College of Policing
Police / Law Enforcement
Action Taken
The College of Policing has updated its First Aid Learning Programme (FALP) to include specific reference to recognising agonal gasps and has developed new Public and Personal Safety Training (PPST) for forces to implement. (AI summary)
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Dear Ms McKenna
Regulation 28 report, Kevin Michael Cashin. 21st June 2024
I am writing in response to your Regulation 28 report following the investigation and inquest into the tragic circumstances of the death of Kevin Cashin on the 20th July 2022.
I would like to update you regarding the concerns raised in your report as follows:
(1) The officers did not understand what agonal breathing was or how to recognise it. This included an officer who had completed the enhanced first aid training required to undertake Public Order Medic duties. Their focus had been on the fact that they could see Kevin’s chest moving and they had not appreciated that his gasping was an indicator of breathing difficulties.
The College of Policing produces the First Aid Learning Programme (FALP) which is used by police forces. The programme is endorsed by the National Police Chiefs Council (NPCC) and the Health and Safety Executive (HSE). The College of Policing is responsible for ensuring appropriate quality assurance processes are in place to guide forces in the provision of first aid.
The College has conducted a significant review of the FALP, which was completed in August
2023. The updated version of FALP now includes specific reference to recognising agonal gasps – this is within the learning outcome relating to performing basic life support. This is taught within modules 2, 4 and 5, and as such will form part of both initial and annual refresher training for all public facing officers, and those in advanced, high-risk roles.
(2) The Court heard that the effect of a cocaine induced Acute Behavioural Disturbance episode meant that Kevin’s agonal breathing was at a faster rate than is typical and would have looked more like regular breathing. The College of Policing has developed new Public and Personal Safety Training (PPST) for forces to implement as of April 2024. It is a scenario based methodology of training delivery
and is focused on learning, decision making, understanding decisions and de-briefing decisions.
The new training includes a revised package for Acute Behavioural Disturbance (ABD) which focuses on identification of the signs, symptoms and possible causes of ABD and management of the incident as a medical emergency and seeking immediate medical assistance. Officers must be able to demonstrate to trainers the correct response to a person experiencing ABD.
(3) The Court heard that there is generally a lack of knowledge on how to recognise when a person is going into a cardiac arrest. The officers had placed reliance on their observation of Kevin’s chest movements and their belief that they could feel his pulse. They had interpreted his lack of muscle tone, facial movements, poor colour and failure to respond to verbal prompts as signs of the effects of drug intoxication rather than indicators that he was in the early stages of cardiac arrest.
The recent review of FALP specifically includes performing basic life support. This includes recognising the components of chain of survival, application of Resuscitation Council guidelines and recognition of agonal gasps. Separate learning outcomes relating to fainting and seizures also articulate a potential presentation of a cardiac arrest. In addition, the FALP now includes a separate learning outcome at module 5 to recognise a casualty in traumatic cardiac arrest.
(4) It was the opinion of the expert that the most effective way to train responders in recognising agonal breathing and on how to identify when a person is going into a cardiac arrest is through the use of video footage rather than solely power-point presentations. The College of Policing develop the learning outcomes for FALP and individual forces develop the learning material in line with their local clinical governance procedures. The College of Policing share learning and good practice through various national platforms and will continue to work with Greater Manchester Police and other forces to do so. We encourage forces to use video footage as well as other media.
(5) The Court is concerned that the above is not currently covered in the curriculum for First Aid Learning Programme delivered to all police officers or the Enhanced First Aid Skills delivered to those officers in high risk roles and to public order medics. The main focus of the recent review of FALP was preserving life. The FALP is subject to constant update and review but we are confident that the recent review of FALP and the development of the new PPST provides those in policing with the necessary skills required to to preserve life and keep the public safe.
I hope that this provides some reassurance about the steps that the College of Policing has taken
to update and improve the provision of first aid training to frontline officers and staff. If there is anything further that I can assist with, please do not hesitate to contact me.
Regulation 28 report, Kevin Michael Cashin. 21st June 2024
I am writing in response to your Regulation 28 report following the investigation and inquest into the tragic circumstances of the death of Kevin Cashin on the 20th July 2022.
I would like to update you regarding the concerns raised in your report as follows:
(1) The officers did not understand what agonal breathing was or how to recognise it. This included an officer who had completed the enhanced first aid training required to undertake Public Order Medic duties. Their focus had been on the fact that they could see Kevin’s chest moving and they had not appreciated that his gasping was an indicator of breathing difficulties.
The College of Policing produces the First Aid Learning Programme (FALP) which is used by police forces. The programme is endorsed by the National Police Chiefs Council (NPCC) and the Health and Safety Executive (HSE). The College of Policing is responsible for ensuring appropriate quality assurance processes are in place to guide forces in the provision of first aid.
The College has conducted a significant review of the FALP, which was completed in August
2023. The updated version of FALP now includes specific reference to recognising agonal gasps – this is within the learning outcome relating to performing basic life support. This is taught within modules 2, 4 and 5, and as such will form part of both initial and annual refresher training for all public facing officers, and those in advanced, high-risk roles.
(2) The Court heard that the effect of a cocaine induced Acute Behavioural Disturbance episode meant that Kevin’s agonal breathing was at a faster rate than is typical and would have looked more like regular breathing. The College of Policing has developed new Public and Personal Safety Training (PPST) for forces to implement as of April 2024. It is a scenario based methodology of training delivery
and is focused on learning, decision making, understanding decisions and de-briefing decisions.
The new training includes a revised package for Acute Behavioural Disturbance (ABD) which focuses on identification of the signs, symptoms and possible causes of ABD and management of the incident as a medical emergency and seeking immediate medical assistance. Officers must be able to demonstrate to trainers the correct response to a person experiencing ABD.
(3) The Court heard that there is generally a lack of knowledge on how to recognise when a person is going into a cardiac arrest. The officers had placed reliance on their observation of Kevin’s chest movements and their belief that they could feel his pulse. They had interpreted his lack of muscle tone, facial movements, poor colour and failure to respond to verbal prompts as signs of the effects of drug intoxication rather than indicators that he was in the early stages of cardiac arrest.
The recent review of FALP specifically includes performing basic life support. This includes recognising the components of chain of survival, application of Resuscitation Council guidelines and recognition of agonal gasps. Separate learning outcomes relating to fainting and seizures also articulate a potential presentation of a cardiac arrest. In addition, the FALP now includes a separate learning outcome at module 5 to recognise a casualty in traumatic cardiac arrest.
(4) It was the opinion of the expert that the most effective way to train responders in recognising agonal breathing and on how to identify when a person is going into a cardiac arrest is through the use of video footage rather than solely power-point presentations. The College of Policing develop the learning outcomes for FALP and individual forces develop the learning material in line with their local clinical governance procedures. The College of Policing share learning and good practice through various national platforms and will continue to work with Greater Manchester Police and other forces to do so. We encourage forces to use video footage as well as other media.
(5) The Court is concerned that the above is not currently covered in the curriculum for First Aid Learning Programme delivered to all police officers or the Enhanced First Aid Skills delivered to those officers in high risk roles and to public order medics. The main focus of the recent review of FALP was preserving life. The FALP is subject to constant update and review but we are confident that the recent review of FALP and the development of the new PPST provides those in policing with the necessary skills required to to preserve life and keep the public safe.
I hope that this provides some reassurance about the steps that the College of Policing has taken
to update and improve the provision of first aid training to frontline officers and staff. If there is anything further that I can assist with, please do not hesitate to contact me.