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An established principle in civilized societies is that prisoners are entitled to the same level of medical health care as the law-abiding community.1–3 Winston Churchill was quoted as saying “a society is measured by the treatment of its prisoners.” Other ethical considerations involve the issue of prisoners’ human rights.4 The exact medical service provided will vary between countries and, in the U.S., due to the federal system, between states.4 The concept of prison health care in general is the subject of debate and outside the remit of this chapter.5,6

EDs may have to provide emergency health care to prisoners. Prisoners could be inmates of a local prison or have been recently arrested for committing a criminal offense in the community and detained in police custody. Management of these patients presents a number of clinical and management problems for the medical and nursing staff of the ED.

Many prisons will have internal medical services of varied capability. There may be a ward or bedded observation unit for the management of uncomplicated medical conditions. Nursing staff are on duty for the full 24 hours working on a shift pattern. Doctors are present mainly for normal working hours, providing night, weekend, and holiday coverage on an on-call basis. Facilities will vary from site to site but may include radiography, a minor surgical treatment room, and consulting rooms for ambulatory care visits by local specialists. On-site or frequent access medical specialties can include a general prison medical officer(s), psychiatrists, psychologists, alcohol and drug abuse counselors, and social workers.7

The population of a prison is not representative of the general population; typical characteristics are listed in Table 298.1-1.2

Table 298.1-1 Prisoner Characteristics

Within the prison, there exists a pool of chronic disease and drug misuse that can lead to significant morbidity and acute hospital presentations.7 Disease profiling of prison inmates exhibits higher prevalence rates of certain diseases than those reported for the general population. The most common groups of morbidity are infectious diseases (hepatitis, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome), diseases of the circulatory systems (ischemic heart disease, hypertension), diseases of the respiratory system (asthma, chronic obstructive pulmonary disease), and musculoskeletal and psychiatric conditions.8 A study of prisoner mortality attributed the most common causes of death to ischemic heart disease, followed by cerebrovascular disease, neoplasms, and pneumonia.9 With the population of prisons increasing, in particular the amount of elderly prisoners and those from an ethnic minority group,10,11 the prevalence of chronic disease will rise, increasing the likelihood of acute medical presentations to the ED.

Safety of Staff and Patients

The management of even one prisoner, ...

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