Background and objective Arrested persons often raise doubts about their medical fitness to remain in police custody, so that a medical examination becomes necessary. In Germany, there are no uniform regulations or guidelines for this assessment. In order to develop solutions, it is necessary to consider the general and legal framework and the specific medical risk profiles. Materials and methods A retrospective evaluation of 1271 examinations of fitness for detention from the period 2013-2018 in Halle (Saale) was carried out. Results Alcohol/drug/medication intoxications and withdrawal syndromes dominated the indications for medical consultation, followed by trauma and internal and mental illnesses. When deciding on fitness for custody, various medical stipulations (e.g., checking at given intervals to see if the person can be aroused) were often imposed, while 7.2% of the persons were found to be not fit for custody. These were mostly intoxications/withdrawal syndromes and cases of internal medicine conditions. Conclusions In the medical assessment of fitness for police custody, all currently possible measures should be exhausted, especially by imposing stipulations, to reduce the risk of serious impairment of health and death. For this purpose, a more detailed knowledge of the risk profile of arrested persons can be helpful. In addition, the legal framework should be changed in Germany and further regional solutions should be developed.