A tiered healthcare system for persons in police custody - the use of a forensic nursing service

In February 1992 the healthcare programme for persons held in police custody within the Melbourne metropolitan area was restructured. This was undertaken as a joint exercise between Police, the Health Department and the Office of Corrections as a response to the need to develop an efficient and cost effective healthcare delivery system. A tiered medical response was instituted, utilising a forensic nurse for the primary medical contact with forensic physicians providing medical consultation and support as necessary. Criteria were developed regarding the delineation of duties appropriate for the forensic nurse and for the forensic physician. The nurses were provided with transport, communication and basic medical supplies enabling a flexible response to requests for medical attention and for the nurse to perform triage, a basic medical assessment and administer appropriate treatment. Over the 15-month period since inception over 3000 consultations have been performed by the forensic nurses. The service has been commended by police, doctors working in the prison system, forensic physicians and community groups. A comprehensive review has demonstrated the efficiency and reliability of such a service. Costs in providing the service have not increased. We conclude that a forensic nursing service is of considerable benefit in complementing a range of services provided by forensic medical officers in a metropolitan setting.