CorrectCare

Fire! But Cool Heads Prevail at McLean County Jail

by Mary C. Hoeniges, RN, BSN, CCHP

Nobody wants to go through an actual emergency to determine whether their response plan is up to the task. But our jail did, and it proved to be a valuable experience. Here’s what happened.

On a quiet morning on June 15, 2003, the power went out and the fire alarm sounded in the McLean County Detention Facility, a 205-bed jail in Bloomington, IL. This happened at 8:40 a.m., when medical director Joan Naour, RN, BSN, CCHP, and I were in our morning routine of delivering care to our patients.

The power soon came back on, but at 9:40 it went out again, this time for good. Even the auxiliary power remained off. The fire alarm again sounded. Joan and I stayed in the office at this time, listening to the correctional officers talk to each other on the radio.

We weren’t sure what was happening until Linda Wells, RN, CCHP, called in while attempting to report for duty. She said that the Law & Justice Center and the jail, which are adjacent to one another, were covered with smoke. Joan went into the dark hallway to ask a correctional officer what the plan of action was. She was informed we were to remain in our office until we could be evacuated.

At 10 a.m., the officer escorted us outside of the jail. We saw black smoke pouring out of the Law & Justice Center through a vent in the sidewalk, covering the side of the two buildings. Fire trucks from Bloomington and nearby Normal, IL, had responded, as did ambulances from the fire stations. We had our orange emergency bag with us, just in case.

Inside the jail, correctional personnel were moving inmates from the cellblocks closest to the Law & Justice Center to areas of greater safety. Work release inmates were allowed to leave, as were inmates ready for release.

Back Into the Black
Shortly before 11 a.m., a jail administrator asked Joan and me to return to the jail to provide medical care to a female inmate having a seizure. Led by a correctional officer, we carefully made our way into the building by holding onto the person in front of us, due to utter darkness caused by the smoke, until we reached the cellblock where our patient was seizing.

We provided supportive care to the inmate during the seizure and called in the EMTs. We decided to evacuate the patient and send her to our local hospital. Our patient was carried down the stairs and out of the building on a chair, as a gurney was not feasible. Accompanied by a correctional officer, she was then taken by ambulance to the hospital, where she was treated and released back to MCDF custody after medical clearance.

Meanwhile, it was determined that a transformer had exploded in the basement of the Law & Justice Center. At around noon, firefighters and McLean County facilities management staff said that MCDF would have no power for at least several days. We were informed that jail administration and health services would be setting up headquarters in the nearby Bloomington Police Station. All inmates were to be evacuated to neighboring correctional facilities accompanied by their scheduled medications.

Managing Meds
Joan, Linda and I returned to the jail after the fire was extinguished and electricians (including my husband) had turned off all the electricity. We boxed up our medications packs and medication administration records and took them to the police station, where we copied the records and attached them to the medication packs for each patient. Packages were put together according to the list of patients who were to be transported to each facility.

During the wait to send inmates out of county, Joan delivered all regularly scheduled medications at 1:30 p.m. Aided by another jail nurse who had arrived, we also provided emotional support for stressed inmates who were waiting for transfer. By 7 p.m., all inmates had been accounted for and transported to their assigned destination. Male inmates were sent to eight county jails and females were sent to a state prison for women.

Transfer forms were faxed to the county jails and the prison with our patients’ medical information. While our patients were being evacuated, medical staff was kept busy communicating the necessary information that was required for the other institutions to care for them.

Home Away From Home
Just as important, we had to quickly set up a working medical office in the police station. Even though the current inmates had been relocated, we would need to deal with newly arrested inmates. We had to be able to perform such duties as assessing new arrivals’ medical status, including patient histories, vital signs, alcohol intoxication, drug withdrawal, injuries and diabetic needs including blood sugar levels, as well as managing immediate needs. We also had to obtain and administer medications.

Medical staff made trips to the jail to bring needed equipment back to the police station. This included equipment for managing chronic diseases such as diabetes, administering medication, performing limited nurse sick call, managing injury, setting up medical charts and communicating with other counties about our patients.

We soon had what we needed to medically assess newly arrested inmates and clear them for transport to other counties. A few inmates were kept at Bloomington police station, which has six cells.

We spent seven days at the police station. After medical staff returned to the jail on June 21, inmates were first kept in the booking area while the housing pods were cleaned of smoke damage and new electrical wiring was installed. Inmates were gradually brought back and placed in the male pods, with females in one pod and males in the other. By July 31, all had been transferred back to MCDF.

Trial by Fire
What lessons did we learn by this experience? For the most part, we found that our existing policies and disaster plan worked very well.

Two nurses are scheduled to be at MCDF seven days a week, 6 a.m. to 10 p.m., although we do use part-time and temporary staffing as needed. At the time of the fire, two full-time medical personnel were present. If those staff members had not been present, it would have been necessary to call in other full-time medical staff for assistance because of their expertise and familiarity with the individual needs of our patients and their ability to attend to those needs during the fire and evacuation. This underscores the importance of having the disaster plan list the names and phone numbers of all medical staff, beginning with full-time staff, who would be contacted by the medical director.

All staff members working that day were well-experienced in NCCHC standards and disaster drills. Our policy of practicing a disaster drill on one shift every year was an asset during this emergency as staff were able to perform their tasks quickly and efficiently. We also found that our policy of keeping an emergency medical bag within easy reach is essential for triage and treatment of patients during a disaster. And administrators successfully used the jail’s evacuation policy to quickly find temporary homes for all of the inmates.

Although our response to the experience was almost problem-free, in the aftermath we did engage in much discussion on evacuation and safety procedures. We emphasized the truly necessary tasks to be done in such a crisis, such as triaging, handling patients’ reactions and managing exacerbations of illness caused by the stressful situation.

We also examined and subsequently changed some disaster policies. Now, the medical staff will always have access to the evacuation keys kept in the jail’s control room so that they could leave the building in case of a fire or other emergency.

— About the author: Mary C. Hoeniges, RN, BSN, CCHP, is a staff nurse at the McLean County Detention Facility, Bloomington, IL. She may be contacted at maryhoeniges63@yahoo.com.

[This article first appeared in the Winter 2008 issue of CorrectCare.]