Medical Problems

Several common medical problems are encountered when the doctor is assessing fitness to be detained in police custody. These are now considered in more detail (Table 3). Alcohol and drugs are fully discussed in Chapter 10.

4.1. Epilepsy

Many detainees state that they have "fits" and there is a need to differentiate, if possible, between epilepsy and seizures related to withdrawal from alcohol or benzodiazepines; it is also important to consider hypoglycemia.

The type of seizure should be ascertained, together with the frequency and date of the most recent one. Medication details should be, obtained including time of the last dose. Treatment may be given if the detainee is in possession of legitimate medication; however, if he or she is intoxicated with alcohol or other central nervous system-depressant drugs, treatment should generally be deferred until the detainee is no longer intoxicated.

The custody staff should have basic first aid skills to enable them to deal with medical emergencies, such as what to do when someone has a fit. If a detainee with known epilepsy has a seizure while in custody, a medical assessment is advisable, although there is probably no need for hospitalization. However, if a detainee with known epilepsy has more than one fit or a detainee has a "first-ever" fit while in custody, then transfer to a hospital is recommended.

Table 4 Signs of Acute Asthma

Parameter

Severe

Life-threatening

Pulse rate Respiratory rate PEFR

>110/min

>25/min

Bradycardia

<33% predicted Hypotension

Blood pressure Speech

Chest auscultation Mental State

Pulsus paradoxus

Inability to complete sentences

Agitation Restlessness

Silent

Exhaustion Confusion Coma

Diazepam intravenously or rectally is the treatment of choice for status epilepticus (11). Any detainee requiring parenteral medication to control fits should be observed for a period in the hospital.

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