Clinical vs Custody Authority — Prehospital Reference

01 Core legal basis — checklist

Tick off as reviewed. These are the pillars the whole position rests on.

Common law duty of care (negligence)

Once a registered clinician begins assessment/treatment, a direct duty of care exists to that patient. This duty is not discharged or transferred by a third party's instruction (e.g. a police officer telling the crew to wait). If harm follows a delay, "we were told to wait" is not a defence for the clinician or Trust — clinical judgement, not rank or instruction, sets the standard.

Common law Bolam / Bolitho standard applies

PACE Code C — health needs take priority

Code C (statutory Code of Practice under the Police and Criminal Evidence Act 1984) governs detention, treatment and questioning of persons in police custody. Its own internal logic makes medical need override custody processing — e.g. detainees who cannot be roused must immediately be treated as a medical emergency, and use of custody as a "place of safety" is only for exceptional circumstances with health needs always coming first.

This is the strongest citable document at scene — GMP, LAS and NWAS custody-liaison protocols are all built downstream of it.

PACE Code C 2023 — gov.uk

PACE Code C, Annex H — rousing / medical emergency

Annex H requires that if a detainee fails to meet the specified rousing criteria, an appropriate healthcare professional or an ambulance must be called. College of Policing guidance reinforces this: if a detainee cannot be roused, they should immediately be treated as a medical emergency — full stop, no discretion to "wait and see."

IOPC recommendation re: Annex H — policeconduct.gov.uk

HCPC Standards of Proficiency / Conduct, Performance and Ethics

As the registered professional physically present, the paramedic is the one legally accountable for the clinical decision. Police officers hold no clinical qualification and have no statutory mechanism to override a treatment or conveyance decision. Deferring a clinical decision to a non-clinician's instruction is itself a professional standards issue for the registrant who does it.

Professional regulation

Arrest ≠ clinical authority

An arrest under PACE gives police lawful grounds to retain custody of the person (so they don't leave, and evidence/continuity is preserved). It does not, in itself, create any power over what treatment that person receives or when. The detained status has to be managed around the clinical decision — travelling with the crew, following to ED, arranging continuity — not the other way round.

PACE 1984, ss.24–30 (arrest powers)

Outside arrest/detention: police have no authority over the patient at all

If there is no arrest, no s135/136 detention, and no other specific statutory power in play, an officer at scene has the same standing as any member of the public with respect to the patient. Their remaining powers (scene control, evidence preservation, public order) relate to the environment, not the person.

02 Mental Health Act — the one genuine grey zone

MHA s135/136 is the exception worth knowing cold, because the officer is the one who lawfully instigated the detention.

s136 (public place detention)

Officer detains under s136 → must request an ambulance. Ambulance service is required to transport all s136 detentions. It is for paramedics to decide, having assessed the individual, whether they go directly to ED or to a place of safety — police custody should only be used in exceptional circumstances, health needs always come first.

MHA 1983 s136 National Ambulance s136 Protocol 2014

s6 / s137 (post-AMHP application)

Once an Approved Mental Health Professional (AMHP) completes an application, s6 gives authority to detain and convey; the patient is then in the AMHP's legal custody under s137. That authority can be delegated (often to police), and reasonable force may be used as necessary and proportionate — but this is a distinct, formally-triggered legal status, not a general police power.

MHA 1983 ss.6, 137

Rousing failure under detention (Annex H, again)

If a detainee under s135/136 can't be roused, or a registered medical practitioner assesses they are not mentally disordered, they must be immediately discharged from that detention — the medical assessment directly ends the legal basis for holding them, not the other way round.

PACE Code C 2023, para 3.16

03 Who controls what — quick table

Domain	Who decides	Basis
Treatment / clinical priority	Registered clinician (you)	Common law duty of care, HCPC standards
Conveyance destination & timing	Registered clinician (you)	Common law + PACE Code C priority on health needs
Whether the person is under arrest	Police	PACE 1984 ss.24–30
Continuity of custody / evidence	Police — but must adapt around clinical need	PACE Code C
Scene safety / public order	Police / Fire (as relevant)	Common law, respective operating procedures
Extrication method (structural/vehicle)	Fire, in consultation with ambulance on patient factors	Joint protocols (JESIP)

04 Worked scenario

Patient under arrest for car theft, badly injured, currently on the ambulance. Officer wants you to wait.

He remains under arrest throughout — that status doesn't lapse because he's being treated, and the officer is entitled to travel with him or arrange continuity to hospital. What the officer cannot do is direct your clinical timeline. "Wait, we need to get a statement / wait for CID / wait for forensics" has no legal basis to override your assessment that he needs to leave now. If you comply and he deteriorates, the negligence exposure sits with the crew/Trust — the instruction from police is not a defence. Document: your clinical rationale, the specific request made by police, your response, and the time you proceeded. That contemporaneous record is what actually protects you, more than any single Act you could quote at the roadside.

06 Sources

Police and Criminal Evidence Act 1984 (PACE) — primary statute governing arrest, detention and treatment powers. legislation.gov.uk
PACE Code C 2023 — statutory Code of Practice for detention, treatment and questioning; Annex H (rousing), para 3.16 (MHA assessment/discharge), para 9 (care and treatment of detained persons). gov.uk
Mental Health Act 1983, ss.6, 135, 136, 137 — detention, conveyance and legal custody provisions. legislation.gov.uk
College of Policing — Mental Health: Detention (APP) — operational guidance confirming health needs take priority and rousing failure = medical emergency. college.police.uk
IOPC / Police Conduct — Annex H recommendation, GMP, Sept 2020 — confirms Annex H's mandatory (not discretionary) wording and the "medical emergency" standard. policeconduct.gov.uk
HCPC Standards of Conduct, Performance and Ethics & Standards of Proficiency — Paramedics — basis for individual clinical accountability irrespective of instruction from non-clinicians. hcpc-uk.org
JESIP — Joint Emergency Services Interoperability Principles — joint working doctrine underpinning local ambulance/police/fire protocols; check your Trust's specific joint protocol with GMP/Lancashire/Cumbria etc. for the most citable local document at incident level. jesip.org.uk

This page is a working clinical/CPD reference, not legal advice. For a live dispute or formal complaint, verify current wording against the linked primary sources and take Trust legal/professional advice.