Custody healthcare providers vary across the UK, as such each provider has different recruitment criteria.  Most contracts employ a mixture of nurses (Adult and Mental Health) and paramedics.

• Registered with an appropriate professional body (NMC for nurses and HCPC for paramedics)
• At least 3-4 years post registration experience
• Successful applicants will undergo enhanced background and security checks
• Most vacancies are advertised via NHS Jobs

There are several companies providing custody healthcare services with some forces currently employing their staff directly.  The primary healthcare providers are;

• G4S
• CRG Medical Services
• Mitie - Care & Custody
• PHL
• Some NHS Trusts

The exact skill mix of the healthcare team will vary depending on the local health needs assessment.  Custody healthcare is varied and includes a mixture of minor injuries, illness, acute medicine, mental health and substance misuse.  As such, relevant experience includes;

• Accident & Emergency / Emergency Department
• Urgent Care / Walk-in-Centre 
• Minor injuries/illness experience
• Acute mental health
• Community mental health 
• Prison nursing
• Substance misuse
• Acute medicine
• Frontline ambulance paramedic
• Emergency care practitioner

Most important is a solid clinical background, ideally with experience of more than one of the above. UKAFNP recommends that anyone interested in becoming a custody nurse or paramedic  UKAFNP (see membership page) to be able to access the UKAFNP Knowledgebase.  To give you additional information, that may give you the advantage in an interview.  The role of custody nurse/custody paramedic is unsuitable for the newly qualified.

Custody nurses and custody paramedics work independently and autonomously at an advanced level; that is, they work beyond the level of their initial qualification. The work is varied and complex and can be challenging. Custody nurses and custody paramedics must diagnose and treat individuals presenting with a broad range of undiagnosed and undifferentiated conditions.  As well as dealing with long-term conditions.  The below is a list of commonly undertaken tasks; it is by no means exhaustive;

• Assessing fitness to be detained in police custody and recommending a level of observation
• Assessing fitness to be interviewed by police and recommending, where appropriate, safeguards such as appropriate adults
• Undertaking detailed examination of an individual, forensically documenting any injuries
• Conducting forensic samples such as;

Blood samples;

For drug and/or alcohol toxicology

For Road Traffic Act Offences

Hand and nail swabs

Cutting and combing head hair or pubic hair

Taking swabs of the penis in some rape cases

• Assessing the need and verifying a detainee’s medication, ensuring that it is available in a timely and appropriate 
• Prescribing medication or administering medication using Patient Group Directions (PGD)
• Assessment of drug and alcohol intoxication and withdrawal
• Assessment and management of minor injuries
• Responding to medical emergencies
• Assessing mental state, mental health, suicide and self-harm risk.
• Assessing individuals following a Taser discharge
• Referring to appropriate services;

Doctor or Forensic Medical Examiner (FME)

Crisis assessment teams

Liaison and diversion

Hospital

Approved Mental Health Practitioners (AMHP)

Child and Adolescent Mental Health Services (CAMHS)

General Practitioner

Social Services (including safeguarding referrals)

Police custody suites are staffed with various staff, including Police Constables, Sergeants and civilian detention officers.  Because of the proximity of police staff, custody nurses and custody paramedics are probably safer in custody than nurses working in Emergency departments or front-line paramedics.  

All healthcare providers are required to provide role-specific induction training and period of supervision for new custody nurses and custody paramedics. The specifics will vary between providers. The role lends itself to further studies in;

• Minor illness/injuries
• Non-Medical Independent Prescribing
• Mental health, Mental disorder and Mental capacity
• Substance misuse, such as the RCGP Part I and II
• Clinical examination and physical assessment skills
• UKAFNP’s ASET (Advanced Standards in Education & Training)
• Licentiate of the Faculty of Forensic & Legal Medicine (LFFLM) – General Forensic Medicine (GFM) – Part I & II
• Resuscitation Council’s Immediate Life Support

The majority are band 6. UKAFNP firmly believes that the role of the custody nurse/custody paramedic should be a minimum band 6 and is lobbying NHS England to include this within their specification.

Custody nurses and custody paramedics working in police custody are likely to have to attend Court at some point.  Custody nurses and custody paramedics are required to prepare high-quality statements for the Court based on their assessments, observations or forensic examination.  Where a statement is insufficient alone, evidence may be given in person in Court.  Custody nurses and custody paramedics provide professional witness evidence and not expert opinion or evidence.

Click on the contact link. Complete the sections and you will be contacted by a UKAFNP steering group member specialising in that area.

The literature on custody nursing and custody paramedics is thin, but it is starting to grow.  Here is a list of available resources.

Articles

• Payne-James, J. (2017) Healthcare and forensic medical services in police custody – to degrade or to improve? Clinical Medicine.  17(1).  6-7. Click here
• Holman, A. (2014) Cops, robbers … and nurses.  Nursing Times.  110 (36).  25.
• Metro (2010) Taken in by custody.  Click here.
• McKean, S. (2013) The forensic paramedic: an outline of the role and essential criteria for the job.  The Journal of Paramedic Practice.  5 (10).  588-590.
• Peel, M. (2015) Assessing fitness to detain in police custody.  Nursing Standard.  30 (11).  43-49.

Books;

• Norman, A. & Walsh, E. (2014)  Nursing in Criminal Justice Services.  Cumbria: MK Publishing.

You should be a nurse, midwife or paramedic with more than three years of post-registration experience.  Ideally, have a sexual health background or experience in gynaecology (A background where you are competent and experienced in the use of a Speculum). Companies that employ Forensic Nurse/Midwife/Paramedic Examiners:

• G4S
• Mountain Health Care
• Some NHS Trusts

Forensic Nurses/Midwives/Paramedics can have full flexibility in their work. There are opportunities for full or part-time contracted hours that usually cover office hours. There is also the opportunity for zero hours work that covers bank holidays, evenings and weekends.

Forensic Nurses/Midwives/Paramedic Examiners vary in their competencies.   It is usual practice to become competent at examining post-pubertal adult women before progressing to become competent at examining men and in some areas examiners have the opportunity to expand their competency to examine post-pubertal adolescents (age 13 and up).

The role of the Forensic Nurse/Midwife/Paramedic Examiner is to collect evidence from clients that have been raped/sexually assaulted within a forensic time frame and to provide immediate after care (i.e. Emergency Contraception; Post Exposure HIV treatment and referral on to appropriate follow-up services including Independent Sexual Violence Advisors and Genito-Urinary Clinics).  The work requires focus and attention to detail. If you don’t have a good support network amongst your colleagues and at home or access to counselling when you require it, it can be stressful.  You may wish to reconsider this type of work if you have other stress factors in your personal life.

While collecting forensic exhibits you need to have a level of detachment from the distress of the client which you can only gain through experience in the role. As nurses, our instinct is to be “nursey”, where as a Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE) role is to balance the nurse role with forensic integrity ensuring not only the collection of exhibits but also documentation and to evidence throughout that you are non-judgmental and unbiased.  Hence the client is referred to as the “complainant” and not the “victim”.

No Forensic examiner should practice without training and Stafford University offer the Advanced Forensic Practice Course and is the first University in the country to provide forensic training for nurses:

• Examination of female / male genitalia (case dependent / based on alleged assault/incident) Recording of DVD genital examinations with Consent (all children aged 16 and under and any case where genital injuries are seen on examination)
• Referral to other health care professionals, agencies as required
• Maintain Contemporaneous notes
• Body mapping
• Photograph injuries
• Gather evidence (forensic) case dependent
• Submit evidence to the Police Peer
• Review cases examined with Clinical Supervisor (allocated Dr)
• Attend team meetings, participation in these and peer reviews
• Training and input for Sexual offence training Police officers courses at the Constabulary Head Quarters
• Answer phone calls/queries from police for advice re cases or victims they have seen
• Answer calls and offer advice to health care professionals concerning sexual assault/rape.
• Examination of Self-referrals to include storage of samples, specimens, etc
• Provided statements as requested top Police
• If required and called attend Court
• Maintain own clinical credibility keep up to date with own training and clinical needs in line with NMC maintain registration, training and development
• Attend own clinical supervision

This variable as it is a service that is often run by private companies although there are areas where the nurses are employed directly by the NHS.  Often pay, and grading is comparable with a Band 6/7 on the AfC scale.

All healthcare providers are required to provide role-specific induction training and period of supervision for new Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE).  The specifics will vary between providers.  The role lends itself to further studies in;

• Minor injuries
• Non-Medical Independent Prescribing
• Mental health and suicide risk assessment
• Clinical examination and physical assessment skills
• Sexual health studies
• Safeguarding studies
• Licentiate of the Faculty of Forensic & Legal Medicine (LFFLM) – Sexual Offences Medicine (SOM) – Part I & II.  Previously referred to as the DFCASA.

There is no accurate figure for the number of Nurses and Paramedics trained in the Sexual Assault Examination.  But what is clear is that many of today’s Sexual Assault Examination healthcare providers are taking on more and more nurses and paramedics.

Your first port of call would be UKAFNP. Click on the contact link. Complete the sections, and you will be contacted by a UKAFNP steering group member that specialises in that area.  As it is such a unique speciality, forensic nurses feel supported by this organisation.

Your other option would be to contact your nearest Sexual Assault Referral Center (SARC) and speak to the SARC Manager for advice and information on what vacancies are available.

Yes you will be cited for court on numerous occasions. You would attend as a Professional witness to provide a witness/statement of factual evidence, based on the clinical notes you made at the time of your assessment of the complainant.  You will not be appearing as an expert witness.

The literature on is thin, but it is starting to grow.  Here is a list of available resources.

Articles;

• Cowley, R., Walsh, E. & Horrocks, J. (2014) The role of the Sexual Assault Nurse Examiner in England: nurse experience and perspectives.  Journal of Forensic Nursing.  10(2).  77-83.
• Day in the Life; Forensic Nurse Examiner.

Books;

• Hammer, R. (2004) Forensic Nursing: A Handbook for Practice.  Canada: Jones and Bartlett Publishers.
• Lynch, V. & Duval, J. (2010) Forensic Nursing Science.  2nd Edition.  Missouri: Elsevier.
• Norman, A. & Walsh, E. (2014)  Nursing in Criminal Justice Services.  Cumbria: MK Publishing.