4 Myths About Hangings in Jails and Prisons
The prison intercom crackles with the news of an emergency on Pod 7. Arriving with the emergency bag in tow, the nurse finds a crime scene in full swing. An inmate is hanging from a makeshift bed linen noose creatively tied around the upper bunk slats.
The actions taken in the first few minutes after a discovered hanging can be the difference between a hospital transfer and an in-custody death. Hanging is the most common form of successful suicide in corrections.
Correctional nurses are confronted with situations unusual in other care settings. Be sure to prepare yourself by eliminating these common jail and prison nursing myths from your practice.
Myth #1: It won’t happen here – this is a small jail.
Although it might appear that most hangings happen in large urban jails, the Bureau of Justice Statistics (BJS) Special Report on Suicide in State Prisons and Local Jails reports that the country’s smallest jails had suicide rates 5 times higher than the largest jails. Jails holding fewer than 50 inmates accounted for 14% of all jail suicides. With smaller staffs and fewer resources, small jails need to remain vigilant to the potential for hangings. Detailed policies and procedures on prevention and post-hanging interventions should be in place. Emergency procedures for a hanging situation should be periodically practices and involve both custody and medical unit staff.
Myth #2: It won’t happen here – We have great suicide screenings and watch suicidal inmates closely.
Improved suicide prevention and management processes have definitely reduced hanging suicides in the correctional setting over the last two decades. As outlined in a prior column I wrote for CorrectionsOne, incarcerated suicide rates in both jails and prisons have declined sharply; with jail suicides still over 3 times the rate of state prisons. Suicidal inmates are creative and will use any resource available to craft a noose and the leverage to asphyxiate by hanging body weight. Screenings can help weed out obvious potential for self-injury, but require a good mechanism for protecting those who do not pass the screen. A strong communication process with mental health services is needed to complete the protective program. All staff must be vigilant for indications of self-harm. Suicide attempts can take place later in the incarceration period triggered by court hearings, family issues such as divorce proceedings or custody issues, and classification changes such as administrative segregation placement. Do you have a process that allows for re-evaluation following such events.
Myth #3: Hangings are lethal. If found strung up and lifeless, no need to intervene.
The major factors leading to a hanging fatality is height of the drop during hanging and the suspension of the body (full or partial). Most hangings in corrections take place in the housing area (primarily the inmate cell) which leaves little chance for a full body suspension and great height. This results in good chances of survival with early intervention. One study concluded that even if the victim is found to be lifeless, aggressive intervention with CPR and emergency medical transport is warranted. Another study found overall mortality associated with hanging was 33%. Those who survived to admission to the hospital had a relatively low rate of severe functional disability. Initiate medical intervention immediately when a hanging is found.
A significant percentage of hanging victims will have spinal fracture, therefore spine immobilization and jaw thrust maneuvers should be taken into account at the scene. In order to accomplish this, easy access to a rescue tool, such as this seatbelt release device, is needed to quickly lower the person to the floor for emergency resuscitation intervention.
Myth #4: Every hanging is a crime scene. The inmate can’t be cut down until the location is photographed and evidence accumulated.
There have been reports of medical staff being delayed from attending to a hanging victim while crime scene investigation takes place. Minutes are precious in emergency treatment and can make a difference in ultimate survival. Cut down the victim and initiate emergency medical intervention as soon as the scene has been secured. Saving a person’s life trumps all need for determining criminality. Nurses must advocate for immediate patient treatment in this situation. Even better, pre-empt an emergency situation like this by reviewing a hanging medical intervention process with custody administration before a hanging event.
What has been your experience with post-hanging treatment. Share in the comment box below.
Photo Credit: © LituFalco – Fotolia.com
Did you enjoy this post? Why not leave a comment below and continue the conversation, or subscribe to my feed and get articles like this delivered automatically to your feed reader.
Comments
True, Ryan, many negatives to jail and prison life as an inmate. The prison culture can be brutal. Correctional nurses try to humanize the process of delivering health care behind bars. Thanks for your input and for reading this blog!
Very helpful Lorry, thanks! I know we worry about the crime scene preservation and it becomes chaotic in deciding how to handle this scenario, so I found this very informative. When this happened @ our facility last year, I know there was major suspicion over whether the cellie actually commited the act, and there was investigations that took place. But if/when this happens again I will know how to react if I am the first to respond or dispatching a team.
Thanks again!
Thanks for the post, Angela: Yes, cellie suspicion is a major cause of delayed emergency treatment in a hanging. I hear this from many quarters. As nurses, we sometimes have to really assert ourselves into the picture to turn the focus on the patient. That can be tremendously difficult on a lot of fronts, as you have probably experienced. Thanks for being a part of the correctionalnurse.net community!
I work in Corrections in Texas. I used to work at a small rural jail facility and now i’m at a larger more urban facility. I’ve gotten into heated discussions about this with coworkers in regards to which type of facilities have higher suicide rates. I think that one of the reasons that contributes to the higher suicides rates in smaller jails is the feeling of being alone. I feel that smaller locations have a solitary feel to them and there is less interactions with other people. Also, in my experience smaller jails have less control measures in place to prevent these suicides from happening. Just my humble opinion.
Unfortunately we just had a suicide occur this month in the ASU (SHO or ad-seg) and it was a matter of 2 hours after my shift ended & being there to respond to the code. Our ~5000 I/P level IV CA state prison takes great measures to prevent these occurances, but the 21YO serving LWOP must of been determined. Having dealt w/my own family Hx of suicide, it has been very difficult subject to face & I appreciate any opinion about this under discussed topic.
I know they certainly don’t offer Nursing in Corrections 101 in nursing school, and I am faced with new encounters each day that create learning experiences. So I find it very useful to review CN.net & the useful articles Lorry offers in this challenging field.
Good points, Irving: You have solid support for your position on small jails in the study I cite in the post. Thanks for sharing your opinion and weigh in often. I value your comments and feedback!
I’m sorry to hear of your recent completed suicide, Angela. It is devastating to so many when it happens. Dealing with hangings is definitely not part of a nursing school curriculum. I’m planning to start a Correctional Nursing 101-type program once my book comes out later in 2012. Stay tuned….
Besides hangings, what other subjects need to be in a starter course for nurses new to corrections? Any thoughts? I’m thinking about things like pepper spray and use-of-force. A lot is needed about drug overdose and withdrawal, I think. Help me develop the course outline, Everyone.
I agree that the first responder has the duty to activate EMS then provide first aid. The caretakers also need some sort of debriefing after the event is completed. This can be quite earth-shaking to the officers as well as the nurses, not to mention other inmates.
Comment to Lorry Schoenly: A Correctional nurse 101 handbook type thing sounds like something needed. One problem I see is that there is a long learning curve meaning that something I may encounter today may not come up again for several months (ie a death) so eventhough I may have once known what to do,I feel inadequate. I keep an index of procedures not used often in the office for reference.
I think there are additional reasons to the suicides in jail. From a male perspective and one who has never been to jail nor prison, I can only imagine the hell of it. I would imagine being in constant fear of my well being. All though the factors stated above do contribute to suicide, I think people who commit suicide in jail or prisons are constantly being victimized. If there is alot of time to potentially serve and inmates are being beaten or raped or forced into homosexual relationships, then is life worth living? I understand life is valuable. I don’t know if I would feel sad for the loss of life in these types of situations. As a caring person I would see it as peace for the soul and respect their choice.