Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-24T12:48:41.475Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of a prison triage system on injuries seen in emergency departments

Published online by Cambridge University Press:  21 May 2015

Nick Kuzak ,
Michael O’Connor ,
William Pickett ,
Terry O’Brien ,
Ken Reid  and
Mary Pearson
Nick Kuzak
Affiliation:
First-year resident in Emergency Medicine, University of British Columbia, Vancouver, BC.
Michael O’Connor*
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont
William Pickett
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont Department of Community Health and Epidemiology, Queen’s University, Kingston, Ont
Terry O’Brien
Affiliation:
Residency Emergency Medicine Program Director, Queen’s University, Kingston, Ont
Ken Reid
Affiliation:
Department of Cardiothoracic Surgery, Queen’s University, Kingston, Ont
Mary Pearson
Affiliation:
Department of Family Medicine, Queen’s University, Kingston, Ont
*
Professor and Head, Department of Emergency Medicine, Queen’s University, Kingston General Hospital, 76 Stuart St., Kingston ON K7L 2V7; 613 548-2368, fax 613 548-1374, [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

1) To describe injuries experienced by the male prisoner population in the Kingston, Ontario area, and to compare them with those observed in the general population; and 2) to compare the incidence and patterns of prisoner injuries seen in emergency departments (EDs) before and after the introduction of a prison injury triage system.

Design:

A chart review.

Setting:

The catchment area surrounding 2 hospital-based EDs in Kingston, Ontario, which includes 8 federal and provincial prisons for adult males.

Observations:

Injuries to male prisoners (ages 18–75 years) who were treated in the ED during 1996–98 were compared with injuries to the general male population of the same age range. An on-site emergency care triage system was introduced to area prisons in 1993. Prisoner injuries seen in the ED during 1996–98 were compared with those seen during a similar period prior to the introduction of the triage system (1981–84). Available comparators included patient demographics, disposition, intent and nature of injury, the need for surgery, and lengths of hospital stay.

Results:

148 prisoner injuries were identified for 1996–98. Prisoner injuries seen in the ED were relatively severe when compared with the general male population, as indicated by the higher frequency of fractures (31.8% prisoner vs. 13.4% general, p < 0.001), blunt head injuries (10.1% vs. 2.2%, p < 0.001), hospital admissions (42.6% vs. 4.1%, p < 0.001) and deaths (2.7% vs. 0.6%, p < 0.001). Since the introduction of the triage system there has been a reduction in the rate of prisoner injuries seen in local hospital EDs (6.1/100/yr [before] vs. 1.6/100/yr [after], p < 0.001). There has been an increase in the relative severity of prisoner injuries seen in the EDs as indicated by the increased hospital admission rate (42.6% vs. 22.7%, p < 0.001), increased rate of surgical intervention (27.7% vs. 12.1%, p < 0.001), and increased length of hospital stay (4.0 days vs. 2.1 days, p < 0.05). The mortality rate has remained low and unchanged (0.7% vs. 1.1%, p = 0.99).

Conclusions:

The introduction of the new triage system appeared to be associated with a decrease in the total number of ED visits by prisoners. The relative acuity of prisoner injuries seen in the EDs appeared to increase following introduction of the triage system.

Type
EM Advances • Progrès de la MU
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 3 , July 2001 , pp. 199 - 204
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

References

1.Boe, R.Review of the offender population forecast: models, data and requirements — with provisional forecasts for 1998 to 2007. Correctional Services of Canada, Research Branch. 1997 Jul. Available: www.csc-scc.gc.ca/text/rsrch/reports/r59/r59e.shtml (accessed 03 May 2001).Google Scholar
2.O’Connor, MH, Stringer, DG.Review of traumatic injuries in regional federal penitentiaries. CMAJ 1985;133:204–5.Google ScholarPubMed
3.Mackenzie, SG, Pless, IB.CHIRPP: Canada’s principal injury surveillance program. Inj Prev 1999;5:208–13.CrossRefGoogle ScholarPubMed
4.Statistics Canada. Profile of Census Divisions and Subdivisions (electronic data product). Ottawa, Statistics Canada, 1997. 1996 Census of Canada.Google Scholar
5.Rosner, B.Fundamentals of biostatistics. 3rd ed. Belmont: Duxbury;1989. p. 171.Google Scholar
6.Rowe, DJ.Medical and health care services in Canada’s federal prisons. CMAJ 1978;118:578–83.Google Scholar
7.Guzzardi, LJ, Braen, RG, Jones, DP.A novel approach to the problem of health care in jails. JACEP 1979;8(9):377–9.Google Scholar
8.Sheps, SB, Schechter, MT, Prefontaine, RG.Prison health services: a utilization study. J Commun Health 1987;12(1):4–22.Google Scholar
9.Bragg, WD, Hoover, EL, Turner, EA, Nelson-Knuckles, B, Weaver, WL.Profile of trauma due to violence in a statewide prison population. South Med J 1992;85(4):365–9.CrossRefGoogle Scholar
10.Novick, LF, Penna, RD, Schwartz, MS, Remmlinger, E, Lowenstein, R.Health status of the New York city prison population. Med Care 1977;15(3):205–16.CrossRefGoogle ScholarPubMed
11.Novick, LF, Remmlinger, E.A study of 128 deaths in New York City correctional facilities. Med Care 1978;16(9):749–56.CrossRefGoogle ScholarPubMed
12.Gage, D, Goldfrank, L.Prisoner health care. Urban Health 1985;14(3):26–8.Google Scholar
13.Walton, CB, Blaisdell, FW, Jordan, RG, Bodai, CI.The injury potential and lethality of stab wounds: a Folsom Prison study. J Trauma 1989;29(1):99–101.CrossRefGoogle ScholarPubMed
14.Williams, RW, Burns, GP, Anderson, MN, Reading, GP, Border, JR, Mindel, ER, et al. Mass casualties in a maximum security institution. Ann Surg 1974;179(5):592–9.CrossRefGoogle Scholar
15.Injury surveillance in correctional facilities — Michigan, April 1994–March 1995. MMWR Morb Mortal Wkly Rep 1996;45(3):69–72.Google Scholar
16.Madden, D, Lion, JR, Penna, MW.Assaults on psychiatrists by patients. Am J Psychiatry 1976;133(4):422–5.Google ScholarPubMed
17.Turner, J.Role of the ED nurse in health care based hostage incidents. J Emerg Nurs 1984;10(4):190–3.Google Scholar
18.Weaver, A.Unusual incident: Code Orange. J Emerg Nurs 1991;17(5):354.Google ScholarPubMed
19.Lessenger, JE.Prisoners in the emergency department. Ann Emerg Med 1985;14(2):179–83.CrossRefGoogle ScholarPubMed
20.Iris, F.Fatal shooting by an ED prisoner during a preplanned escape. J Emerg Nurs 1991;17(5):333–4.Google Scholar
21.Chuni, R.Penitentiary medicine: the emergence of a new perspective. CMAJ 19797;120:872–3.Google Scholar
22.Treat prisoners in ED with caution and dignity. Emerg Dep Manage 1996;8(10):117–20.Google Scholar