blood borne viral infections
The Impact of
HIV
A recent report in the
publication of the British
Medical Association, The
Lanceti, draws our attention
to an incident of great
interest to Police Officers in
general, and those
responsible for formulating
Generic Risk Assessments
for the Police Service in
particular.
The incident occurred in
Italy. Following a road
traffic accident involving
two vehicles the drivers
became embroiled in a fight
during the course of which
one of the drivers head-
butted the other. The victim
was wearing metal-framed
spectacles and the blow
caused a cut on the forehead
of both victim and assailant.
Both men, as is often the
case with head wounds,
bled copiously. After the
fight it was revealed that the
assailant had a history of
intravenous drug use and
was HIV & hepatitis B and
C positive. Immediately
following the assault the
victim tested HIV negative
but within two weeks
developed symptoms of
primary HIV infection and
within 3 months had tested
positive for both HIV and
hepatitis B.
Analysis of the DNA
pattern of the men’s HIV
infection against a control
sample of mother/infant
HIV carriers from the same
region of Italy, showed that
it was highly probable that
the source of the victims
HIV antibodies was his
assailant. The implications
of this incident for a service
which has frequent dealings
with violent confrontation
and those suffering from
is clear and compelling, and
requires our urgent
attention.
It is therefore timely in this
regard that the service has
adopted the ACPO Personal
Safety Programme’sii,
‘Conflict Resoloution
Model,’ (CRM). The CRM
is an aid to facilitate the
operational officer in
deciding as to the
appropriate level of
intervention in conflict
situations, a structure upon
which to formulate the
decision making process in
a stressful environment. It
is based upon three
platforms which are most
easily visualised as
interlocking circles, each
effecting and impinging on
the other to a greater or
lesser extent dependent
upon which of the factors
are present in the situation
confronting the officer.
The first platform is
Profiled Offender
Behaviour, six levels of
conduct ranging from
compliance to serious or
aggravated resistance. The
next is Reasonable Officer
Response Options, five
levels of intervention open
to the officer from officer
presence alone to the use of
deadly force. The last
platform is Impact Factors,
those elements present in
the situation which
exacerbate or nullify the
need for the use of force.
The list of Impact Factors
given in the CRM is not
exhaustive, nor is it
intended to be exclusive of
other elements which a
situation may present but
which are not mentioned in
the CRM. It is in this area
where we find the
appropriate hook upon
which to hang our problem
1
‘Drug intoxication’ is
already listed as an Impact
Factor due to its effect upon
inhibition, (Making the
subject more likely to fight
or less able to restrain
themselves from so doing
according to your
viewpoint), its status as an
indicator of potential
lifestyle acquired infections
such as HIV in intravenous
drug users is not discussed
but readily understandable.
‘Special Knowledge’ is
another of the listed Impact
Factors, the specific
examples being generally
given as PNC markers for
violence (V) or
weapons(W). The facility
to have markers against
recorded persons as
contagious (C ) already
exists on PNC but is little
used due to the implications
of Data Security and, it
must be said, political
correctness. With the
forthcoming incorporation
of the service under the
auspices of Health &
Safety legislation this is a
pattern of behaviour which
will have to be re-
addressed.
Where an officer is
involved in a confrontation
with a person whom they
know to be the carrier of
blood borne viral infection,
this special knowledge must
form part of the decision
making process in relation
to the appropriate level of
intervention. The same may
be said when the officer is
dealing with a person whom
he suspects may be the
carrier of such an infection
due to the persons drug
intoxication or some other
circumstance, such as the
presence of drugs
paraphernalia, which may
give rise to such a
suspicion. Clearly it will be
impossible to tell in most
cases whether the person
with whom we are dealing
has such an infection or not,
but in most instances it will
clearly be most appropriate
to err on the side of caution.
The presence of blood or
open wounds on an
offender will also be impact
factors which an officer
ignores at his peril.
It is here that the ACPO
programme’s tactical
techniques come to our aid.
Maintaining distance
between the officer and
potential aggressors,
tactical communication and
the use of personal
protective equipment, such
as Incapacitant sprays and
batons, to avoid becoming
embroiled in close contact
with an attacker, becomes
more important than ever
when such an infection is
known or suspected. When
medical advice that the
pulled quick from a
fingernail leaves a wound of
sufficient size for cross-
contamination is
considered, then the case is
all the more compelling.
It is not being suggested
that those suffering from
HIV and the like should, as
a group, be treated more
forcefully than any other
persons. This would clearly
be inappropriate and
unreasonable, however,
when such persons present a
threat to officers on an
individual basis it would be
equally inappropriate and
unreasonable to require
officers to disregard the
possibility of infection
arising from fighting them.
The sole objective of the
police use of force is to
preserve the safety of
officers and innocent
persons by establishing
control, it is to the
appropriate level of policy of the Lincolnshire
intervention in instances of Police. Anyone seeking
individuals with infectious further information may
diseases which this article is contact him at Lincoln
addressed not the treatment Police Station Ph 01522-
of such sufferers as a whole. 882222.
Clearly when dealing with
i
any such person a level of Transmission of HIV-1
intervention will need to be and HCV by head-butting A
assessed as to the best way Brambilla, The Lancet, Vol
to establish control over that 350, November 8, 1997.
ii
individual in those ACPO Personal Safety
particular circumstances. Programme National Police
When a blood borne Training, Harrogate
infectious disease is known, 110697
or suspected, to be present
then the choice of technique
would not ordinarily
include primary control
skills or unarmed defensive
tactics involving direct
personal contact with an
aggressor.
For those responsible for
making Generic Risk
Assessments (GRA) the
area of infection from HIV
and other communicable
diseases is one that will
already have been
addressed. The possibility
of contamination via
confrontational situations is
one that has been generally
missed. If, as appears to be
the case, the incident above
represents an enhanced
statistical possibility of
infection in this area then it
is incumbent upon us to
give it due consideration
when making GRA’s. The
adoption of training in
Personal Safety techniques
and the issue of personal
protective equipment as
control measures should be
incorporated into GRA’s for
those officers and staff
dealing with the public.
James Keenan is a Police
Sergeant and personal
safety instructor with the
Lincolnshire Police. The
views expressed in the
article are his own and do
not necessarily reflect the