Jumpsuits & Pinstripes

Providing care for the incarcerated patient can be challenging from both a logistical and medical perspective


   It is 2 a.m. when your unit is dispatched to the medical unit of the state prison for a "possible stroke." As you approach the facility, the brightly lit prison and grounds are juxtaposed against the dark backdrop of the night sky. Beyond a sign that reads "No unauthorized vehicles or personnel beyond this point...State Department of Corrections...State Prison," a vehicle awaits to escort you to your point of entry into the facility.

   You pull the ambulance into a large garage bay and, as the door closes, corrections officers approach and ask you and your partner for your names, unit number and employee IDs. You are led through a door into an entryway, where you are asked the same questions again by an officer seated behind a desk and double-paned bulletproof glass. For the next few minutes, you are led through countless doors and hallways, and then to a door that opens up to the outside. More officers join the group as you walk across a large field and toward a building labeled "Medical Unit," where you are asked for your name and unit number a third time. Finally, you hear the loud, unmistakable sound of the lock on the heavy metal door in front of you being disengaged and as it slowly slides open, you are confronted with the familiar smell of disinfectant.

   You and your partner are directed to prisoner "Bob," age 62, who is wheelchair-bound and lives permanently in the medical unit. He has a significant medical history including hypertension, several MIs, several pulmonary emboli and two past CVAs. Upon assessment, you find Bob exhibiting a neurological status different from his baseline. Four officers surround you and your partner as you attempt to transfer the feeble man onto your stretcher. Bob is extremely nice, respectful and cooperative during treatment and transport, which lasts a little less than an hour. After transferring care at the hospital, you make sure Bob is comfortable before leaving his room and wishing him a quick recovery.

   "Bob" is just one example of the many types of patients in custody of law enforcement for whom you may be called. Law enforcement officers are authorized by federal, state and local lawmakers to arrest and confine persons suspected of crimes. The judicial system is authorized to confine persons convicted of crimes. This confinement, whether before or after a criminal conviction, is called incarceration.

A CHALLENGING RESPONSE

   Caring for an incarcerated patient poses several challenges for responders. Logistical and operational problems may arise, and treatment modalities may need to be adjusted. More important, your entire mind-set may need to be modified in order to appropriately care for such a patient. There are many factors that can interfere with providing adequate patient care to the incarcerated population, including the potential for intangible moral, psychological and personal issues to surface. These ever-present interpersonal issues are more complex than the logistical and operations concerns you may encounter in caring for these patients, such as extended times to initial patient contact or providing care for a patient restrained in handcuffs and leg irons. Careful consideration of all these potential problems is essential in providing appropriate care to the incarcerated population, and they should be addressed together, each related to--and dependent upon--the next.

GOING INSIDE

   There are many types of facilities where you may encounter an incarcerated patient, varying greatly depending on your response area.

   Logistical concerns regarding the passage in and out of correctional facilities can be especially pronounced for county and state facilities due to their size, capacity and configuration. The specific configuration of a facility varies based on the prison model used. The congregate system of confinement of the early 19th century later evolved to become the basis for United States penitentiaries today, and prisons built based on this congregate system are constructed in several ways. In order to minimize confusion while navigating in and out of the facility, familiarize yourself with the layout and procedures of the correctional facilities within your primary response area. This will maximize your efficiency in time management and ultimately your patient care.

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