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‘Don’t let your guard down’: 5 takeaways from a prison bus MCI

Lessons in communication, coordination and safety from an unusual response involving several inmates

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Does your mass casualty incident plan include details about managing multiple in-custody patients that need security to make sure they do not escape or become a danger to responders or the public?

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It is the plot of more than a few classic movies and television shows: a group of convicts are being transported outside of the prison and, either accidentally or intentionally, the bus or plane crashes, releasing the dangerous occupants to flee into the nearby woods, neighborhoods or malls.

Thankfully, in real life, correctional agencies are particularly good at safely and securely transporting prisoners, but incidents do occasionally happen. The recent crash of a Pennsylvania Department of Corrections bus on the Pennsylvania Turnpike resulted in one corrections officer (CO) and 11 inmates requiring transport to a hospital for minor injuries.

Does your mass casualty incident plan include details about managing multiple in-custody patients that need security to make sure they do not escape or become a danger to responders or the public? Take a moment to consider the following takeaways on this unique occurrence.

1. Coordination of agencies

A primary concern will be the interagency communication and coordination needed to safely respond and transport the prisoners. This is no time for silos or authority squabbles. For the safety of everyone involved, EMS, fire, law enforcement and hospitals must be able to work together efficiently and professionally to:

  • Identify patient care and transport needs and priorities
  • Provide security to transporting crews
  • Coordinate hospital destinations based on patient care needs and ability to secure detainees

Except for life-threatening conditions, prisoners should not be loaded into ambulances and transported until the law enforcement officer or CO in charge gives the OK and assigns someone to provide security and maintain custody. It may take time for them to bring in their resources but safety is the priority.

2. Patient tracking

We know that keeping track of patients at any MCI scene is important but factor in that these patients are in custody of law enforcement or a corrections agency, and it becomes critical. Incident command must definitively know the identity, status and location of each and every person involved in the event. No patients can be allowed to leave the scene without the transporting personnel reporting the details of who they are transporting and the intended destination. The transportation log should also include details about the LEO or CO accompanying the transport to maintain the security of the prisoner.

3. Transport safety

EMS transport of a person in custody is not an unusual occurrence and EMS agencies should have policies in place for the safe care and transport of these individuals. Considerations include:

  • Appropriate methods to provide prisoner restraint. It is usually not acceptable to handcuff or shackle a prisoner directly to a fixed part of a vehicle, but they may be secured to the stretcher.
  • The need to have a LEO or CO on board the ambulance versus following close behind in their vehicle.
  • Search of the prisoner for weapons before placing them in the ambulance. It is common law enforcement practice that anytime a detainee is turned over from one officer to another or loaded into a vehicle, they are searched.
  • Clearing the patient care area of anything the prisoner could grab and use as a weapon to harm themselves or others. Think about trauma shears, pens, clipboards, tablets, stethoscopes, oxygen tubing, IV lines, needles and batteries. Are there any supply or equipment cabinets within reach?

4. Special resources

Almost by definition, MCIs and multiple patient incidents require EMS agencies to consider special resources for the response. Whether it be activation of mutual aid resources, multiple patient transport vehicles, specialized rescue units or operation support teams, additional layers of resources will be needed. You may simply need several ambulances to avoid having more than one prisoner in an ambulance.

Do not forget to include the hospital or hospitals that will likely receive patients. Are there emergency departments in the area that are designated and prepared to treat prisoners safely and securely? In some instances, the prison system will have a contract with a particular hospital for inmate emergencies. Contact them early so that they can activate their plans and have the secure rooms ready.

5. The job remains the same

As your response comes together, keep in mind that our role in an incident involving inmates or other in-custody individuals really does not change from what we do on every call. EMS provides safe and quality care to sick or injured persons without any prejudice for who we think they are or what they may have done. The criminal justice and corrections systems have the heavy task of dolling out punishments and enforcing sentences. Don’t let your guard down and be safe, but provide the same great care you do to all your patients.

Be safe out there.

Read next: How to make scene safety a core part of every EMS response

Michael Fraley has over 25 years of experience in EMS in a wide range of roles, including flight paramedic, EMS coordinator, service director and educator. Fraley began his career in EMS while earning a bachelor’s degree at Texas A&M University. He also earned a BA in business administration from Lakeland College. When not working as a paramedic or the coordinator of a regional trauma advisory council, Michael serves as a public safety diver and SCUBA instructor in northern Wisconsin.

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