Emergency Care and Disposition of Prisoners in the Emergency Department

ABSTRACT

PURPOSE: Most emergency departments (EDs) treat prisoners; however, in so doing, there is often a disruption in the normal routines of the ED and associated problems for the treating physician. The current study was conducted to describe the use of emergency medical care by the prison population in an effort to better understand the needs of prisoners and to plan specific services to care for prisoners. METHODS: We retrospectively analyzed 220 ED admissions involving 188 prisoners at Konyang University Hospital between August 2004 and January 2009. The medical records of all prisoners admitted to the ED were collected and analyzed from the ED computerized database. The following data were extracted for each prisoner time and reason for admission, age, gender, Emergency Severity Index (ESI), final diagnosis, and disposition. RESULTS: The 220 admissions (188 prisoners; mean age, 42.3 years; range, 20-78 years) consisted of the following medical illnesses (64.1%), self-injuries (16.8%), surgical conditions (7.7%), injuries sustained from violence (6.4%), accidental injuries (3.6%), sports injuries (0.9%), and miscellaneous (0.5%). Eighty ED admissions (36.4%) had significant medical histories, including hypertension, diabetes, myocardial infarctions, and seizure disorders. Ninety-six ED admissions (43.6%) were subsequently admitted to the hospital as inpatients. Twenty prisoners visited the ED more than 1 time (a total of 52 times), including 2 prisoners who were admitted to the ED 5 times each. There were 19 ED admissions for ingestion of foreign objects by 15 prisoners. The most common foreign body was a metal wire. The overall mortality rate was 6.9%. CONCLUSION: Prisoners referred to the ED have serious medical conditions with a high mortality rate that require specific emergency management. In rendering care for a confined prison population, the ED staff should be aware of the increased risk of sudden cardiac death.