Incident Investigations Branch (IIB): Information Bulletin for Staff 4th Edition (November 2016)

Heading: Correctional Service Canada
Subheading: Changing Lives. Protecting Canadians.

Title: Incident Investigations Branch (IIB): Information Bulletin for Staff 4th Edition (November 2016)

LESSONS LEARNED - WHAT DOES A MEDICAL EMERGENCY LOOK LIKE?

An inmate may appear to be uncooperative and/or under the influence of intoxicants but may actually be experiencing a medical emergency.

This bulletin will provide information on a medical condition called Altered Level of Consciousness (ALOC)

Scenario: ALOC & Use of Force

Scenario #1: While inmates were returning to their cell for the stand-to-count, Correctional Officers ordered an inmate, who appeared to be acting “out of it” and behaving oddly, back to his cell for the count. They assumed he was likely intoxicated and touched the inmate's arm to gain compliance which caused the inmate to become agitated, resulting in a spontaneous use of force. This inmate, who was a large man, was cuffed from the rear and left in an awkward position. He struggled and OC spray was used several times, after which he complained he was having difficulty breathing. The inmate later died.

Scenario #2: While inmates were returning to their cell for the stand-to-count, Correctional Officers ordered an inmate, who appeared to be acting “out of it” and behaving oddly, back to his cell for the count. When he did not respond to their requests to return to his cell, Officers spoke to him calmly in an attempt to assess why he was not following direction. As they tried to interact with him, they assessed that he did not appear to be aware of his surroundings or understand the direction provided. The Correctional Officers then contacted Health Services. The inmate was assessed by Health Services who determined that he required medical intervention. He was then assessed and treated by Health Services and returned to his range.

Refer to GL 800-4 Guidelines on Response to Medical Emergencies for more information and direction on how to respond to medical emergencies.

Subheading: What is an Altered Level of Consciousness (ALOC)?

ALOC may vary from minor thought disturbances and confusion to unconsciousness and unresponsiveness.

Examples include:

  • A person with diabetes with abnormal low blood sugar level may present with an ALOC and display symptoms of intoxication.
  • A person who has taken medication (or other substance) may appear disoriented, sluggish, and/or agitated.
  • A person experiencing a mental illness may have stopped taking their medication or may not be stabilized yet on medication.
  • A person fell and hit his/her head and is experiencing slow but progressive confusion and is unable to respond to questions or follow directions.
  • A person has an unwitnessed seizure and when it is finished, he/she seems unable to stay awake, is unsteady on his/her feet, and is wandering on the Range.

Subheading: How do I recognize someone with ALOC?

While interacting with the person you will sense that they seem unable to respond to your attempts at conversation in a typical way. They may seem like they are:

  • ‘not there’
  • ‘not making sense’
  • ‘mentally absent’
  • unable to follow simple directions
  • uncoordinated in their movements

Overall, you may simply get the impression that ‘something is not right with this person’.

Subheading: What should I do if I come across someone I think has ALOC?
Do:

  • Treat all persons who present with ALOC as a medical emergency.
  • Keep the individual as calm as possible.
  • Call for medical assistance immediately, whether it be Institutional Health Services or
  • 9-1-1.
  • Remember to stay calm yourself.
  • If possible, try to maintain the person in the location they are found until help arrives if there are no immediate threats to the person or to you.
  • Continuously monitor the person’s ability to breath.

Don’t:

  • Agitate the person or seem threatening to the person.
  • Restrain persons with ALOC unless it is a last resort. If the person must be restrained, the minimal amount of force should be used in accordance with policy.
  • Use restraints without considering body position and body weight. If the person must be restrained ensure they are supported and can breathe.
  • Ever make an assumption as to why the person may be experiencing an ALOC.

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