Not long ago, a police officer brought an adult female to an emergency room to be evaluated for risk of suicide. While inside an ER examination room (and in custody) the woman managed to find some glass tubes used for blood draws. She broke the tubes and used the razor sharp glass shards to shred the veins in her wrists. Luckily, she was discovered before she could bleed-out to the point of no return.
An inmate is padlocked to a bed in the emergency room of the General Hospital of Port-au-Prince, Haiti. (AP Photo/Ariana Cubillos)
Angry that she’d been discovered, the patient resisted the attempts to save her life. The officer attempted to use pepper spray to subdue the now enraged and bloody patient. The spray seemed to have no effect on her but it worked well on the nursing and medical staff.
The officer managed to clear the emergency room of many bystanders, including the patient’s nurse, who ran out into the parking lot to regain her sight and clear her lungs, but did little to subdue the suicidal woman. Fortunately, there were no cardiac or respiratory cases nearby to send into unrecoverable distress.
The remaining emergency medical staff that could still function sprang into action, subduing the woman and stabilizing her for emergency surgery. The patient still hadn’t lost her will to die, however, so she struggled with the staff for an opportunity to finish the job. After suturing her wounds, they applied some restraints to her now sore and bandaged wrists and prepared to transfer her to a psychiatric treatment facility.
In the mean time, nothing else had changed. Waiting inside the same room was the same suicidal subject, the same officer, and the same attitude. So while the officer’s back was turned once again, the prisoner freed one arm from the restraint, found a glass shard from the previous attempt, and reopened the sutures on her wrist.
The hospital medical staff and administration, needless to say, were not happy. What’s the definition of insanity? Doing the same thing twice and expecting different results, right?
What can we learn from this incident? Don’t get me wrong — police and corrections officers bring prisoners to hospitals all the time and usually they do it without any problems. Still, people send me stories like this so often that I can’t just dismiss them, and escapes and other serious incidents inside hospitals seem to be increasing. Perhaps it’s time police, corrections, and healthcare administrations tightened up their training and procedures for handling prisoner patients
Keep the spray holstered First, if you’re a police or corrections officer don’t use Mace®, pepper spray, pepper foam or pepper balls inside a hospital. If you’re a security director of a hospital, don’t issue aerosols to your officers. If you’ve already done so, get rid of it.
If you clear out a movie theatre after using pepper spray, all anyone will likely miss is the end of the movie. But if you fill the ventilation system of a hospital with pepper residue or tear gas, it can have serious results.
Hospitals attract patients with cardiopulmonary diseases and they are supposed to be a safe environment for them, so chemical agents should be considered unusually high-risk options in hospitals. It just isn’t possible to quickly evacuate someone who’s hooked up to a maze of tubes, wires, and other life-sustaining equipment.
Talk before you shock Some experts tell me that TASER® may be a problem in the clinical environment as well. Talk to your department’s TASER® instructors about the hazards of using TASER® in an environment filled with oxygen and flammable liquids.
In either case, train and get good with your baton. Better yet, train and get good at manual stabilization and, if possible, always have a back-up present. The clinical environment is a perfect example of why public safety people shouldn’t get too comfortable with one intervention option. They should always be proficient with many.
Secure the environment Secondly, hospital exam rooms in general are not safe places. In fact, they are one of the most dangerous artificial environments on earth. They are confined spaces, usually with glass doors. They are also typically filled with sharp objects, blunt force instruments, biohazards, flammable liquids, dangerous gases, chemicals and dangerous objects literally jut out from the walls.
When bringing your prisoner to an ER exam room, change the environment as much as you possibly can. Chairs, wheeled tables, rolling cabinets and anything else not nailed down should be rolled out into the hallway. Biohazard bins and buckets can be placed out of the room. Soiled laundry cans, extra I.V. poles—get everything out! Ask the staff what’s in the remaining drawers and cabinets or take a look yourself, then secure anything dangerous, if possible.
Secure the patient Also, your forensic patient should be restrained with administrative restraints, i.e., police restraints like handcuffs and shackles. Use the hospital’s restraints instead of handcuffs and shackles only if you know what you’re doing and if they are locking security restraints. Even if you use hospital restraints to stabilize your patient, you may want to consider keeping a pair of cuffs on the patient, in addition to the hospital provided equipment.
Don’t assume that the hospital staff knows what they are doing, either. Very few police officers, corrections officers, or hospital personnel have been formally trained how to safely do a supine stabilization, much less apply four-point restraints. So if you haven’t been trained how to use, apply, and test them for fit, then behavioral restraints made by RIPP™, POSEY®, or any other manufacturer won’t improve anyone’s safety and security.
Medical cloth and disposable restraints are next to worthless, so you won’t be able to rely on them. They are designed for medical-surgical restraint and not for security. Their purpose is to stabilize a part of the body to facilitate a medical procedure or promote healing. Though they are often used for behavioral restraint in hospitals, they shouldn’t be. If it’s all the hospital provides, go ahead and use cloth or paper restraints (you heard me right, paper) to stabilize the arms of a reluctant patient for medical procedures or added safety, but still keep some cuffs or other appropriate police restraint going from that prisoner to a gurney or a wheelchair.
Eyes on the prize Keep your eyes on the patient at all times. I repeat, KEEP EYES ON AT ALL TIMES! If there is one common thread that unites most of the restraint related incidents that I’ve evaluated it’s this: Someone failed to continuously monitor the prisoner or patient. Someone took their eyes off them just for a brief time.
I am reminded of one of Gary Klugiewicz’s prisoner transport axioms, “out of sight, out of your mind”.
The failure to continuously monitor is the culprit in the vast majority of hospital escapes, serious injuries and deaths involving, not only forensic patients, but anyone restrained in a hospital or psychiatric facility.
When it comes to maintaining the security of your patient prisoner, no one can do it for you - not the hospital security staff, the nurse, an EMT or anyone else. A prisoner in your care and custody is your sole responsibility. The officer who brings in a prisoner for medical clearance or psychiatric evaluation is responsible for everyone’s safety until that prisoner is jailed, committed, or lawfully released.
About the author
Joel Lashley has worked as a public safety professional for 25 years, including 17 years of service in the health care setting. Joel leads the training program for hospital, clinical, and social outreach staff in Violence Awareness, Prevention, and Management at Children’s Hospital of Wisconsin in Milwaukee, the only level 1 pediatric trauma center in the region, serving critically injured and ill patients throughout the Mid-West
He has trained hundreds of nursing, clinical, social work, psychiatric, and public safety professionals in the management and prevention of violence. He is a certified instructor for Interventions for Patients with Challenging Behaviors and Principles of Subject Control (POSC®) – Security Personnel, and Non-violent Crisis Intervention®, from the Crisis Prevention Institute. He is a member of the International Association for Healthcare Security and Safety and the International Association of Non-violent Crisis Intervention Certified Instructors.
Joel has developed a program for managing the care of children, adolescents, and adults with autism and other cognitive disabilites. The fact that his son has autism has made him concerned about how this segment of our population is managed in the medical, security, and law enforcement arenas. Future articles deal with this and other issues facing our medical and mental health facilities as we search for ways to best treat their patients.