01-03 Medical Advisory Notes

Question 1

When attending a scene where the risk of contact with blood or body fluids exists, members shall exercise extreme caution and use universal precautions. These include, but are not limited to..

Answer 1

wearing of disposable examination gloves (nitrile), using waterless antiseptic wash or hand wipes, and using a disposable one–way air valve for mouth to mouth respiration.

Question 2

the most important infection control measure for the prevention of self and cross contamination

Answer 2

Hand washing

Question 3

Where it is suspected or known that a person is a carrier of an air–borne transmitted disease such as tuberculosis members shall

Answer 3

 shall when at a police station, place the person in an area where adequate ventilation exists. Members shall not place a person suspected or known to have tuberculosis or other air–borne transmitted communicable diseases in areas with little or no ventilation, such as interview rooms
 should wear surgical masks when in close contact with the person and when transporting the person to a police station or other location. Where possible, the infected person should also be asked to wear a surgical mask when in close contact with other individuals. If surgical masks are not available or the infected person refuses to wear a mask, members shall transport the person as the sole occupant of a compartment of a prisoner transport vehicle, or, if not available, with a window of the police vehicle open.

Question 4

When considering the need for further medical attention, the Officer in Charge should be cognisant of some circumstances which may impact on the health of the individual

Answer 4

 where a drug that is not designed to be swallowed has been swallowed by an individual (i.e. for the purpose of concealing or transporting), or held in the mouth in such a way that the drug is exposed (e.g. no wrapper, or damaged wrapper)
 where the individual cannot, declines or fails to recall what substances (whether prescribed or non–prescribed), quantity, or when the substances were taken
 where the quantity of drugs taken suggests a possible overdose (i.e. more than prescribed)
 where any drug has been taken in conjunction with alcohol
 where the individual is acting irrationally or aggressively, appears ill, is complaining of pains, nausea, etc., or reports feeling differently than other times when they have taken the same drug
 where cocaine has been used by the person, and the person has had to be physically restrained, or has exerted themself physically (e.g. foot pursuit, struggle, etc.)
 where the prisoner exhibits an unexplained change in behaviour (e.g. becomes aggressive, lethargic, sleepy, etc.)

Question 5

The following services are available at no cost to assist the Officer in Charge in making a determination as to whether a prisoner is in need of further medical treatment. These services may be used where the Officer in Charge requires further information (e.g. effects of drug interaction) to complete their assessment of the individual

Answer 5

 Telehealth Ontario (1–866–797–0000, TTY 1–866–797–0007) – provides quick easy access to a qualified health professional (registered nurse) who can assess the symptoms of the prisoner and offer advice as to whether the individual is in need of immediate hospital care. Depending on the number of people making use of this service, a representative may have to return your call. When leaving a message, for faster service, ensure you identify yourself as a police officer seeking advice regarding a prisoner who has taken a drug prior to arrest.
 Ontario Regional Poison Information Centre – SickKids Hospital (416–813–5900 or 1–800–268–9017, TTY 416–597–0215 or 1–877–750–2233) – can provide information regarding drug interactions, and potential overdose information. If the concern to be addressed deals only with an interaction or potential overdose, call this service directly; otherwise contact Telehealth Ontario first.
- When there is a delay in receiving the required information from the above mentioned services, the prisoner shall be continuously monitored until the information requested is received and the Officer in Charge has made a final determination whether to accept the individual at the police facility.

Question 6

Individuals who have taken hard drugs such as cocaine, heroin, etc., shall be monitored more closely for at least…

Answer 6

3 hours from the time when the drug was taken.

Question 7

Alcohol Withdrawal Syndrome (AWS) is characterized by

Answer 7

physical and mental symptoms that can occur after a person discontinues consuming high doses of alcohol. Symptoms of AWS may appear within 6 – 12 hours after a person’s last consumption of alcohol. AWS more commonly affects those with a history of alcoholism and/or those who have experienced problems with alcohol withdrawal in the past.

Question 8

AWS Symptoms can depend upon..

Answer 8

the amount of alcohol consumed, frequency of consumption, and the duration of consumption prior to discontinuance. Determining a “time-stamp” as to a person’s last consumption of alcohol is important in assessing the onset of AWS.

Question 9

AWS Mild Symptoms

Answer 9

 tremors (trembling or quivering)
 anxiety
 sleep disturbance (insomnia)
 sweating (diaphoresis)
 over responsive reflexes (hyperreflexia)
 nausea/vomiting
Mild symptoms can occur within 24 hours after discontinuance and should subside within 48 hours.

Question 10

AWS Moderate Symptoms

Answer 10

 intensified Mild Symptoms
 rapid breathing (tachypnea)
 racing heart rate (tachycardia)
 agitation
Moderate symptoms can occur within 24 – 36 hours after discontinuance and should subside within 48 hrs.

Question 11

AWS Severe Symptoms

Answer 11

 severely intensified Mild and/or Moderate Symptoms
 hallucinations
 seizures
 disorientation
 abnormally high fever (hyperthermia)
Severe symptoms can occur within 48 hours after discontinuance and/or after a decrease in consumption of alcohol and can cause a person’s condition to deteriorate to a very serious condition known as delirium tremens (DTs).

Question 12

Symptoms of DTs usually occur 48 – 72 hours after discontinuance and include:

Answer 12

 profoundly intensified Mild, Moderate, and/or Severe Symptoms
If left untreated, DTs can result in death.
- The time frames for the onset of AWS symptoms have been generalized. Symptoms occurring outside of the time frames (before and after) must still be considered (e.g. Seizures may present between 12 – 60 hours after a person’s last consumption of alcohol).

Question 13

A diabetic suffering a reaction from low blood sugar will exhibit behaviour normally apparent in

Answer 13

an intoxicated person, such as confusion, unsteadiness, profuse perspiration or other unusual behaviour.
In such cases, a diabetic shall be given a soft drink containing sugar, sweetened orange juice, chocolate bar or candy containing sugar. After consuming the item, the diabetic must be immediately transported to the nearest hospital.

Question 14

Excited delirium is a condition that can be caused by drug or alcohol intoxication, psychiatric illness or a combination of both. Symptoms displayed by individuals suffering from this condition may include any combination of

Answer 14

 abnormal tolerance to pain
 abnormal tolerance to pepper spray
 unexpected physical strength
 violence towards others
 shouting
 sweating, fever, heat intolerance
 sudden calm after frenzied activity
 bizarre or aggressive behaviour
 impaired thinking
 disorientation
 acute onset of paranoia


Question 15

Methadone is a synthetic opioid used as a replacement therapy for narcotic addiction. Treatment is obtained only by prescription and the prescribed dosage varies between individuals. The short–term (24 – 36 hours) effects of abstinence from methadone by a patient are….

Answer 15

not life–threatening, although the patient may show signs of anxiety.

Question 16

Individuals who bring a prescribed dosage of liquid methadone with them into custody (called a ‘carry’) shall

Answer 16

not be given the medication. The risk of an adulterated sample being brought into custody presents too great a health danger to allow such dosages to be consumed by prisoners.