The Prevalence and Management of Head Injury in Police Custody: A Pilot Study 
There is increasing interest and awareness of associations between brain injury and offending. In a police custody setting, screening for recent head injury (HI) may be a relevant factor in relation to safe management of potentially life threatening damage, and management of behaviour and legal processing of individuals who may have resulting cognitive impairment. However, little has been published on the need for or outcome of routinely asking a specific question about recent HI in police custody settings. 
In Scotland a vulnerability risk assessment (VRA) of health is routinely carried out in police custody by police sergeants. For example, this includes questions about mental health, medication and drug use. It allows the police to consider whether the individual needs hospital attention, to be seen by forensic nurses or doctors linked to the police station or to be placed in an observation cell. In this pilot study an additional question about the occurrence of a HI in the previous 48 hours was added to the VRA. A research worker observed and noted responses to the question and the actions taken by the police as a consequence. Perceptions of the usefulness of the question about HI was obtained from the police sergeants involved.
Of 100 people processed in police custody in Glasgow, 13% reported sustaining a HI within the past 48 hours. Most of the HI occurred on the day of detention (9/13), were caused by an assault or fall (11/13) and the detainee was often intoxicated (9/12). Five were referred to the forensic nurse service and of these two were placed in a police observation cell. All police sergeants reported that a question on HI was a useful addition to the VRA.
The HI in this pilot study were ostensibly mild, but if representative, would translate to more than 18,000 people with a recent HI being processed in police custody in Scotland each year. At this scale there is high risk of a minority having significant HI. The inclusion of a HI question in the VRA is recommended and is now included in police custody settings in Scotland. This study is part of an initiative to provide a health service to people with brain injury throughout the criminal justice system in Scotland1 . 
1 http://www.nphn.scot.nhs.uk/wp-content/uploads/2016/07/NPHN-Brain-Injury-and-Offending-Final-Report.pdf