Emergency Response in the Correctional Setting

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The following course content

Correctional nurses have limited access to hands-on experience with medical emergencies. Therefore, they must rely on the knowledge and skills they have and adapt them to the correctional setting. This course will discuss how correctional nurses can use the resources they have to provide the best possible care for their patients in an emergency. It will also review the types of emergencies they may encounter and the correctional nurse’s role in managing the emergency. 

Introduction 

There are many roles in the correctional setting that nurses must perform, but the response to emergencies could be seen as the most challenging.  

In an emergency, correctional nurses are responding for immediate assistance. They are required to pick up emergency equipment to hand off and arrive on the scene. They assess the scene with limited access to essential personnel or staff with limited equipment.  

It is much different than a nurse’s role within the hospital setting.  

Within the hospital setting, when a nurse enters a patient’s room and finds them unresponsive- they call for help. By the time the code is called, a team of experts arrives on the scene to assist you in caring for the patient. 

Preparedness 

For most challenges in life, being prepared always helps. There are different aspects to being prepared: 

• Planning  
• Communication 
• Training and Practice  
• Equipment  

All of these are important when it comes to emergency response in the correctional nursing setting. 

There are two main scenarios that correctional nurses may encounter: 

1. Man down 
2. Mass disaster

We will discuss both later in more detail; for now, we will look at preparedness in general. 

Plan 

Having an emergency response plan is crucial to a good patient outcome. The plan for an emergency should be a multidisciplinary team effort that is based upon agreed policies and procedures. These principles are a critical component of the overall emergency preparedness process, along with understanding the threats and providing appropriate resources (4). If you do not know of your facility’s emergency response plan, ensure that you contact a supervisor or someone who can provide you with information on it.  

Communication 

There are many levels of communication that need to occur for an emergency to be managed well. The first call for medical attention needs to be easily heard by the medical team. There are many ways this occurs, depending on your facility. Some nurses have radios on their person, which allows them to hear a call coming through. Others rely on what can only be described as “word of mouth” – for example – security may hear it over the radio and tell the nurses second hand, and some phone the medical center who then tells the relevant staff member to attend. 

This initial call for help from security can literally be the difference between life and death. Our fast emergency response will buy time for a critically ill patient. 

During an emergency, communication between nursing staff and security also needs to be planned and efficient. As the medical team, security often waits for our decision or information being relayed to them as to what needs to occur next. If you assess that it is obvious the patient needs an ambulance, do not assume that the officer sees this too. Clearly state to the security staff that this is the case. It is very important that you close the loop of communication between all members involved in the correctional setting team. You must not assume that everyone has a medical background.  

Let’s think about the emergency response plan again: 

If the plan is for the sergeant to communicate with the charge RN as to the status of the patient, then there is a clear path for the information to be relayed. If there is no plan for what happens, then time can be wasted until “someone says something.”  

Think of a scenario in your facility – was there a clear line of communication for nurses to instruct security? 

Communication between the nursing team is also an important aspect for the best outcome.  

Who gets the equipment to the scene? 

Who takes the lead? 

Who documents? 

Most of these questions can be answered by proper planning, but sometimes a situation can arise where we have to be flexible and adaptable. For example, what if a nurse freezes because she realizes the patient is a family friend and is suddenly unable to manage the airway? Nurses in these situations must work as a team and use effective communication throughout the emergency to competently and efficiently manage the patient’s care.  

Training and Practice 

The role of the nurse in an emergency in the correctional setting is very similar to that of an EMT or paramedic. If you are lucky enough to have a paramedic working in your facility, it is a good idea to set up practice scenarios with them and learn some of the skills that they have. While nursing and EMTs share similar skill sets, EMTs focus is on rapid assessment, prevention of further injury, and transport to a higher level of care if needed. This process is not necessarily how nurses are trained or think.  

How many times have you placed a C-collar on a patient? 

How many times have you gained IV access on a patient in the last year? 

How many times have you run a full code in the last year? 

Practicing basic skills, such as these above, will improve your abilities and efficiencies for real-life situations. Get the C-collar out and practice. Take the IV access kit out and use a banana to practice on; it will keep you familiar with the equipment. Suggest gathering the team at a staff meeting to practice running a code.  

Equipment 

In correctional settings, equipment is not always in plentiful supply. The situations that nurses are faced with can be so varied that stocking for all the various possible emergency possibilities would be expensive and inefficient. As a result, the equipment does tend to be limited. However, if you know that your facility has an issue with overdoses, then having multiple doses of Narcan on hand would be a priority. If your facility had a problem with physical altercations, then wound supplies would need to be kept to a good level. 

Having a specific emergency bag or cart is the best option, no matter what size your facility is. This bag should be checked every shift to ensure it is sealed and complete. If oxygen is available, it is also advisable to check the oxygen cylinder to ensure that there is an adequate amount in the tank and that it is functional. There is nothing worse than getting to an emergency that requires a piece of equipment, and it is not there, or it is not working! 

Patient Assessment 

Primary Assessment 

With any emergency response, medical personnel must begin the care of their patient with a primary assessment. There are varying examples of what this looks like, and if you look at the nursing literature alone, there is a key missing component; that is safety.  

Basic Life Support (BLS) may teach nurses to look at the environment first, but if you have worked in a hospital or long-term care (LTC) facility, you know your environment. Safety may cross your mind, but it will more than likely be fleeting in this instance. However, in the correctional facility, safety must be paramount. 

So, let’s use the EMT/paramedic book for responding to an emergency in the correctional setting.  

A primary assessment starts with “Scene Set-up” (1) – when you access the area of your facility that the emergency is in, your primary assessment starts here.  

What is the noise level? Who and how many people are out and have access to you? How many security personnel are around? Are there any tools or external dangers?  

Security personnel may not have done this, especially if they were on the scene at the time the emergency took place. Clearly communicate any dangers that you see to security before attending to the patient. 

Then, and only then, can we go on and do what we do best! Airway, Breathing, Circulation, Disability (includes the level of consciousness). 

Now stop! 

A primary assessment has a goal of identifying and beginning treatment of any imminently life-threatening conditions and acting to correct them. This does not involve vital signs. At this stage, you may be able to decide if the patient needs a higher level of care and if an ambulance is required (1). 

Now we can move on to the secondary assessment. 

Secondary Assessment 

This is a full head-to-toe assessment of the patient. If there is a team of nurses or security at the scene, then there is no harm in getting one nurse to take vital signs at the same time as another doing a full head-to-toe. Throughout this period, it is always very important to talk with the patient (if conscious) and explain what you are doing, why, and to preserve their dignity. 

Be aware that a full examination may be done in a more private area, such as at your medical area, if you have assessed that the patient can be moved safely.  

Types of Emergencies 

As previously mentioned, two types of emergencies can occur in the correctional setting:  

Man down 

This is when an emergency where only one person requires medical attention. These emergencies can be anyone in the facility – whether a member of staff, a volunteer, or a patient.  

This is the most common emergency that nursing staff will be called to. 

Mass Disasters 

Mass disasters are where more than one person requires attention. These require a triage system where the medical team needs to be organized to be able to identify who needs attention as a priority. There are many examples of triage systems that can be adapted to the correctional setting and there has yet to be an identified “best” one (2).  

The most common triage method that is used is the traffic light system where a patient is given a colored tag after having a primary assessment. The tags are: 

• Red – immediate (care required) 
• Yellow – delayed 
• Green – walking wounded 
• Black – deceased 
• This is where a primary assessment comes to the fore.  

If you are a team of three nurses attending a riot that has now been contained, you may be faced with 10-12 patients who have injuries. A primary assessment is going to give you the ability to quickly tag each patient so that you can concentrate on the most immediate care needs and call for a higher level of care for the right number. 

Emergency Drills 

Emergency drills are a key component in being able to identify the effectiveness of the emergency response plan. The drills should be simulated for a man-down situation and, separately, for a mass disaster. 

For best practice, it is advised that a man-down drill should be practiced once a year on every shift where medical staff is assigned in correctional facilities (3) 

And it is advised that a mass disaster drill is conducted for every shift every 3 years (3). 

When was the last time you took part in a drill? 

Did you critique it with the team? 

Did you feel more confident responding to the next emergency call?

The critiques are designed to record actions, including response time by staff, communication processes, roles undertaking by staff members, overall outcome. Although the critique can identify inappropriate actions by staff members, the whole concept is for everyone involved to learn from the drill. Bear in mind, it is a drill and designed to practice skills that correctional nurses do not use often. 

Summary 

Emergency response in the correctional setting is a skill that nurses need to learn and practice to ensure the patient gets the best outcome. Nurses who come to work in correctional settings are not always trained or experienced in these skills, so it is important that nurses understand their role and responsibility when an emergency is called. 

The facility in which you work should have a man down and mass disaster drills to help with the development of these skills. The critique of these will enable you to review what your actions were and allow you to learn from the experience. This will promote teamwork and will ultimately lead to the best delivery of patient care.  

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