1. Quality Education for a Healthier Scotland Role of the Forensic Practitioner Dr George Fernie LLB MB ChB MPhil FFFLM FRCGP FRCP Edin DFM georgefernie@nhs.net FME Central Scotland Police FME Lothian & Borders Police Honorary Senior Lecturer in Forensic Medicine University of Glasgow Road Traffic Act 1988 (1)

2. Quality Education for a Healthier Scotland PRG recommendations Standardised training Joint training Field Impairment Testing Standardised impairment testing Drug sign recognition Standardised examination form

3. Quality Education for a Healthier Scotland Functions of the Forensic Practitioner Ensure fitness for detention - exclude illness and injury Is there a condition present which might be due to a drug? Determine whether or not there is impairment through drink/drugs If there is no sign of impairment, are the findings still in keeping with earlier impairment? Take a blood sample if required

4. Quality Education for a Healthier Scotland Background information From arresting officers From custody officer From custody record PNC checks Ensure officers familiarity with the procedures

5. Quality Education for a Healthier Scotland Consent Implied Explicit Verbal Written Competence Refusal – make observations

6. Quality Education for a Healthier Scotland History Of presenting complaint and injury Past medical and surgical Psychiatric Educational background Medication –prescribed, OTC, illicit Self harm Time last ate and slept

7. Quality Education for a Healthier Scotland Drug history Prescribed/illicit/OTC Length of usage Route of administration Daily quantity Last dose Injection sites

8. Quality Education for a Healthier Scotland Prescribed drugs Tranquillisers Anti-depressants Anti-psychotics Anti-histamines Narcotics Analgesics Anaesthetics

9. Quality Education for a Healthier Scotland Physical examination Pulse, BP, temperature Examination of eyes - conjunctiva - pupil size - nystagmus Heart, lungs, abdomen Signs of substance misuse Mental state Repeat impairment tests

10. Quality Education for a Healthier Scotland Assessment of mental state Demeanour Orientation Memory - chronology of that day Thought processes Hallucinations/delusions Depression

11. Quality Education for a Healthier Scotland Conclusions Fit to detain and interview? Condition that might be due to a drug? Impairment? Blood/urine option Assist in filling in MGDD/E

12. Quality Education for a Healthier Scotland Conclusions after assessment Condition vs. impairment: No formal definition Doctor doesn’t have to establish impairment What is a condition? – open to debate

13. Quality Education for a Healthier Scotland F97 pro-forma I hereby certify that, in my opinion at the time of examination, the ability of the above named person to drive a motor vehicle was/was not* impaired through drink or drugs. *Delete as required

14. Quality Education for a Healthier Scotland ROAD TRAFFIC ACT 1988 (c) the suspected offence is one under section 3A or 4 of this Act and the constable making the requirement has been advised by a medical practitioner that the condition of the person required to provide the specimen might be due to some drug;

15. Quality Education for a Healthier Scotland Interpretation of Section 7 (3)c of RTA 1988 Condition that might be due to a drug Conclusions drawn from relevant information from suspect or police Can consider the findings of the arresting officer in coming to a conclusion re a ‘condition’ When assessing a person’s clinical impairment, doctor will consider overall condition of the individual rather than rely on a single sign It may be that the doctor feels a condition exists in the absence of abnormal clinical findings on the basis of police officer assessment Stark MM, O’Keefe V and Rowe D Letter to the Editor - JCFM (2000) 7 Page 59

16. Quality Education for a Healthier Scotland Common conditions that may mimic impairment Neurological: - Head injury - Stroke - Cerebral tumour - Multiple sclerosis - Acute vertigo - Fatigue

17. Quality Education for a Healthier Scotland Common conditions that may mimic impairment 2 Epilepsy - Type of epilepsy - ? drug/alcohol withdrawal - Medication - Last dose - Most recent seizure - Status epilepticus

18. Quality Education for a Healthier Scotland Common conditions that may mimic impairment 3 Cardiovascular - Angina or infarction - Hypertension or side-effects of treatment - Arrhythmias - Heart valve problems - Heart block

19. Quality Education for a Healthier Scotland Common conditions that may mimic impairment 4 Endocrine - Diabetes- insulin dependent - NIDDM - hypoglycaemia

20. Quality Education for a Healthier Scotland Common conditions that may mimic impairment 5 Respiratory - Asthma - COPD (bronchitis/emphysema) - Neoplasms

21. Quality Education for a Healthier Scotland Other useful points Breath odour - Alcohol - Cannabis - Solvent - Ketones

22. Quality Education for a Healthier Scotland Nystagmus An abnormal oscillatory movement of the eyes - Congenital - Acquired - Optokinetic - Drug induced ? Part of FIT

23. Quality Education for a Healthier Scotland Needle phobia An increasing problem? Confirmed past history Absence of body piercing Repugnance v phobia Bradycardia Document findings carefully

24. Quality Education for a Healthier Scotland Needle phobia Key points -Distinguish between ‘repugnance’ and ‘phobia’ - Distinguish between ‘unwillingness’ and ‘inability’ - History of the index event - Foreign travel Immunisations? - Body piercing or tattoos? - Dental procedures?

25. Quality Education for a Healthier Scotland Proformas Scotland F97 Faculty proforma in England, Wales and NI www.fflm.ac.uk Please use!