Jason Payne-James

Violence in clinical forensic medicine.

Objective: to investigate the levels of physical and verbal violence experienced in the preceding year by doctors working in clinical forensic medicine. Design and subjects: anonymised questionnaire sent to all full members of the Association of Police Surgeons. Results: 517 eligible questionnaires were returned; 18.2 per cent of respondents had experienced physical violence, a total of 150 incidents. Of those incidents ‘warning signs’ of violence had been present in only 25 per cent. A total of 54 working days were lost. Injuries included a fractured wrist and corneal scarring. Of the respondents, 65.5 per cent had experienced verbal violence (of which the most common type was obscenity); 11.8 per cent had received training in dealing with verbal violence and 10.4 per cent in dealing with physical violence; 88 per cent believed that training on how to deal with violence should be part of police surgeon/forensic medicine training. Conclusion: verbal and physical violence are common in clinical forensic medicine. Training in dealing with these issues should be introduced.

Effects of incapacitant spray deployed in the restraint and arrest of detainees in the Metropolitan Police Service area, London, UK: a prospective study

PurposeIn the United Kingdom (UK) police restraint and control of detainees is undertaken by assorted means. Two types of incapacitant spray (IS) are approved by the UK Home Office for use: CS (o-chlorobenzylidine malononitrile, dissolved in an organic solvent—methyl iso-butyl ketone and pelargonic acid vanillyamide (PAVA). The aim of this study was to document the effects of incapacitant sprays, by symptom assessment and medical examination, within a few hours of deployment.MethodsA detailed proforma was produced to explore the nature of the arrest, the nature of exposure to the incapacitant spray, the type of incapacitant spray, the symptoms experienced and the medical findings.Results99 proformas were completed. 74xa0% were completed by detainees and 26xa0% were completed by police officers. 88xa0% were exposed to CS spray, the remainder to PAVA spray. The mean time of assessment after exposure was 2.8xa0±xa02.33xa0h (meanxa0±xa0SD). The most frequent sites of IS contact were the face and scalp (nxa0=xa078), and exposure to the left and right eyes (nxa0=xa032). The most common symptoms were: painful eyes (nxa0=xa068); red eyes (nxa0=xa058); runny nose (nxa0=xa059); lacrimation (nxa0=xa055); nasal discomfort (nxa0=xa052); skin irritation (nxa0=xa049); and skin burning (nxa0=xa045). The most common medical findings were: conjunctival erythema (nxa0=xa034); skin erythema (nxa0=xa021); and rhinorrhea (nxa0=xa020).ConclusionsSymptoms and signs of exposure to IS lasted longer than was expected (a mean of 2.8xa0h). Approximately 30xa0% of those exposed had ocular effects and 20xa0% had skin effects. The findings of this study will enable the guidelines on the expected effects and duration of symptoms resulting from exposure to incapacitant sprays to be reviewed and suggestions for their management to be refined.

Injury Assessment, Documentation, and Interpretation

Assessing, documenting, and interpreting injuries or scars which have been xadsustained as a result of trauma or violence is one of the key roles of any forensic physician or forensic pathologist. Crimes of violence – for example inter-personal, part of armed conflict, or accident, or terrorism, occur globally. Although crime in general is decreasing in the UK, the incidence of serious violent crime is stable and some (such as sexual assault) is increasing in incidence [1]. Nonjudicial assault (such as torture) has also become more widely recognized and documented [2]. This chapter addresses the issues of physical assault and the assessment and documentation of wounds, scars, or injury. It has been suggested that the definition of physical injury in the forensic medical context should be “damage to any part of the body due to the deliberate or accidental application of mechanical or other traumatic agent” [3]. The latter term would include agents such as heat or cold.

Healthcare and forensic medical aspects of police detainees, suspects and complainants in Europe

Death and harm is well-recognised in detainees in police custody worldwide. Based on the results of previous global surveys and the CPT (European Committee for the Prevention of Torture) recommendations a questionnaire was developed to summarise the current medical aspects of police custody in European countries. The survey was distributed to named contacts in all European countries. Data from 25 European countries was obtained. The results reveal significant differences in the regulations among the different countries, with nothing close to a harmonised European standard in place at present. This study has identified interesting variations in the methods and standards of healthcare and forensic medical services to detainees in police custody (e.g. quantitative mode of monitoring, qualification of the doctors, maximum time allowed for holding a detainee in police custody, body or an organisation that investigates complaints against the police). There are both very detailed legal regulations in some countries while in others there are only generally observed provisions that sometimes are only given in the form of recommendations. A multinational, multiprofessional expert group is required to identify best practices, recommend basic standards of care and identify qualifications which would be appropriate for healthcare professionals working in this field.

Provision of clinical forensic medical services in Australia: A qualitative survey 2011/12

The provision of clinical forensic medicine services is dependent on jurisdiction and relevant legal instruments. A needs analysis was performed to understand the current service provision within NSW and compare and contrast the service with other jurisdictions in Australia. The aim of this study was therefore to identify the roles, functions and clinical forensic medical services currently provided in the different Australian jurisdictions.

Current practice in forensic medicine

Current practice in forensic medicine , Current practice in forensic medicine , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

Clinical Forensic Medicine: History and Development

The term “forensic medicine” is now used to embrace all aspects of forensic work of a medical nature. In the past, the term was often used interchangeably with “forensic pathology” – the branch of medicine which investigates death. Nowadays the phrase “clinical forensic medicine” is properly applied to that part of medical practice whose scope involves interaction between the law, the judiciary, and the police involving (generally) living persons. Clinical forensic medicine is a term that has become widely used only in the last three decades or so, although the phrase has been used at least since 1951 in the UK, when the National Association of Police Surgeons (which became the Association of Forensic Physicians in 2003 till its demise in 2006) was first established. The absence of a clear medical specialty of clinical forensic medicine has resulted in practitioners of clinical forensic medicine being given many different descriptive names over the years. The term “forensic physician” (FP) is now widely accepted. Police surgeon, divisional surgeon, forensic medical officer (FMO) and forensic medical examiner (FME) are examples of other names or titles that have been used to describe those who practice in the specialty of clinical forensic medicine, but names such as these refer more to the appointed role than to the work done. Worldwide, there are many who are involved in both clinical and pathological aspects of forensic medicine.

Aggression against doctors

Professor Hobbs and Dr Keane (February 1996jRSM, pp69-72) say that core services such JS accident and emergency and out-ofhours general practice are especially threatened by aggressive individuals. We would add forensic physicians. These are independent doctors who provide medical care and forensic assessment of prisoners and suspects in police custody. Most forensic physicians are general practitioners providing apart-time service; a few doctors, mainly those working in busy metropolitan areas, work exclusively in this increasingly complex sphere of medicine. Many of the examinations performed in the custodial setting of the police station are related to assault, alcohol, drugs and mental disorder! and may therefore place the doctor at higher risk of experiencing aggression. We enquired about physical and verbal violence experienced by forensic physicians in the preceding year-. Of the respondents 65.5% had experienced verbal violence and 18.2% had experienced physical violence. Injuries included a fractured wrist and corneal scarring, and a total of 54 working days had been lost. Interestingly, only in a quarter of cases had warning signs of impending violence been present. In 71% of cases a police employee was acting as a chaperone when actual physical violence occurred, therefore the presence of a chaperone may not prevent an assault. Only between 10% and 12% of the forensic physicians had received training on how to cope with verbal or physical violence and 88% believed that training should be part of the initial training programme for forensic physicians. Training is included in the Durham course for new police surgeons but not as yet in the London Metropolitan inital training course. The education and research subcommittee of the Association of Police Surgeons are considering how such training can be introduced.

Confidentiality & consent in police custody: General principles

The care of detainees (prisoners) in police custody has had much focus in recent years. The nature of the role of the doctor or other healthcare professionals within the police custodial setting may often be subject to conflicts, but their respective duties as healthcare professionals should generally overide any police or forensic issue that may be relevant. The laws or rules or statute that govern doctor, nurse or paramedic practice may vary from country to country, but the broad principles of healthcare ethics are universal and have been formulated not only by national healthcare regulatory bodies but by international organizations such as the World Medical Association. This article discusses in particular the duties of consent and confidentiality within the police custodial setting, giving examples of where conflicts may arise, and how they should be dealt with.

Deliberate Self-Harm Patterns: Patterns of Injury

Presentations of deliberate self-harm or self-injury are not uncommon and may range from the trivial to the severe and fatal. For the forensic physician, who sees an often unique group of potential self-harmers within the medicolegal system, the question of deliberate self-harm may be challenging. This chapter discusses the classical features of physical injuries encountered and of how a determination may be made as to whether or not the injuries may the result of deliberate self-harm.