Running Code Blues in Prison

Hey Sheri,

A memo went out at my institution recently that said we are to call 911 in cases of cardiac/respiratory arrest and have the inmate transferred directly from the site of arrest to an outside facility. Thus, we would wait for paramedics to arrive before removing the inmate from the scene (unless the scene is unsafe or there are other issues that require you to move the inmate out of the cell) or would at least move them only part of the way to make it easier for the medics to make contact with the inmate. Seeing as how we both work for CDCR and what works for one facility may not work for another, this is something that definitely needs to be brought up to your SRN, DON, and CMO for clarification. CPR should be started immediately on sight of the arrest and the AED needs to be immediately available (hopefully you have this in your clinic). At my institution, custody normally enters the cell first to determine unresponsiveness (and some will even handcuff the inmate) before medical enters. Is there an ambulance available on grounds to pick this inmate up and transport to the ER? If your cells are as cramped as many of the cells in my institution, it would be best to remove the inmate from the cell first if it is getting in the way of you doing CPR. Otherwise, leave the inmate where he is, start CPR, apply the AED, and wait for paramedics to arrive to transport them out of the institution. The memo at my institution went out not just to medical, but to custody as well. Custody has to get used to us doing things differently than the MTA's. In some instances, it is better to take a patient out of the cell and down to medical for further care if you don't have the equipment you need or the scene is unsafe (routy inmates), but it's different when the patient is in full arrest. You just never know when you are going to need something and custody isn't trained on how to ask us for what we will need (and never will be as that really is medicals' job) and I know we are guilty at my institution of this, but it always seems like what we need, we don't have on a man down. Preparation is key so make sure you have those items that are needed immediately in certain situations (i.e. BVM, AED, Oxygen). Otherwise, call down to the clinic and ask for additional things as needed or bring the inmate down to the clinic. Is there a room in the housing unit that you could move the inmate to in this event that would put custody at ease? I know they don't like to be on the tiers if they don't have to for their own and your own safety. Let custody know you are willing to work with them on this issue, but also help them understand where you are coming from. See if you can't reach a compromise. Hope this gives you some ideas. We are still working out the kinks, too, but things are slowly but surely starting to get better.

We really need a memo like this because, as far as I know, the paramedics cannot get direct access to the inmate as you described. First the inmate has to go to our medical clinic (which is a logistical nightmare), then our mini-ambulance picks them up from there and brings them to our TTA. So by then, it can easily be too late.

Thanks for the info though because I'm going to bring this up with our DON asap. If this is the way other CDCR facilities are doing it, we probably should do it this way also. Afterall, it's the only sensible solution.

we run into the same problems at our facilty.

Custody needs to be more on board on what exactly we do, though. but that our fault in assuming they know what we want from them.

know I'll tell you from a military background. If you arrive on a scene and you need something you better bark at these C.O's I dont care if we are medical or not I'd rather get my butt chewed later for being demanding then let an inmate die on my watch because I was scarred about the C.O.'s might say.

They are you to being yelled at. A majority of them are prior military and unfornuatley thats what they respond to.

don't get me wrong don't go around burning bridges in the prison system. You need as many friends as you can get. But educate when medical is on scene we are in charge.

Remember where you are at and safety comes first. But I know many ex-MTAs who will take over a scene if they feel medical is unwilling to.

The C.O's know they are there to help but sometimes you need to tell them to help roll a patient. hold pressure. glove up. maintain an airway. they are CPR certified. In our facility it is part of their uniform to carry a pocket mask.

And yes I do check and ask them if they are carrying it. You never know when they might need it.

Most of our man down we will routinely not take them to the clinic.

we take them directly to TTA. Now with that being said I always notify the nurse working in TTA what to expect and give them the CDC# C/O and what to expect. SHe'll have the chart pulled and standing by before we arrive.

each facilty is different but we make everything is done before the arrival.

Do you pull the inmate out of the cell first or not. Most people say you pull them out before you do anything for security reasons but, if the inmate is unconscious, weighs 300 pounds and can't be moved easily, do you start CPR in the cell under in that situation or any other cirumstance? Or do you insist that the inmate gets pulled out of the cell, period?

Our veteran ER nurses also tell us to try to do at least 5 CPR cycles before we get them over to the prison ER. But custody's first impulse is to get them outta there as quickly as possible. They just don't seem to understand how important CPR is and that quicker transport isn't going to help much if the inmate is DOA. It's created some really difficult situations with custody.

I would insist on doing 5 cycles of CPR first before moving the pt (unless the scene is unsafe)

I know this was posted a couple of weeks ago but I just had to respond.

At our prison (all men's mod/max... 3,000+ inmates) they are so not prepared for code blues. All of security is CPR certified but not one will initiate it. Medical is a long haul to the outer housing units so I feel its mandatory for a CO to initiate CPR until we can get there. We had a code blue (we had 3 overdoses) and 2 were down. All medical responded except one nurse that had to stay in the infirmary. We called 911, grabbed narcan (which is locked up) grabbed the jump bag and oxygen and off we went. NOT ONE CO started CPR. When we got there they were blue. It made us SO mad that they were just sitting waiting. I wrote a complaint letter to the warden. The whole scenario should have been handled differently. Luckily they made it. Thank goodness for narcan and CPR that WE gave them. They were all in the same housing unit. BUT the next day they found an inmate dead (overdose of the same drug) on his bunk the next morning. He was in a different housing unit (next door) Security is suppose to check on these guys every 30 minutes. BIG INVESTIGATION as you can imagine!

All the nurses were awesome though. We all worked together and responded appropriately!!