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4 Myths About Hangings in Jails and Prisons

The actions taken in the first few minutes after a discovered hanging can be the difference between a hospital transfer and an in-custody death.  Hanging is the most common form of successful suicide in corrections.

Correctional nurses are confronted with situations unusual in other care settings. Be sure to prepare yourself by eliminating these common jail and prison nursing myths from your practice.

Myth #1: It won’t happen here – this is a small jail.

Although it might appear that most hangings happen in large urban jails, the Bureau of Justice Statistics (BJS) Special Report on Suicide in State Prisons and Local Jails reports that the country’s smallest jails had suicide rates 5 times higher than the largest jails. Jails holding fewer than 50 inmates accounted for 14% of all jail suicides. With smaller staffs and fewer resources, small jails need to remain vigilant to the potential for hangings. Detailed policies and procedures on prevention and post-hanging interventions should be in place. Emergency procedures for a hanging situation should be periodically practices and involve both custody and medical unit staff.

Myth #2: It won’t happen here – We have great suicide screenings and watch suicidal inmates closely.

Improved suicide prevention and management processes have definitely reduced hanging suicides in the correctional setting over the last two decades. As outlined in a prior column I wrote for CorrectionsOne, incarcerated suicide rates in both jails and prisons have declined sharply; with jail suicides still over 3 times the rate of state prisons. Suicidal inmates are creative and will use any resource available to craft a noose and the leverage to asphyxiate by hanging body weight. Screenings can help weed out obvious potential for self-injury, but require a good mechanism for protecting those who do not pass the screen. A strong communication process with mental health services is needed to complete the protective program. All staff must be vigilant for indications of self-harm. Suicide attempts can take place later in the incarceration period triggered by court hearings, family issues such as divorce proceedings or custody issues, and classification changes such as administrative segregation placement. Do you have a process that allows for re-evaluation following such events.

Myth #3: Hangings are lethal. If found strung up and lifeless, no need to intervene.

The major factors leading to a hanging fatality is height of the drop during hanging and the suspension of the body (full or partial). Most hangings in corrections take place in the housing area (primarily the inmate cell) which leaves little chance for a full body suspension and great height. This results in good chances of survival with early intervention. One  study concluded that even if the victim is found to be lifeless, aggressive intervention with CPR and emergency medical transport is warranted. Another study found overall mortality associated with hanging was 33%. Those who survived to admission to the hospital had a relatively low rate of severe functional disability. Initiate medical intervention immediately when a hanging is found.

A significant percentage of hanging victims will have spinal fracture, therefore spine immobilization and jaw thrust maneuvers should be taken into account at the scene. In order to accomplish this, easy access to a rescue tool, such as this seatbelt release device, is needed to quickly lower the person to the floor for emergency resuscitation intervention.

Myth #4: Every hanging is a crime scene. The inmate can’t be cut down until the location is photographed and evidence accumulated.

There have been reports of medical staff being delayed from attending to a hanging victim while crime scene investigation takes place. Minutes are precious in emergency treatment and can make a difference in ultimate survival. Cut down the victim and initiate emergency medical intervention as soon as the scene has been secured. Saving a person’s life trumps all need for determining criminality. Nurses must advocate for immediate patient treatment in this situation. Even better, pre-empt an emergency situation like this by reviewing a hanging medical intervention process with custody administration before a hanging event.

What has been your experience with post-hanging treatment. Share in the comment box below.

This post originally appeared in CorrectionalNurse.Net

Guest post by Dr. Lorry Schoenly nurse author and educator specializing in the field of correctional health care. She has written 6 continuing education courses especially for the Correctional Healthcare Campus.

Correctional Healthcare Processes
Safety in the Correctional Setting
The Correctional Healthcare Patient and Environment
Medication Administration in the Correctional Setting
Risk and Documentation in the Correctional Setting
Special Issues in Corrections

You may see all of the online continuing education offered at the Correctional Healthcare Campus by clicking View Entire Catalog.
Posted: 7/29/2015 7:25:14 AM
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