Guidelines 800-4: Response to medical emergencies

To provide direction to staff responding to medical emergencies

Applies to all staff, as applicable

• Responsibilities and procedures
  • Staff responsibilities
• Enquiries
• Annex A: Cross-references and definition

Responsibilites and procedures

1. The Institutional Head will ensure that the following items are put in place by the Assistant Warden, Operations:
   1. all staff have ready access to necessary protective and first aid equipment in all work locations
   2. all Correctional Officers/Primary Workers are issued, carry on their person and use approved protective equipment (e.g., protective masks, gloves) for the purpose of administering cardiopulmonary resuscitation (CPR) or first aid
   3. there are quarterly on-site simulations of medical emergencies that allow staff to practice and remain current in their skills
   4. the scenarios used for the medical emergency exercises are as realistic as possible, by taking into account the availability of medical resources in the community and emphasizing the specific needs of the midnight shift
   5. debriefings occur without delay following a medical emergency (to inform CSC managers of the details related to the medical emergency) and critical incident stress management services are offered to all staff involved in the incident, as set out in Guidelines 253-2 Critical incident stress management, and
   6. naloxone is to be secured in strategic locations within accommodation units where there are dedicated staff, or in inmate accessible storage kits in accommodation units where there are no dedicated staff (e.g., houses).

Staff Responsibilities

2. All staff and contractors (including non-health) will respond to medical emergencies. The primary goal is the preservation of life while ensuring the requirements of Commissioner's Directive 567-2 Use of and Responding to Alarms pertaining to cell entry are met to ensure the personal safety of staff and other individuals.
3. Non-Health Services staff arriving on the scene of a possible medical emergency must immediately call for assistance, secure the area, and initiate CPR/first aid, according to their certification and training applicable to their CSC functions, without delay. The primary goal is the preservation of life regardless of the possible existence of an advanced medical directive or DO NOT RESUSCITATE (DNR) order.
4. Non-Health Services staff must initiate CPR/first aid according to their certification and training applicable to their CSC functions and where physically feasible, even in cases where signs of life are not apparent. (See Interim Revisions to Cardiopulmonary Resuscitation (CPR) Procedures during COVID-19.) In the case of suspected opioid overdose, institutional correctional staff will administer naloxone nasal spray to the inmate to preserve life. This also applies to other Non-Health Services staff trained in the use of naloxone. The administration of naloxone must immediately be followed by calling an ambulance to transport the offender to a community hospital while continuing CPR until relieved by medical personnel. Information regarding the use of naloxone can be found on the Health Services section of the HUB at the following link: Naloxone in institutions. In the case of strangulation with use of a ligature/hanging, staff shall cut and remove the ligature from the inmate while, when possible, preserving the knot as potential evidence.
5. Non-Health Services staff must continue to perform CPR/first aid according to their certification and training until relieved by Health Services staff or the ambulance service.
6. The decision to discontinue CPR/first aid, and pronouncement of death, can be made only by authorized Health Services staff (e.g., institutional Physician, Nurse Practitioner, or Nurses, consistent with their professional practice standards) or by the ambulance service.
7. Initiation of CPR by non-Health Services staff is not required in the following situations:
   1. decapitation (i.e., the complete severing of the head from the remainder of the body)
   2. decomposition (i.e., condition of decay, deterioration, disintegration of the body).
8. The existence of a DNR order does not preclude the use of other forms of treatment or care (i.e., treatment for a non-life threatening injury).
9. All staff must use approved protective equipment when administering CPR/first aid.
10. As soon as a possible medical emergency is identified, the Correctional Manager or officer-in-charge must notify Health Services and the ambulance service in accordance with the Institutional Contingency Plan, Standing Orders or Post Orders.
11. The Correctional Manager or officer-in-charge must immediately establish appropriate security for responding staff and the ambulance service.
12. Once on the scene, Health Services or the ambulance service will determine the medical response to the situation.
13. Correctional staff on the scene will continue to provide assistance as directed by Health Services or the ambulance service.
14. Without delay following a medical emergency, the Correctional Manager must:
    1. complete the Response to Incidents Involving a Medical Emergency – Correctional Manager/ Officer-in-Charge Checklist form (CSC/SCC 1323-01)
    2. ensure that only one Response to Incidents Involving a Medical Emergency – Staff Checklist form (CSC/SCC 1323-02) is completed collectively by the responding non-Health Services staff member(s)
    3. advise Health Services that naloxone was given so that it can be replaced
    4. in the case of a suspected overdose incident, consider enhanced patrols following the incident to ensure the well-being of inmates.

Enquiries

15. Strategic Policy Division
    National Headquarters
    Email: Gen-NHQPolicy-Politi@csc-scc.gc.ca

Assistant Commissioner,
Health Services

Marie Doyle

Annex A: Cross-references and definitions

Cross-references

Guidelines 253-2 Critical incident stress management
Commissioner's directive 567 Management of incidents
Commissioner's directive 568-4 Preservation of crime scenes and evidence
Commissioner's directive 800 Health services

Hospice palliative care guidelines
Interim revisions to Cardiopulmonary Resuscitation (CPR) procedures during COVID-19
Pharmacy HUB

Medical emergency: an injury or condition that poses an immediate threat to a person’s health or life which requires medical intervention.