Emergency response

I recently had the pleasure of meeting with groups of older male prisoners to discuss the matters that are most pressing to their age group in custody. As ever, it was a valuable opportunity to get the views of people at the centre of our work.

One concern quickly and overwhelmingly stood out amongst those raised. There were wide-ranging reports that responses to medical emergencies were so poor that prisoners, particularly those who are older and have pre-existing health issues, were left with genuine fear for their lives.

Those I spoke to attributed the poor responses to a number of factors. Anxieties particularly focussed on incidents occurring at times of low staffing such as during night state. Limited availability of staff authorised to unlock cells had led to long delays in accessing those in need of emergency assistance. There were complaints that some prison staff had made unreasonable judgements about the urgency of a person’s health need, sometimes with little interaction, which caused delay in getting help. Emergency services getting held up at the gate was also a recurring factor, regardless of time of day, with reports of ambulances stood at the gate for up to thirty minutes despite attending for a serious medical emergency.

Sadly these are not new issues, though this makes them no more acceptable. Our advice and information service has heard of poor responses for serious incidents, such as those experiencing symptoms of a stroke. PPO investigations into fatal incidents have also made observations and repeated recommendations about emergency responses, highlighting a lack of staff understanding of medical codes, poor communication with the control room and emergency services being delayed by security processes when moving through the vehicle lock and prison grounds.

In 2013, PSI 03/2013 – Medical Emergency Response Codes was introduced by NOMS to learn from PPO investigations.  The instruction contains clear directions on when staff should call an emergency medical code, which should result an ambulance being called immediately. This includes incidents where there are signs of chest pain, difficulty in breathing, unconsciousness, severe loss of blood, severe burns or scalds, choking, fitting or concussion, severe allergic reactions or a suspected stroke. It advises staff that if they are in any doubt about the nature of the injury, they must call an ambulance. It also states that local protocols should prevent any unnecessary delay in escorting ambulances and paramedics to the patient and discharging them from the prison.

PSI24/2011 – Management and Security of Nights also includes relevant instructions including guidance that ‘the preservation of life should take precedence’ over normal directions for unlocking cells. It also makes further reference for the need for unhindered admission of the emergency services during the night state.

Despite these instructions, in his 2014/2015 annual report the PPO continues to find failures to follow these instructions when responding to emergencies. Clearly these lessons still need to be learned.

One emerging factor may be complicating matters further. The prevalence of New Psychoactive Substances (NPS) was raised as a significant contributor to the problem (as indeed it was to many problems). Prisoners felt that regular incidents caused by ‘spice’ were dominating the attention of staff and leaving little for those who had other medical issues. In other cases medical symptoms were not taken seriously due to their similarity to those of spice use. With the PPO recently reporting a rise in the number is deaths in which NPS may have played a part, it is apparent that NPS are having a wide effect on the safety of the prison environment. It would be hard to overstate the importance of individuals not experimenting with these dangerous and unpredictable drugs.

Recent figures show a significant increase in deaths in custody. In the 12 months to March 2016 there were 290 deaths in prison custody, an increase of 51 compared to the previous 12 months. It is as yet unclear what the main contributors to this rise are, but it is a worrying trend nonetheless. With people aged 60 and over the fastest growing age group in the prison estate, the associated health problems which accompany this group need to be better provided for.

As one prisoner I met eloquently and rightly put it ‘the sentence imposed by the court was a period of imprisonment and loss of liberty. It was not… that older vulnerable prisoners with the increased propensity to suffer the most common cause of deaths in the UK, heart attack or stroke, be subjected to a period of high risk of death.’

You can contact the Prison Reform Trust’s advice team at FREEPOST ND6125 London EC1B 1PN. Our free information line is open Monday, Tuesday and Thursday 3.30-5.30. The number is 0808 802 0060 and does not need to be put on your pin.