Many emergency departments (EDs) care for the types of detained patients who require a legal blood draw to validate alcohol intoxication levels, or who sustain injuries from an altercation. However, a select group of emergency departments service a substantial volume of medium to maximum security patients brought from local, state, and federal prisons for emergency medical care and non-emergency specialized clinical treatment.

A nontraditional design strategy helps treat this high-risk population more securely with an enhanced level of safety for the other ED patients, care providers, and hospital staff. We recently formalized a facility approach to meet the needs of this specific patient type.

Patient Arrival Sequence

Medium to maximum security patients typically arrive at the hospital by prison transport van. We recommend they first enter the hospital via a Sally port (a garage with front and back vehicle doors,) to reduce the likelihood of escape and/or confusion at at the location most vulnerable to an incident.

Incarceration protocol recommends directing patients from the Sally port to an internal jail within the hospital for staging. From the jail, direct access to a secured ED detention unit keeps incarcerated patients separate from public areas of the hospital and from other ED patients and their families at all times.

Wide corridors accommodate the 2-6 armed guards who escort each patient. Patients are locked inside the treatment rooms, and the entire unit is on lockdown at all times. Once the security officers deliver the patient to the treatment room, they continue to monitor their behavior from an enlarged team work space.

Treatment Room Design

Within the treatment room, one set of locking rolldown doors at the headwall conceals medical gases. A second set of rolldown doors secures the sink and staff work area.

Concrete Masonry Unit (CMU) walls, tamperproof hardware, and anti-ligature fixtures prevent the patient from harming themselves or others. Sitters monitor the patients through a viewing station outside each treatment room. For procedures requiring sharp objects, ED staff treat fully restrained patients in dedicated procedure rooms with additional security protection.

Disaster Event Protocol

Because an ED detention unit must comply with I-3 rather than I-2 building code requirements, the design must include provisions for evacuation into a secure area. In the event of a fire, security officers escort patients one at a time to the designated area, and then to the jail where they systematically relocate offsite via secure transport.

Throughput Approach

The prison triages the patient and notifies the ED of their condition prior to arrival, alerting the various specialty physicians to stage to the detention unit to see the patient. Moreover, after the patient arrives, they can wait in the jail until space becomes available in the ED as volumes dictate.