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
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.
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.
Try to obtain a history of what and how much has been concealed
Domestic abuse can affect anyone and often its not readily disclosed on an ED admission. We must be alert to the fact some of our patients may be attending with domestic abuse. Please explore concerns and escalate if you’re unsure. Our colleagues in the Pennine Domestic Violence Group have kindly drawn this a guidance up for us.
Unfortunately under 1 year olds are at a higher risk of NAI and this needs to be considered in ALL presentations. But remember if the child can’t Crawl/Stand/Cruise/Walk they shouldn’t injure themselves.