Near miss

Introduction

The 2021 conviction of white ex-police officer Derek Chauvin for the killing of black civilian George Floyd was welcomed as an example of no-one - not even a law enforcement officer - being exempt from the rule of law. George’s tragic death, caused by Chauvin kneeling on his neck, highlighted the dangers of law enforcement officers deploying unsafe restraint mechanisms on detainees. It also birthed the Black Lives Matter campaign and its I can’t breathe slogan.

Misses

What wasn’t so much talked about, though mentioned in the trial, was the fact that even the most professional person is only as good as his or her training. A rogue person at the centre of a major incident is rarely the perpetrator of a one-off error. Usually, they will have been committing ‘near misses’ for years.

A near miss is an unplanned event that had the potential to cause injury or ill health but did not actually do so. A risky-behaving professional could behave in an unsafe manner - such as deploying an unsafe restraint technique - 100 consecutive times with the first 99 episodes being near misses. Finally though, the 100th episode results in harm. Sometimes that harm is serious or even fatal.

So often, long before the fateful event, the risk-taker is well-known within his or her workplace - for taking a cavalier approach to health & safety, for not following policies & procedures, or for being difficult to line manage. And this is true for all kinds of professionals, not just law enforcement officers. Take healthcare professionals:-

We’ve just had a near miss in the prison I work in. A drug-addicted prisoner nearly received a duplicate dose of methadone [a prescribed alternative to street heroin]. I prescribed a dose for her, ignorant of the fact that she had already received a dose earlier that day. I didn’t know about that first dose because it had been marked erroneously as declined - that is, not swallowed - in her medical record. It was only by sheer luck that the true situation came to light before she was given my prescribed dose. I insisted on submitting a ‘near miss’ report because, just like unsafe restraint positions, methadone in excess can cause fatal respiratory depression.
(Anonymous UK prison doctor)

Restraints

Restraint has been used since time immemorial in both law enforcement and health & social care settings, either by physically holding the person, mechanically using equipment such as handcuffs or velcro straps, or chemically using pepper spray or a sedative. It should only be used within the bounds of law. Within healthcare, it should never be used as punishment, but only if there is a risk of harm to the person being restrained or to others around them. And there should be safeguards in place to ensure that the benefit outweighs the potential harm of the restraint itself.

The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) provides guidelines on the use of restraint on prisoners, including the training of prison staff in its use:-

Training referred to in paragraph 2 of rule 75 [All prison staff shall possess an adequate standard of education and shall be given the ability and means to carry out their duties in a professional manner] shall include, at a minimum, training on:
(c) Security and safety, including the concept of dynamic security, the use of force and instruments of restraint, and the management of violent offenders, with due consideration of preventive and defusing techniques, such as negotiation and mediation…
(Rule 76)

Turning then to the issue of detainees like George Floyd being restrained, we could extrapolate this guideline as applying to any professional who may have to use restraint in their work environment. All would-be restrainers should be optimally trained to ensure that they may carry out their duties safely, and employers should be accountable for the provision of high quality training.

Whether you are a healthcare professional, a law enforcement official or a member of the public, you should have confidence in the safe and appropriate use of restraint. And we all have an obligation to support these individuals in pushing for optimal training and corporate responsibility.

Concerns

The higher the degree of deprivation of liberty, the higher the risk of a near miss. So, have you seen someone repeatedly ‘get lucky’ with unsafe working practices behind bars - be it unsafe restraint, inadequate record keeping, or anything else? Then raise a concern. Doing so helps managers and their organisations - to improve training for all their staff, to close down unsafe practices, and to discipline the small minority of personnel who refuse to abide by safe practices. The end result is a safer environment for everyone - the detainees, the discipline staff, and healthcare professionals like us.

This piece, written by then clinical fellow Dr Esme MacKrill with assistance from our CMO Dr Rachael Pickering, was first published on 23rd April 2021. It underwent a minor edit in December 2025.

Speak up for those who cannot speak for themselves, for the rights of all who are destitute.
Speak up and judge fairly…
Proverbs 31:8-9