PULSE Magazine | October 2018 Issue PE

There is some question as to whether the jail nurs- ing staff can obtain some kind of refusal of their own, but I have not been able to confirm or deny this as of this writing. It was one of the questions I hadn't thought of when interviewing these ladies. It's my under- standing that they have some kind of refusal pro- cedure in place but I'm unsure of its parameters. As you can see, many of the patients we transfer from Central Booking either meet some liability criteria or are beyond the scope of practice for the limited resources and protocols of the nursing staff there. Another thing to keep in mind is the tenor of most of the people the jail nursing staff sees. None of them are happy to be in jail and don’t want to be seen by medical personnel. Many have known psy- chiatric histories, are repeat offenders, or still ag- gressive after their interaction with law enforce- ment. That does not make for the most positive work environment. While a percentage of our pa- tients may be difficult to handle in a given shift, 100% of theirs are unhappy, scared, agitated or combative. This translates into a very challenging work environment. With that in mind, being cognizant of how EMS providers approach these calls in regard to attitude and professionalism is important. In full disclosure, the reason I have taken on this project is because I was involved in a verbal altercation with one of the jail nursing staff. It was nothing more than a misunderstanding but I am grateful for the incident because it helped me gain insight into how the jail nursing staff operates. Understanding their limita- tions has greatly improved my own ability to com- municate with jail nursing staff and I now under- stand the “whys” of many of the calls generated there. As medical providers we all experience the onus of compassion fatigue and its effects are very real. Dealing with high stress situations on a regular ba- sis, different types of difficult patients we see in the downtown area given our high homeless popu- lation and the ease of accessibility to both alcohol and illegal drugs wears on every medical provider. However, we must stay vigilant and continue to demonstrate the decorum and professionalism I believe we personify as an EMS system. In the past I have transported patients the nursing staff at Central Booking deemed too violent for jail and I asked about this situation because at face value it seems odd. There are times when inmates have either ingested a substance that is making

them aggressive, or have some type of mental is- sue that makes them prone to extreme episodes of violence to either themselves and/or others. The nursing staff have no way to sedate or monitor the patient to ensure that patient’s safety. Think of the typical presentation of an excited delirium patient and all it necessitates in treatment and monitoring, and you begin to understand their limitations and reasoning for transport. Also, from a security standpoint this type of inmate creates not only a need for more personnel to manage but also diverts attention away from the rest of the inmates in the general area. In the past this has given inmates an opportunity to attack another inmate while the jail staff are occupied. Again, many of the protocols and SOPs that the jail uses are standardized and widely accepted to miti- gate injuries, safety risks, and liability concerns. Remember, whoever has jurisdiction over the in- mates is responsible for their inherent safety. There are reasons these procedures are in place. Another way the jail nursing staff is hindered is when there is a need to transport patients. They can recommend whether the patient “can go by sedan”, to use their terminology, or by EMS. In this case the arresting officer is the determining factor in whether they are comfortable transport- ing the patient themselves, if not EMS is called to transport. I was not aware of this procedure but some of these patients are transported without EMS intervention. In a recent CE session Dr. Pickett mentioned that the jail was getting remote medical consulting and partnering with Dell Seton but this is only partially correct. The Del Valle site is testing the program now and it’s estimated that Central Booking may have something similar in the next 1-2 years depending on budget and availability of equip- ment. In summary, the nursing staff at Central Booking have much more constraint than I realized. They have a difficult job and very limited resources and protocols, not only from a medical standpoint but from Travis County Corrections Department Stand- ard Operating Procedures as well. Hopefully this article has given you some insight in to what those constraints are and more importantly the ephem- eral “why” for some of the calls we respond to there. Please feel free to direct questions to me or to Chief Hofmeister. Till then, see you out there.

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