Category: Safe-Guarding

Mental Capacity Act (2005)

Applies to all over 16’s

Principles

  1. Everyone is presumed to have capacity – until a lack of capacity has been established
  2. All practical efforts have been made to help patient make a decision
    • Explain decision and options as clearly and concisely as possible (be flexible)
    • Make every effort to help the person understand (language line, writing, etc.)
    • Are there others who might help them understand? (nursing, medical, family, freinds)
  3. People are free to make an unwise decision
  4. Anything done under the act MUST be in the patients best interest
  5. Carefully consider what is the least restrictive option

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Concealed Illicit Drugs

Background

Those suspected of concealing illicit drugs often present near ports and borders however they can present to any ED or be brought in by the police.

Body Packers – Swallow large quantities of well packaged drugs to smuggle them into countries or institutions.  These are often well manufactured with a low risk of rupture but the potential for serious toxicity if rupture occurs.

Body Stuffers – Swallow small quantities of poorly packaged illicit substances often at the point of arrest to conceal them. These have a much high risk of package rupture but involve smaller quantities of substances.

 

Investigations

Authorisation for an intimate search or radiological investigation must come from an inspector or higher with written consent from the patient.

Intimate searches must be carried out by a police surgeon but require immediately available resuscitation facilities therefore may be conducted in the ED. ED physicians should not handle the drugs at any time.

AXR or low dose CT scanning can be used to detect concealed packages in Body Packers.

 

General Management

Try to obtain a history of what and how much has been concealed

Look for toxidromes suggestive of package leak – treat as per Toxbase

  • Cocaine: Tachycardia, hypertension, agitation, diaphoresis, dilated pupils, hyperpyrexia, seizures, chest pain, arrhythmias and paranoia.
  • Heroin: pinpoint pupils, respiratory depression, decreased mental state, decreased bowel sounds
  • Amphetamines : – Nausea, Vomiting, Dilated Pupils, Tachycardia, Hypertensions, Sweating, Convulsions and the development of non-cardiogenic pulmonary oedema

 

Toxicology screens (urinary/blood) should not be used to guide management or discharge decisions (Level 5 evidence).

 

Body Stuffers & Pushers should be observed for signs of toxicity for a minimum 8 hours, consider activated Charcoal

Body Packers with positive imaging who are asymptomatic can be discharged back to police custody for monitoring. Bowel preparation such as Cleanprep or movicol can be used.

 

Body Packers with signs of cocaine or amphetamine toxicity or signs of obstruction/ileus require urgent surgical intervention.

Body packers with signs of Heroin toxicity should be treated with Naloxone infusion as per toxbase guidelines

All patients transferred to police custody should receive a discharge letter, including
Suspected Internal Drug Traffickers.

 

Algorithms

 

 

 

Full RCEM Guide

Underage Sexual Activity

This applies to all children/young people under 16 years old and those 16-18 years who are considered vulnerable, engaging in sexual activity. Getting this right is immensely challenging, as it is impossible to cover all variables influencing decision making within this guidance, further more you need to carefully weight the often conlicting needs of the child. (Involve seniors early if you have any doubts) Read more

Rape & Sexual Assault

Don’t

Preform intimate examinations on Sexual assault/Rape patients

  • Unless life-threatening injuries are suspected e.g Haemorrhage.
  • As our examination will inevitably destroy evidence that may aid this patient’s case

Do’s

  • Consider contamination injury (HIV, HepB, HepC) – Guide
  • Consider emergency contraception
  • Children must have police referral for safeguarding
  • Refer to The Sexual Assault Referral Centre, either via Police or Self referral

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Are You CO Aware?

With the onset of colder weather, many households in the UK are turning on their heating for the first time in months. Heating appliances need chimneys and flues to work safely – and these can block up over the summer months. So autumn is traditionally the period when people get poisoned by carbon monoxide (although it can happen any time of the year!)

Carbon monoxide (CO) is produced when anything containing carbon burns or smoulders. For practical purposes, this means the burning of any kind of fuel, commonly:

  • Gas
  • Coal
  • Wood/Paper/Card
  • Oil/Petrol/Diesel – (All UK cars have a ‘catalytic converter’ in the exhaust system, which converts carbon monoxide (CO) to carbon Dioxide (CO2), which is less poisonous. However, these converters need to warmed up – a cold car produces fatal amounts of CO in the exhaust)

CO is very poisonous. Exposure to as little as 300 parts per million (that’s just 0.03%) can prove fatal.

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Paeds Liaison Form – EPR

The Paediatric Liaison Form (PLF is now part of EPR – how to guide)

This form alerts the Paediatric Liaison Team to your concerns so that they can investigate and provide appropriate support to the child & family.

You SHOULD inform the family that you are completing the form as the Paeds Liaison Team or other agencies (e.g. social services or school nurse)may contact them.

You SHOULD NOT use this form for patients who have either suffered or at risk of significant harm. In this case you should discuss directly with the paediatric consultant on-call.

PDF: Paediatric Liaison Form

PDF: Safeguarding Guide