Commissioner's directive 567: Management of incidents

Responsibilities

1. The Director General, Security, will:
   1. provide direction and support to regions in relation to policy, safety and security issues
   2. inform the Assistant Commissioner, Correctional Operations and Programs, of any issues or deficiencies arising from security policies/procedures or their implementation.
2. The Assistant Deputy Commissioner, Correctional Operations, will:
   1. provide support to the institutions following an incident
   2. report to the Director General, Security, any issues or deficiencies arising from security policies/procedures or their implementation.
3. The Regional Director, Health Services, will:
   1. ensure support is provided to Health Services staff following an incident
   2. report to the Director General, Mental Health, or the Director General, Clinical Services and Public Health, any issues or deficiencies arising from health policies/procedures or their implementation.
4. The Institutional Head will:
   1. following an incident, return the institution to a safe and secure environment as soon as possible, managing any resulting challenges
   2. ensure staff are equipped and trained in their duties, including training on the Engagement and Intervention Model (see Annex B)
   3. establish processes to monitor compliance and the effective implementation of policies related to the management of incidents
   4. ensure staff follow processes and respond to medical emergencies pursuant to GL 800-4 – Response to Medical Emergencies.
5. The Assistant Warden, Operations/Manager, Operations, will:
   1. provide oversight related to the application of the Engagement and Intervention Model
   2. provide the Correctional Managers support and guidance in relation to their role in managing incidents
   3. identify trends related to incident management, reinforce appropriate application of the Engagement and Intervention Model and identify any deficiencies.
6. The Chief, Mental Health Services, and the Chief, Health Services, will:
   1. provide general oversight of health care professionals with regard to the application of the Engagement and Intervention Model
   2. identify trends related to the provision of health services during incidents.

Procedures

Engagement and Intervention Model

7. The Engagement and Intervention Model is a risk-based model intended to guide staff in both security and health activities to prevent, respond to, and resolve incidents, using the most reasonable interventions.
8. All interventions used to manage incidents will be consistent with law and policy in the application of the Engagement and Intervention Model, and will:
   1. take into consideration the inmate’s mental and/or physical health and well-being, as well as the safety of other persons and the security of the institution
   2. when possible, promote the peaceful resolution of the incident using verbal intervention and/or negotiation
   3. be limited to only what is necessary and proportionate
   4. take into consideration changes in the situation through the use of continuous assessment and reassessment.

Risk Evaluation

9. Staff will evaluate, on an ongoing basis, each situation to determine the level of risk relative to a threat using the Ability, Intent, Means (AIM) tool which is based on the following factors:
   1. Ability: physical and mental capacity and opportunity to carry out the threat
   2. Intent: shows intent to behave or act in a specific manner (verbal/non-verbal) to carry out the threat
   3. Means: has the means to carry out specific action or behaviour associated with the threat.
10. Using the AIM risk evaluation tool, staff will arrive at a level of risk, based on the probability of harm occurring and the severity of the harm. The level of risk will be determined as low, moderate or high.

Assessment of Situational Factors

11. In formulating an intervention, staff will consider, as part of the overall evaluation of risk, the following types of situational factors (not a sequential list):
    1. available staff
    2. the level of containment
    3. self-injurious or suicidal behaviour (or history of)
    4. the inmate’s current health status
    5. the inmate’s mental state and ability to comprehend direction
    6. the inmate’s institutional behaviour
    7. the inmate’s characteristics
    8. the location
    9. the presence of weapons
    10. the number of inmates
    11. the inmate’s level of compliance and associated actions, including:
        1. cooperative
        2. verbal resistance
        3. passive resistance
        4. active resistance
        5. assaultive
        6. showing the potential to cause grievous bodily harm or death
        7. escaping.
12. Additional information should be gathered in consultation with partners, such as health care professionals, Elders, Chaplains and Parole Officers, and using tools such as, but not limited to, the Offender Management System and the Open Source Clinical Application Resource.
13. Situational factors related to the incident, the associated risk, and the effectiveness of the intervention will be assessed on an ongoing basis. Interventions will be reformulated to reflect any significant changes.
14. Staff members will consider withdrawing, reassessing and re-planning the intervention option so that the most appropriate response is always implemented.

Engagement and Intervention Strategies

Engagement

15. All staff will engage in dynamic security, including regular and consistent interactions with inmates to assist in:
    1. active information gathering and documentation via observations, interviews, and interactions with inmates
    2. effective analysis of acquired information leading to early identification of issues
    3. early intervention to prevent or minimize threats and conflicts.
16. Staff presence will be used generally and strategically to prevent and resolve incidents. The mere presence of a staff member demonstrating positive attitudes and behaviours can serve to de escalate a situation.

Intervention Strategies

17. Every intervention will be limited to only what is necessary and proportionate to resolve the incident.
18. The appropriate intervention strategies will be chosen following the initial and ongoing assessment of the individual(s), the situational factors, and the associated level of risk.
19. Once the level of risk has been determined and the goal is identified, one or more of the following intervention strategies will be selected:
    1. Isolate, Contain and Control: the purpose of isolating the area as quickly as possible is to prevent others from joining the situation and increasing the overall risk/threat level. The situation should be contained to the smallest possible area. This prevents the situation from moving or spreading to other parts of the institution and provides opportunity to plan and organize
    2. First Aid: emergency care or treatment given to an ill or injured person before regular medical aid can be obtained
    3. Health Care Intervention: the application of health-related principles, knowledge and expertise by a licensed health professional when intervening in a medical situation
    4. Communication: physical presence and non-verbal cues, use of verbal intervention, conflict management and resolution and/or verbal orders
    5. Controlled Non-Intervention: a response option for a situation that does not require immediate intervention. Containment, observation and communication can be used for periods of time in order to reduce resistance and gain compliance
    6. Tactical Manoeuvring and/or Intervention: strategically manoeuvring an individual away from an antagonist or away from a vulnerable location; or intervening using a necessary and proportionate force response option to gain compliance and control.
20. When appropriate, staff will respond to incidents using an interdisciplinary team approach. When evaluating a response, staff will consider the many partners available to create collaborative and appropriate interventions.
21. Staff involved in the planning and/or application of the intervention strategies may include, but are not limited to, the Institutional Head, the Correctional Manager, front-line staff, health/mental health professionals, Indigenous Elders/Spiritual Advisors, Chaplains, Parole Officers, Crisis Negotiators, Emergency Response Teams and/or any person who has a good rapport with the inmate. As the level of risk increases, so will the level of expertise required to manage the situation.

Responding to Incidents

22. Staff will respond to incidents in a timely manner pursuant to the Engagement and Intervention Model.
23. For each shift, and within each sector, a Correctional Officer/Primary Worker will be assigned the role of Sector Coordinator. Within the sector, this officer will be identified as a primary responder.
24. When arriving on scene, the primary responsibility of the Sector Coordinator is to ensure intervention options are appropriate and to continuously reassess their appropriateness, which includes monitoring the physical and mental health status of the inmate. As the event unfolds and based on the scope and complexity of the incident, assistance with the monitoring of physical and mental health responsibility may be assigned to another staff member. The Sector Coordinator will:
    1. be the primary communicator to the Correctional Manager, Operational Desk, including seeking authorization for an intervention plan when time and circumstance permit
    2. ensure others on scene know that they are the Sector Coordinator
    3. determine through ongoing assessment what type of response is appropriate
    4. not get physically involved in order to effectively oversee and coordinate activities, unless required
    5. provide guidance and direction to staff on scene, including the requirement for video recording and asking staff to return to their original post if their assistance is not or is no longer required
    6. consider the use of partners to de-escalate the incident
    7. ensure the inmate’s mental and physical health are considered when formulating and undertaking the intervention
    8. take all necessary steps to ensure that health interventions can be implemented
    9. provide direction on the requirement for first aid/cardiopulmonary resuscitation (CPR)
    10. communicate immediately with responders when intervention strategies are negatively impacting the inmate’s well-being and/or there are cues of distress or an altered level of consciousness (Annex B)
    11. determine the need and initiate the request for internal and/or external professional medical assistance, if and when needed
    12. transfer responsibilities, when appropriate, to a Correctional Manager if and when they arrive on scene
    13. transfer responsibilities to the On Scene Controller when the Crisis Management Model has been enacted.
25. When Health Services professionals are on site, they will assume responsibility for the overall management of the health intervention as soon as they arrive on scene. They will advise of any required health interventions, which will then be initiated when it is deemed by the Sector Coordinator safe to do so.

Security Response

26. When verbal intervention, conflict management and/or negotiation have been proven as ineffective or have been assessed as inappropriate options based on the individual, the situational factors and corresponding assessment of risk, tactical intervention may be an appropriate strategy.
27. If the incident requires a tactical intervention, one or more of the response options below may be employed pending ongoing assessment of risk and the condition of the inmate (only the force necessary and proportionate to manage the incident will be applied):
    1. restraint equipment
    2. physical handling
    3. chemical and inflammatory agents
    4. batons, impact munitions and other intermediary weapons
    5. firearms.
28. Unless an immediate use of force is necessary, interventions will be planned and approved by the Correctional Manager, Operational Desk, or the Crisis Manager (when the Crisis Management Model is enacted) to provide the opportunity to identify intervention strategies and to organize resources.

Health-Related Response

29. There are instances when communication strategies and conflict management may not produce the expected outcome, such as when the inmate appears to be under the influence (i.e. drugs and/or alcohol), or the inmate’s mental state is at a point where they are not able to comprehend the direction or communication from staff. In these cases, where possible, institutional health care staff should be consulted immediately. This interdisciplinary approach will support the ongoing intervention.
30. If a staff member notices that an inmate is displaying cues of distress, they must:
    1. treat the situation as a medical emergency and call for medical assistance
    2. stay calm and help the inmate remain calm
    3. try to keep the inmate conscious
    4. continually monitor and assess the situation
    5. stay with the inmate until help arrives
    6. attend to the inmate’s complaints or calls for help immediately, even if the signs and symptoms are not obvious.
31. All staff will respond to medical emergencies pursuant to GL 800-4 – Response to Medical Emergencies, with the primary goal of preserving life. Staff arriving on the scene of a possible medical emergency must immediately call for assistance, secure and/or make the area safe, and initiate first aid/CPR, with the primary goal of preserving life. If the incident requires intervention by a health care professional, staff on scene may also be required to assist Health Services partners with their health intervention. One or more of the following response options may be used in accordance with the Engagement and Intervention Model, relevant to the Health Services professional standards of practice:
    1. restraints
    2. medication
    3. health care assessment/intervention
    4. consultation of health specialists
    5. admission to Treatment Centre
    6. paramedics
    7. transfer to a community hospital.

Following an Incident

32. All staff involved in the incident will complete a Statement/Observation Report and submit the completed Statement/Observation Report to the Correctional Manager, Operational Desk, immediately following the incident, unless operational requirements prevent such, but no later than the end of their shift.
33. A Correctional Manager will obtain and review the Statement/Observation Reports and share the information pertaining to health care interventions with the Chief, Health Services. The Correctional Manager, in conjunction with the Chief, Health Services (when there is a health care intervention), will conduct an operational debriefing prior to the end of shift, where operationally practicable, with the individuals (based on staff availability) directly involved in the intervention, including the health care professionals. When the Chief, Health Services, is not on site, a subsequent debriefing will be held, as required. The goal of the post-incident debrief is to improve the quality of interventions.
34. Following the gathering of all information pertaining to an incident (e.g., video, written reports), there may be a need to have an additional debriefing with staff.
35. Staff will be offered critical incident stress management services pursuant to CD 253 - Employee Assistance Program and GL 253-2 - Critical Incident Stress Management
36. Immediately following a medical emergency, the Correctional Manager must:
    1. complete the Response to Incidents Involving a Medical Emergency (Correctional Manager/Officer-in-Charge Checklist) form (CSC/SCC 1323-01)
    2. ensure that only one Response to Incidents Involving a Medical Emergency (Staff Checklist) form (CSC/SCC 1323-02) is completed collectively by the appropriate responding non-health services staff member(s).
37. Inmates who require attention following critical incidents will be offered support services by mental health professionals, Chaplains and/or Indigenous Elders/Spiritual Advisors.
38. A list of inmates who may be in need of assistance will be developed as soon as possible after an incident, through consultation with inmates’ representatives, if appropriate, as well as with mental health professionals, Chaplains or Indigenous Elders/Spiritual Advisors who have offered to meet with inmates affected by a critical incident. The participation by inmates is voluntary.
39. Support services will also be available, upon request, to other inmates not previously identified.
40. Mental health professionals, Chaplains and Indigenous Elders/Spiritual Advisors providing services will document (in a manner respective to their discipline) the interventions in the inmate’s file and submit, to their supervisors, the names of the inmates to which services were offered.

Management and Control Framework

41. Incidents will be managed and controlled using a framework which includes, but is not limited to, the following:
    1. GL 800-4 - Response to Medical Emergencies identifies the processes and requirements for responding to medical emergencies
    2. CD 567-1 - Use of Force identifies the processes and requirements ensuring that the response and the manner in which force is used are appropriate and in accordance with CSC policy and applicable legislation
    3. CD 567-2 - Use of and Responding to Alarms identifies the processes and requirements for the use of and responding to alarms
    4. CD 567-3 – Use of Restraint Equipment for Security Purposes identifies the processes and requirements for the appropriate use of restraint equipment
    5. CD 567-4 - Use of Chemical and Inflammatory Agents identifies the processes and requirements for the appropriate use of chemical and inflammatory agents
    6. CD 567-5 - Use of Firearms identifies the processes and requirements for the appropriate use of firearms
    7. CD 600 - Management of Emergencies in Operational Units identifies the processes and requirements to ensure that all critical locations are prepared to deal effectively with emergencies.

Commissioner,

Original Signed by:
Don Head

Annex A: Cross-References and Definitions

Cross-References

• CD 001 – Mission, Values and Ethics Framework of the Correctional Service of Canada
• CD 003 – Peace Officer Designation
• CD 253 – Employee Assistance Program
• GL 253-2 – Critical Incident Stress Management
• CD 560 – Dynamic Security and Supervision
• CD 567-1 - Use of Force
• CD 567-2 - Use of and Responding to Alarms
• CD 567-3 - Use of Restraint Equipment for Security Purposes
• CD 567-4- Use of Chemical and Inflammatory Agents
• CD 567-5 - Use of Firearms
• CD 568-1 - Recording and Reporting of Security Incidents
• CD 600 - Management of Emergencies in Operational Units
• CD 702 - Indigenous Offenders
• CD 800 -Health Services
• GL 800-4 - Response to Medical Emergencies
• CD 843 - Interventions to Preserve Life and Prevent Serious Bodily Harm
• Security Equipment Manual

Definitions

Active resistance: when the offender uses non-assaultive physical action to resist or while resisting a staff’s direction/orders (e.g. the offender may prevent or escape control by pulling away or walking/running away from staff).

Assaultive: when the offender:

1. engages in physical behaviours, actions or gestures, with the intent to harm another person, or
2. directly or indirectly applies force against another person in a manner that causes, or has the potential to cause, harm or injury.

Cooperative: when there is no verbal or physical resistance and the offender responds to staff presence, verbal communication, and complies voluntarily with verbal commands or orders.

Dynamic security: regular and consistent interaction with offenders and timely analysis of information and sharing through observations and communication. Dynamic security is the action that contributes to the development of professional, positive relationships between staff and offenders, and is a key tool to assess an offender’s adjustment and stability.

Engagement and Intervention Model: a risk-based, person-centred, graphic representation (see Annex B) used to assist staff with activating engagement and intervention strategies.

Escape: any act or attempted act to breach (break) prison, escape from lawful custody, or without lawful excuse be at large before the expiration of a term of imprisonment to which that person has been sentenced.

Grievous bodily harm: any injury having the potential to endanger life, or which results in permanent physical impairment, significant disfigurement or protracted loss of normal functioning. It includes, but is not limited to, major bone fractures, the severing of limbs or extremities, and wounds involving damage to internal organs.

Health Services: physical and mental health services, which include health promotion, disease prevention, health maintenance, patient education, diagnosis and treatment of illnesses.

Interdisciplinary team: a group of staff from diverse fields who work in a coordinated fashion toward a common goal.

Intermediary weapons: batons, impact munitions, high pressure water and any other intermediary equipment that may be approved for use in the Security Equipment Manual.

Necessary and proportionate intervention: taking into account the reasonable need for maintaining certain operational routines, if the threat may be safely managed without a use of force, then force is unnecessary. The amount of force used must also be the minimally necessary force (proportionate) to safely manage the threat. The concept of necessary and proportionate also applies to health interventions.

Passive resistance: when the offender uses little or no physical action when refusing to cooperate with staff’s direction/orders. This can be a verbal refusal or a physical inactivity such as the offender letting their body go limp, or having a lack of understanding of the verbal orders due to their mental/physical state.

Sector: for the purpose of this policy, physical areas/zones identified locally, associated with division of responsibility related to coordination of security operations and response to medical and security situations.

Sector Coordinator: the Correctional Officer/Primary Worker identified to coordinate security operations within a specified sector, as well as incident response, under the supervision and direction of the Correctional Manager, Operational Desk.

Shows potential to cause grievous bodily harm or death: when the offender displays a behaviour that leads the staff to believe that such behaviour could or will result in grievous bodily harm or death of another person or themselves.

Verbal resistance: when the offender displays behaviours that include, but are not limited to, verbal assaults, profanity, taunts, or refusal to communicate with staff but complies with verbal orders.

Annex B: Engagement and Intervention Model

Assess Situation

Identify Threat/Risk/Problem/Health Status

• Level of Compliance and Associated Actions
• Cooperative
• Verbal resistance
• Passive resistance
• Active resistance
• Assaultive
• Grievous bodily harm or death
• Escaping
• Altered Level of Consciousness/Cues of Distress
Appearance
• Dishevelled – in part of change from normal
• Blank stare/dazed look
• Red face/pale complexion
• Signs of blood or trauma
Speech
• Slurred speech
• Unusually fast/slow speech
• Delayed response to questions/directions
• Repetitive/non-sensible statements
• Speaking incoherently
Behaviour
• Swaying/staggering/unable to sit straight
• Overly animated/crying
• Drowsiness/disoriented/unresponsive
• Excessive perspiration
• Other Situational Factors
• Available staff
• Level of containment
• Self-injurious or suicidal behaviour (or history of)
• Offender’s mental state and ability to comprehend direction
• Offender’s institutional behaviour
• Offender’s characteristics
• Location
• Presence of weapons
• Number of offenders
• OMS – Flags, alerts, needs
• OSCAR

Risk Evaluation

• AIM
• Ability: physical and mental capacity and opportunity to carry out a threat
• Intent: shows intent to behave or act in a specific manner (verbal/non-verbal)
• Means: has the means to carry out specific action or behaviour associated with the threat
• Need for immediate response?
• Reasonable perception
• Risk – low, moderate, high
• Low: no imminent harm
• Moderate: potential for harm
• High: imminent severe harm

Self-Awareness & Perception

• Staff’s role is essentially defensive (not aggressive or passive)
• An incident is an emotional and physical event
• Self control is key – mind and body are one
• Indicators of hostility, fear and/or aggression:
• Kinesics (body language)
• Proxemics (body space)
• Paraverbal communication (pitch, tone, volume)

Engagement & Intervention Strategies

• Dynamic security and staff presence
• Communication
• Isolate, contain and control
• Controlled non-intervention
• First aid/health assessment
• Health care intervention
• Tactical intervention and manoeuvring
• Interdisciplinary team and any person who has a good rapport with the offender

Response to Cues of Distress

• Treat all persons who present with Cues of Distress as a medical emergency and call for medical assistance; either institutional Health Services or 9-1-1
• Stay calm and help the person remain calm
• Try to keep the person conscious, ask them questions to encourage them to keep talking, ask the person to keep their eyes open
• Monitor, assess and stay with the person until help arrives
• Do not ignore the person’s complaints or calls for help even if the signs and symptoms are not obvious

Reassess

• Reassess interventions
• Reassess situational factors
• Reassess the person
• Has the level of risk changed?

Debrief, Report & Quality Improvement

• Debrief Process
• Assessment/Intervention/Debrief (AID)
• Why now
• Legal, moral, ethical
• Necessary and proportionate
• Report Writing
• Most appropriate report(s)
• Clear, concise, accurate
• Articulate decisions made