The radio calls a 10-99, Medical Emergency on unit 6-B. Arriving with the emergency bag, the nurse finds a crime scene in full swing. A person is hanging from a makeshift bed linen noose creatively tied around the upper bunk slats.

Hanging is the most common form of successful suicide in corrections, and the actions taken in the first few minutes after a discovered hanging may be the difference between a hospital transfer and an in-custody death. 

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 Large jail with plenty of resources.

Different from previous reports that stated the country’s smallest jails had suicide rates 5 times higher than the largest jails, the Bureau of Justice Statistics (BJS) Report on Suicide in Local Jails and State Prisons 2000-2019 states that in 2019 the deaths by suicide were concentrated in the largest jails. More than half of the jails housing 1000 incarcerated persons or more reported at least one suicide. Suicides were more likely to occur in large state and federal prisons as well. Detailed policies and procedures on prevention and post-hanging interventions should be in place, and staff should be trained so that they can appropriately react to potentially suicidal persons and maintain safety. Emergency procedures for a hanging situation should be periodically practiced and involve both custody and health staff.

Myth #2: It won’t happen here – We have great suicide screenings and watch suicidal persons closely.

Improved suicide prevention and management processes have been put in place in many facilities over the last 20 years, but from 2001 to 2019, suicide rates increased 85% in state prisons, 61% in federal prisons and 13% in local jails. Jail suicides are still over three 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 identify 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 knowledgeable about and 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. It is very important that your process 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 housing unit cell) which leaves little chance for a full body suspension and great height. This results in potential for 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 a seatbelt cutting device, is needed to quickly lower the person to the floor for emergency resuscitation intervention.

Myth #4: Every hanging is a crime scene. The person 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 one actually occurs.

What has been your experience with post-hanging treatment? Share in the comment box below.