PULSE Magazine | October 2018 Issue

This was a poor assumption on my part in that the surrounding security issues inherent at Central Booking alone make practical nursing an all but impossible task. And while the Del Valle site has more ER type capabilities, they also have some of the same security issues. And while the Del Valle site has more ER type capabilities, they also have some of the same security issues. First, I'll focus on Central Booking as the majority of the calls to our system for assistance start there. Hopefully I can answer some of the ques- tions you may have as to why some patients need transport to a medical facility. There are plenty of instances where the need for transport is apparent but it's the ones that don't fit the EMS thought process that always seem to cause the most friction. Those are the ones I hope to shed some light on; if I'm able to help bridge the gap of misunderstanding it benefits all involved and ensures the inmate the best possible medical outcome. In the end, both our medics and the jail nursing staff are part of the city and counties continuum of care. First and foremost you have to understand that Central Booking is a non-permanent jail facility. Long term incarceration is at the Del Valle site. While that may seem obvious reading this now, this consideration is often overlooked when EMS responds there. Once someone has been arrested and taken to Central Booking for intake, they go through a medical screening. If they meet certain criteria that has been mandated by the Medical Director for TCSO Inmate Medical Services, Dr. Alexander Meagher and the TCSO Jail System protocols, this prompts the nursing staff to follow through with whatever their standard of care is regarding the corresponding protocol. Most of the operating systems that Travis County uses are fairly standard throughout the prison systems and jails in the US. Meaning that when an arrestee comes in for arrest review and intake, part of that intake is a medical screening. This is to protect the inmates’ health, safety, and rights, but also to protect Travis County and the City of Austin, or whatever jurisdiction the arresting officer represents. The nursing staff at Central Booking actually has very little medical capability secondary to the transitional nature of people who have been arrested. They do not have the ability to observe a patient like an ER nurse can, especially at busier times such as weekends and during the many and

nearly constant activities here in Austin that often facilitate ETOH consumption. We as the city and county EMS provider see those spikes as well. The people being arrested are only going to be housed at Central Booking for a short time and the nursing staff downstairs at intake, staffed at one or two people depending on the situation don't have the ability to fully treat then monitor patients. Occasionally I forget about the level of autonomy I enjoy in comparison to that of nurses in general, but especially the RNs working in the triage intake area of Central Booking. They must have a physi- cian’s order for EKGs or X-rays and that physician must then read and interpret them. While medics don't do X-rays, our ALS staff routinely do EKGs and not only interpret them but are able to treat and transport to appropriate facilities. The staff at Central Booking have a BLS medical bag and AED abilities readily available. They have a very small array of drugs they can give: EPI pens, Narcan, and Benadryl. These are limited for a number of reasons; the amount of people a nurse is responsible for at any given time, the inability to monitor patients after a medicine admin, and liability issues to name a few. In contrast, the Del Valle site is basically a small ER. They have a physician on staff, the ability to monitor patients, start IVs, and treat the usual suspects like chest pain, dehydration, and OD. Central Booking simply does not have that capabil- ity due to the transient nature of housing along with a varied and constant influx of inmates and the security of all involved. Consternation is caused when someone is arrested on scene, but was seen by EMS at the scene and a refusal was obtained before this person is trans- ported by law enforcement to Central Booking. Once this person reaches the intake process, the jail nursing staff must complete a questionnaire for each new arrestee. This includes any recent trau- ma, MVAs , etc. The patient and officer can tell the nursing staff that a refusal was generated by EMS on scene, however the nursing staff have no pa- perwork or any way to confirm that the patient waived medical liability. This creates liability for both the nurse's licensure and Travis County. Since these people are now basically under the protec- tion and care of Travis County, you can see where liability plays a large role in many of the jail nurse functions and ability to operate. Their protocols require the patient to be cleared by a physician or medical authority with some type of documenta- tion supplied to the jail nursing staff.

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