Emergency response, a fact of life in healthcare, has some interesting twists in a custody setting. Correctional nurses are called upon to respond to injuries from inmate scuffles in the yard, suicide attempts in isolation, and unresponsive inmates in the housing units. Are you ready for the next emergency you will encounter during your shift?
Like the Scouts – Be Prepared
Preparation is all when it comes to rapid emergency response. Be sure there is someone assigned to lead an emergency intervention on each shift and that staff know where the supplies are kept. Since nurses must bring equipment along to the yard or cells, it needs to be portable and easy to move through corridors and up stairs.
Consider what is needed to stabilize a patient while outside EMS services are being contacted. The secure nature of a jail or prison can make access by outside services difficult and time-consuming. Initiate this operation as early as possible to allow time for arrival and entry through the various security checkpoints to reach the emergency location.
Never Leave until Relieved
I have reviewed several inmate death cases where the correctional nurse arrived, assessed the patient, and then left the area to obtain needed equipment or treatment supplies. Never leave a patient in an emergency situation once you are the first healthcare member on the scene. Ask security officers or other staff members to retrieve needed supplies. An only healthcare professional leaving a patient in a life-threatening situation is considered abandonment. Be sure the patient is in good hands before leaving an emergency scene.
Know Your Protocols
Before you get into an emergency situation, know your responsibilities and protocols for managing an emergency until a provider arrives or is in communication. Some settings allow the initiation of various emergency medications and treatments while others require that a provider be contacted for orders. Be ready to fully implement everything needed and available to you while awaiting further assistance and direction.
Risky Situations in Corrections
The following situations are of high concern in a correctional setting due to the nature of the environment and patient population.
- Anaphylaxis Treatment: Epinephrine is the gold-standard treatment for an anaphylactic allergic reaction. Highly allergic individuals carry on their person an epinephrine auto-injector at all times to self-administer a life-saving dose. For safety reasons, however, inmates cannot have personal possession of needles. How does your facility handle the need for immediate access to epinephrine? Are you aware of all highly allergic inmates in your patient population?
- Drug Overdose: The high level of drug use in the inmate population means that drug overdose should be considered in any emergency situation. Even in prison, inmates can get access to contraband drugs. A classic sign of drug overdose in an unconscious patient is constricted pupils. Narcan (naloxone) should be available with a protocol for administration in suspected overdose situations.
- Neck Injury: I have reviewed several emergency response cases where the patient was found lying unconscious on the floor of their cell. The nurse performed the ABC’s of initial response but did not consider a possible neck injury from a preceding fall. In one such case the patient sustained a C-spine fracture and permanent paralysis. In an unknown situation, always remember to protect the spine until cleared.
- Hangings: Hanging is the most popular suicide method behind bars. No matter what the assumed hang time, immediately cut down the patient and evaluated for resuscitation efforts. Do not assume it is too late. Do you know where your hanging cut-down tool is located? Is this a custody or healthcare responsibility?
The Oregon Department of Corrections has established this list of emergent conditions that correctional nurses should be prepared to handle. Use this as a guide to develop and prepare response for man-down emergencies.
- Acute agitation unresponsive to treatment
- Acute altered mental status
- Airway related problems (Asthma with < 85% O2 saturation or non responsive to treatment)
- Cardiac related chest pain (unresponsive to treatment)
- Cerebro-vascular accident
- Continuous decreased LOC
- Diabetic ketoacidosis
- Drug overdose
- Fractures to the maxillary jaw
- GI bleed
- Head injury with GCS < 13, cerebrospinal fluid leakage, more than one episode of vomiting.
- Hypertensive crisis
- Major burns
- Neuro compromise
- Non responsive diabetic (not responding to treatment)
- Open abdominal wound
- Open chest wound
- Penetrating foreign body of the eye
- Precept or breech birth
- Puncture wound of the neck or torso (or that of an artery)
- Respiratory or cardiac arrest
- Seizure activity (first, sustained or change in previous)
- Sucking chest wound
- Symptomatic Hypotension
- Temp > 104 degrees F or hypothermia (core temp 3.6 degrees F. below normal body temp)
- Uncontrolled hemorrhage
How do you manage response for man-down emergencies in your setting? Share your experiences in the comments section of this post.
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