Watching the watchhouse

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Australian-first research is assessing the benefit of providing 24-hour emergency nursing care to police watch house detainees, in a bid to reduce the number of transfers between the watch house and hospital. The research is being led by Dr David Green and Associate Professor Julia Crilly and will provide analysis of a Watch House Emergency Nurse (WHEN) model of care of care.

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Background
Funded by the Queensland Emergency Medicine Research Foundation (now the Emergency Medicine Foundation) and the Gold Coast Hospital Foundation, the research is underpinned by recommendations from a coronial inquest following a death in custody in a Queensland watch house. The coronial inquiry stated:
“Almost 100,000 people pass through Queensland watch houses each year. Many of them suffer from serious chronic and/or acute health complaints… Some cautious discernment is needed when determining which prisoners should be transferred to hospital and which should be kept in watch houses. Police are not medically trained… Medically trained staff should be posted in all of the larger watch houses to make initial assessment and to carry out ongoing monitoring and re-assessment.”
– Office of the State Coroner’s report, 2012, p13.
There has been an increase in high-risk activities across the general community, which has led to a subsequent rise in chronic illnesses, violence, homelessness, drug use and criminal activity.
The latest data from the Australian Institute of Health and Welfare shows an increase in emergency department presentations of more than 25% in the past five years, with the proportion of emergency presentations arriving by police increasing by 13% over the same period.
Prisoners are a vulnerable group and often require health care when presenting at police watch houses. Many suffer from mental health problems and engage in risky health behaviours such as smoking, excessive drinking, illicit drug-taking and other behaviours that lead to contracting communicable diseases.
It is essential, however, that these behaviours do not negatively impact the level of health care they receive. The United Nations Basic Principle for the Treatment of Prisoners states:
“Prisoners should have access to the health services available in the country without discrimination on the grounds of their legal situation”
– Principle 9, A/RES/45/111
The current situation
Health care provision can vary between watch houses. The local arrangements for health care provision in one busy Queensland watch house (prior to the trial) included 24/7 access for police to a Forensic Medical Officer (FMO), who provides advice and support, along with on-site contracted domiciliary nurses who work approximately 3-6 hours /day 7 days a week.
FMOs have a large portfolio of responsibility, which includes forensic examination of complaints and offenders (including sexual assault victims), attending death scenes, writing opinions and reports and attending court to give evidence. If the FMO is unavailable to attend the watch house or after-hours nursing care is required, detainees are transported (often by ambulance) to the emergency department in the custody of two police officers.
The research
The Watch House Emergency Nurse (WHEN) model was trialled for 66 days. This model involved emergency nurses from the Gold Coast Hospital supplementing the existing on-site contracted domiciliary nurses so that 24/7 nursing cover was provided in a watch house located in the region.
The WHEN model aimed to provide assessment and management (under FMO supervision) for detainees requiring health care, thereby reducing some of the potential risks associated with watch house detention.
Leveraging the knowledge and skills of emergency nurses, a considerable number of health issues (such as diabetes, wound care, high blood pressure, drug withdrawal) were detected and treated on-site in conjunction with the FMO.
Emergency department nurses have a different set of skills and experience from domiciliary nurses, and these specialised skills are extremely useful in the watch house setting.
The WHEN model also provides emergency department nurses with greater experience and diversity in work duties by allowing them to work outside the traditional hospital environment.
Associate Professor Crilly’s research aims to answer the following questions:

1. What are the characteristics of police and non-police ED patient presentations?


2. What are the characteristics of watch house vs non-watch house police ED patient presentations?


3. Do patient, health service and police outcomes differ before, during and after the WHEN trial?


4. What are the structures required for the WHEN model of care to operate?


5. What are the processes required for the WHEN model of care to operate?

Results
The results of this research are expected later this year. They have the potential to inform policy decisions on health care delivery for emergency departments and improve health assessment and referral practices in the police watch house setting.
There is extremely limited literature available on custodial/forensic nursing, particularly in Australia, and the results of this research are eagerly anticipated.
Results will be published in international and national medical and forensic journals once available.

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“Police are not medically trained…Medically trained staff should be posted in all of the larger watch houses to make initial assessment and to carry out ongoing monitoring and re-assessment.” – Office of the State Coroner’s report, 2012, p13.

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Dr David Green and Associate Professor Julia Crilly
Dr David Green has more than 30 years of Emergency Department clinical experience as well as research experience. In his role as the Director of Emergency Medicine at the Gold Coast Hospital and Health Service, he facilitates and supports research within the Emergency Departments and has successfully received research funds from QEMRF and other sources (such as the Gold Coast Hospital Foundation and government strategic funding). These have resulted in 15 peer-review publications in which he is a lead or co-author, further collaboration with agencies such as the CSIRO and universities such as Griffith University, and capacity building within the Emergency Departments. He has established and had formally evaluated (usually with University partners) innovative models of care within the Emergency Department that have also led to peer-review publications and service refinement/improvements.
Associate Professor Julia Crilly is a PhD prepared registered nurse. She has a strong clinical background, having worked as a registered nurse in the Gold Coast Hospital Emergency Department for nine years before progressing into full-time research in 2007.
Julia is currently in a joint appointment between Griffith University’s Menzies Health Institute Queensland and Gold Coast Health as Associate Professor of Emergency Care.
She has led and been involved in multi-disciplinary and multisite research working with organisations such as the CSIRO, Queensland Ambulance Service, Queensland Police Service and international partners from the USA, UAE, Sweden, South Africa and the UK.