pregnancy
At present the risks to the foetus are thought to be very low but the evidence upon which this assessment is based is continually reviewed.
5.1.3 How is a taser used?
When using a taser the police are advised that centre mass of the body should be the primary target area when firing; particularly centre mass of the back, as clothing tends to be tighter on this part of the body. The head and face should not be targeted unless the appropriate level of force can be justified. It is to be used as a way of averting a potentially injurious or dangerous situation.
The tasers authorised for use by UK police are the TASER X26™ and the newer TASER X2™.
When fired, the X26 taser emits a sound similar to small calibre gunfire, although it is significantly lower in volume. The officer deploying the X26 taser should take appropriate steps to ensure the safety of others in the vicinity and prior to use shall announce that he or she is about to deploy by saying “taser!” in a clear and audible tone, so that other officers will be aware the taser is to be used.
5.1.4 Removing the barbs
The removal of the barbs is the responsibility of the police. However, there may be occasion when assistance is needed from the nursing staff to reassure the patient and gain their co-operation for the safe removal of the barbs.
The current injection needles are about 10mm long and have a 1mm high barb located about 3mm from the tip. The trailing wires that conduct the electrical current between the taser handset and the propelled barbs should have already been cut close to the barb.
In instances where the barbs become embedded in the skin, removal may be achieved by holding the skin taut with one hand and applying gentle pressure to the barb shaft with the other. In the unlikely event that the barbs have embedded in the eye, face or genitalia, the patient is to be transferred to the local accident and emergency department.
All barbs extracted from the skin should be checked by the Police for completeness.
Probes that have been removed from skin will be treated as Bio-Hazards “sharps”.
They should be placed point down into the expended cartridge bores and secured with tape. If available, the probes will be cleaned by the police with a bleach or water solution prior to storage.
The police are advised to take photographs of the probe impact sites and any other related injuries. If the ward has a camera available this can be offered for use by the police.
All Humberside police officers carrying taser will wear body worn video and if deployed in a taser capacity will activate the body worn video.
5.1.5 Post taser care of the patient
If a taser has been used, the police will arrest the patient. A decision will then need to be made by the police in conjunction with the Nurse in charge of the ward and the on call doctor, as to where the safest place is for the patient to be. This will either mean the patient being arrested and taken into custody or remaining on the inpatient unit to continue their treatment.
Any patients who remain in the care of the inpatient services will be transferred to one of the trust psychiatric intensive care units for a period of assessment and staff will monitor and record their early warning score every 15 minutes for at least 1 hour post-Taser use, in line with the early warning score policy.
Appendix C provides information on the medical management of people subjected to discharge from conducted energy devices (“tasers”).
The patient will also be offered the opportunity to speak with staff about the incident which led police assistance being required (staff are to refer to the patient debriefing guidance in the main policy).
Note, staff need to be aware that the patient’s pulse rate will be slightly raised post-taser use, but should return to a normal rate within 30 minutes (dependant on other conditions which may be present).
5.2 Irritant sprays
5.2.1 What is an irritant spray
In the UK there are two types of irritant spray, CS Gas and PAVA sprays. Nationally, the Police are moving away from using CS Gas irritant sprays to the use of PAVA sprays, brand name Captor.
The change is because CS spray affects a wide area and requires careful decontamination, and it has some health risks and side effects, in particular affecting the respiratory system. PAVA is a more targeted spray and cross-contamination is less likely, decontamination of the area is easy and there are very few health risks and side effects.
This change over is taking place gradually, therefore staff still need to have an awareness of how to safely manage both types of irritant spray.
5.2.2 Medical implications of irritant spray use
The effects of irritant spray on an individual can depend on where and how the spray has been used.
Factors that will influence the effects upon an individual are:
- if the spray has been used out of doors or in a confined space
- hot and moist conditions – which make the spray more effective than cold dry conditions
- the accuracy of its delivery
The primary effects of the spray on an individual usually occur within 10 to 15 seconds but can take longer. However, there is variation between individuals and some are more susceptible to the effects of the spray than others, with up to 10% not being affected enough to be subdued.
The effects are temporary and reversible and usually last for between 15 minutes and one hour after exposure for the individual. They can last up to 45 minutes for the immediate environment.
The primary signs and symptoms of exposure to the spray include:
- intense pain and redness in the eyes
- excessive watering of the eye
- a burning sensation in the throat
- constriction of the chest
- choking, coughing, retching
- excessive mucus production
- irritation of the skin
5.2.3 Post exposure management and care
The following procedure should be followed when patients who have been sprayed with irritant spray, are admitted, or others are contaminated with spray.
On admission or immediately after contamination (or as soon as practicable):
5.2.3.1 Staff
- If the person requires assistance to get undressed and washed, staff must wear protective clothing, that is:
- gloves
- plastic gown
- eye protection is advisable if liquid incapacitant is still on the clothing
- If staff feel the effects of the spray, they should remove themselves from the area immediately (if safe to do so) into fresh air.
- If the contaminant is on the skin, wash with copious amounts of cold water. If there is a concern, consult a doctor.
5.2.3.2 The person
- The contaminated person should be advised to rinse the face and eyes with copious amounts of cold water, or on the coldest setting available. For extensive contamination, or if the effects are felt on the body, the contaminated person should have a shower on as cold a setting as possible (hot water re-activates irritants used in the spray). If necessary, use a bowl of cool water for the most contaminated areas (probably the face, hair, neck etc.) then a shower.
- Ordinary soap may be used, but it is not essential. Skin irritation or blistering can occur up to 72 hours post exposure. Refer to a doctor for advice on treatment if this should happen.
5.2.3.3 The clothing
- All contaminated clothing is to be removed as soon as possible. Ideally all clothing to prevent further contamination.
- Place clothes in a sealed plastic bag.
- Hand clothing to carer on next visit (or person on discharge) with advice to open bag in well-ventilated area or outside preferably. Also give the carer or person a copy of the instructions at appendix A.
- Clothing should be hung out to ventilate for a couple of hours before putting through a normal wash cycle using ordinary detergents.
- Contaminated clothing should be washed separately to avoid cross contamination
- Clothing may need to be washed twice to fully remove the Irritant Spray particles.
Note, these instructions may be superseded by infection prevention and control procedures which may be required.
5.2.3.4 The area
- The irritant spray degrades naturally and requires no special procedures other than ventilate the area for 30 to 50 minutes.
- However, excessive use may leave a residual film of particles on surfaces. A simple wipe down with a wet or damp cloth will suffice. If a film is present, it will be potentially uncomfortable if the film is touched, then the eyes rubbed.
6 Training implications
There are no specific training needs in relation to this policy, but the following staff will need to be familiar with its contents: ward managers and shift leaders in areas where violence and aggression are possible and any other individual or group with a responsibility for implementing the contents of this policy. As a trust policy, all staff need to be aware of the key points that the policy covers.
7 Monitoring arrangements
7.1 Use of sprays and, or tasers by the police in any of the trust inpatient settings
- How: Internal investigation.
- Who by: Modern matrons.
- Reported to: Care group directors and the trust patient safety lead. board of directors.
- Frequency: Investigation reports will be submitted as and when an incident occurs.
8 Equality impact assessment screening
To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.
8.1 Privacy, dignity and respect
The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.
As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).
8.1.1 How this will be met
There are no additional requirements in relation to privacy, dignity and respect
8.2 Mental Capacity Act
Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.
Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.
8.2.1 How this will be met
All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005).
9 Links to any other associated documents
10 References
- Operational deployment of Taser Information for GPs and hospital clinicians, ACPO, 2008.
- Guidance on The Use Of Incapacitant Spray, ACPO, London, 2009.
11 Appendices
11.1 Appendix A Report into the use of an irritant spray or taser by police on an inpatient
ward
11.2 Appendix B Advice notes for people contaminated by irritant spray on the decontamination of clothing
You have been given a sealed bag of clothing.
This clothing has been contaminated by an irritant spray and needs careful handling in line with the guidance below.
The substances used in the irritant sprays are basically harmless however care should be taken to prevent contamination.
Although the risks are very small, anyone who is prone to asthma should not be involved in managing the contaminated clothing until it has been washed once.
Follow these instructions:
- open the bag in a well ventilated area, preferably outside
- use gloves or tongs to handle the clothing
- hang clothing outside to allow irritant spray particles to blow off the clothing naturally (1 to 2 hours)
- wash in a normal cycle using ordinary detergents. Wash separately from other clothing for the first wash
- clothing may need two wash cycles to fully remove irritant spray particles
If you feel the effects of the spray, it has not been left outside long enough for the particles to dissipate. Leave the clothing outside, wash your hands and face in cold water. If you have any concerns consult a doctor.
11.3 Appendix C Medical management of people subjected to discharge from
conducted energy devices (“TASERs”)
Conducted energy devices (CEDs) are battery operated pistol-like weapons that exert their effects by injecting brief pulses of electricity into the body. The pulses are delivered in one of two main ways, termed probe mode and drive-stun mode. The CEDs authorised for use by UK police are the TASER X26™ and the newer TASER X2™.
In probe mode, the electrical pulses are delivered by two or more probes that are fired at the subject from a distance. These probes, which remain connected to the CED handset by electrically conducting wires, attach to the subject’s clothes or can penetrate the skin up to the full length of the probe shaft. The probes of the TASER X26™ and TASER X2™ look like this:
The electrical pulses delivered by the probes produce intense pain and involuntary muscle contraction. While most uses have benign outcomes, a broad range of adverse health effects is possible, including medical statement on TASER X2 (opens in new window), Defence Scientific Advisory Council sub-committee on the medical implications of less-lethal weapons (DOMILL) (opens in new window): injuries to the skin and underlying tissue and organs from probe penetration and from the passage of electrical current; joint injury; bony injury (including skull and traumatic brain injury) from falls; the physiological stress from the pain and muscle contractions could exacerbate pre-existing conditions (such as disorders of the heart, circulation and respiratory systems).
In drive-stun mode, the discharge is applied directly to the subject using the electrodes at the front end of the CED handset. This produces extreme localised pain but does not produce generalised muscle contraction. Injuries include electrical burns to the skin and physical trauma of the dermis from the application of the electrodes.
The physiological effects and range of injuries anticipated with the new TASER X2™ device are similar to those associated with the TASER X26™, although there is presently limited experience of injuries to the skin and underlying tissues and organs from penetration and removal of the TASER X2™ probe.
Injuries from CED discharge should be assessed in the context of injuries from other types of force used by the police at the same incident (such as irritant spray and physical restraint). The implications of concurrent intoxication with drugs (licit or illicit) or alcohol must also be taken into account as part of the medical assessment.
The advice in this leaflet has been adapted from TASER: Clinical Effects and Management of Those Subjected to Taser Discharge (opens in new window). The leaflet is intended to complement local guidelines, which should take precedence.
All persons subjected to CED discharge must ultimately be examined and assessed by a registered medical practitioner, a doctor (for example, forensic physician or emergency medicine doctor), who is familiar with the risks and complications associated with use of these devices. Doctors unfamiliar with these unique risks and complications must be provided with a copy of this leaflet.
In most cases, initial first aid or probe removal (if not already done) may be undertaken by any appropriate healthcare professional (for example, nurse or paramedic) and, where probes have not penetrated the skin, by police officers. Penetrating probes may be removed by the police in circumstances where leaving them in place may lead to further harm to the subject. Probes that have penetrated the skin may be removed by stabilising the skin surrounding the probe and, while firmly grasping the probe, removing it with rapid traction, ensuring that the shaft and barb elements of the extracted probe are intact (no metal fragments remaining). Clean the skin around the probe exit point with an antiseptic wipe.
Where probes have penetrated in or close to sensitive or high risk areas (such as the eyes, ears, nose, mouth, face, neck, genitalia, spine, hands, feet or joints), doctors should use their judgment and seek specialist advice on probe extraction where necessary. For deeply penetrating probes an assessment of injury to underlying tissue and organs should be made, bearing in mind that the depth of injury in soft tissue may exceed the shaft length due to tissue compression during the initial entry of the probe or if the patient has fallen onto an embedded probe.
A full history must be taken to document any health conditions (for example, cardiac arrhythmias, pacemaker, drug or alcohol use, epilepsy, diabetes, psychological vulnerability). Record any symptoms reported by the subject during or following the use of the CED. Establish from the police and other staff (for example, paramedics) the circumstances around the use of the CED. Consider, for example, mental health issues, extreme acute behavioural disturbance (ABD or ‘excited delirium’), post-ictal confusion or aggression, substance misuse and uncontrolled diabetes. Immediate transfer to hospital is recommended for persons detained after a prolonged or violent struggle or where a state of extreme ABD is identified or suspected. FFLM guidelines on management of ABD in police custody (opens in new window).
A full external examination (including documentation and assessment of the sites of probe penetration or drive stun application) should be undertaken to provide a record of visible injuries. A full cardiovascular, respiratory, musculoskeletal and neurological examination should also be undertaken to identify, or exclude, any CED- associated complications.
Follow clinical guidelines in the event that head injury has been sustained. NICE guideline CG176 on assessment and early management of head injury (opens in new window).
It is unlikely that the TASER would have been used in isolation from other forms of control and restraint actions. Concurrent injuries or effects arising from police use of other forms of force should also be considered during assessment of the patient. FFLM advice on the clinical effects and management of people exposed to CS and PAVA sprays (opens in new window).
The effects of CED discharge on the fetus are unknown; pregnant women should be referred for specialist obstetric review.
All those subjected to CED discharge must be advised to attend their GP or Emergency Department if they have any subsequent concerns. Electrocardiography, x-ray, ultrasound, CT or MRI scans may be indicated depending on the medical assessment.
Revision 3 (dated September 2017) Distributed by the National Police Chiefs’ Council (lesslethalweapons@westmercia.pnn.police.uk).
Document control
- Version: 2.1.
- Unique reference number: 30.
- Approved by: Clinical policies review and approval group.
- Date approved: 3 November 2020.
- Name of originator or author: Advanced nurse consultant.
- Name of responsible individual: Executive director of nursing and allied health professionals.
- Date issued: 5 April 2023.
- Review date: 30 November 2023.
- Target audience: All inpatient clinical staff and people who may come into contact with material contaminated by irritant spray, or have to care of a patient post use of a Taser.
- Description of change: Minor amendment, section 5.2 added as although listed in the index it was not included in the policy when last review in error.
Page last reviewed: April 30, 2024
Next review due: April 30, 2025