BOP Program Statement 6031.06 § 8

Each institution will devise a method to provide access to 24-hour medical, dental, and mental

health care. The CD and HSA will develop and implement an Institution Supplement that

establishes standard procedures for responding to emergencies that will include CPR certified

staff in the institution for the hours medical staff are not available. Refer to the Program

Statement Health Services Administration section on Continuous Health Care Coverage.

a. Emergency Care. Facilities are required to provide access to emergency care services 24-hours a day. A medical emergency is a life- or limb-threatening situation where immediate

intervention is required. During hours when clinical staff are available, the inmate can be

assessed to determine if the medical needs can be addressed at the facility or if transfer to a

higher level of care is warranted. This may be determined after routine hours by consultation

with the on-call provider or a telehealth emergency/triage consultation service. All emergencies

are referred to a nearby emergency room when the necessary care exceeds the capability of the

facility to provide, even when clinical staff are on site to assess the inmate.

 Four-Minute Response Time. All staff are trained to respond within four minutes when

a medical emergency is identified. The four-minute response time begins when a medical

emergency is identified, and it encompasses the time it takes for staff to be notified and

arrive at the emergency scene. After arrival, responders begin applicable assessment and

administer life-saving interventions when the scene is safe and accessible.

 For institutions with multiple facilities physically separated by a significant distance

(e.g., complexes, distant satellite facilities), the HSA or designee will develop

standard procedures to meet the required four-minute response time to appropriately

manage medical emergencies at all facilities.

 Basic Life Support (BLS). During medical emergency events, Bureau staff are expected

to perform only basic life support techniques consistent with their documented training.

 All credentialed staff are required to maintain American Heart Association (AHA)

BLS Provider certification. Lieutenants are required to minimally maintain AHA

Heartsaver CPR/AED certification.

 Because it is a required training element for all facility staff, the BLS training

program is overseen by Human Resource Management Division, including tracking

completion, scheduling, training equipment maintenance, and issuance of certification

cards. See the Program Statement Employee Development Manual.

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 Advanced Cardiac Life Support (ACLS). Non-MRCs are not authorized to provide on-site ACLS medications unless approved through a policy waiver. MRCs that want to

utilize ACLS protocols as part of their emergency response must have an appropriate

written plan in their Institution Supplement. The plan should include verification of

ACLS certification training requirements, equipment maintenance, and appropriately

provisioned crash carts. Refer to the Program Statement Pharmacy Services and the

Bureau National Formulary for guidance on emergency medications.

 Inmate Consent. During medical emergencies in which the inmate’s health is threatened

and their condition interferes with the ability to consent (e.g., cardiac arrest), clinicians

may perform functions (e.g. establish peripheral venous access to administer fluids,

and/or collect blood samples for analysis) necessary for preservation of life. The only

exception to this standard is a DNR order or Advance Directive. See Section 37.

ADV ANCE DIRECTIVES, LIVING WILLS, AND DO NOT RESUSCITATE (DNR)

ORDERS.

b. Emergency Equipment. The HSA approves and periodically reevaluates the contents,

number, and locations of emergency response equipment, including crash carts, go-bags,

stretchers, gurneys, backboards, and AEDs. The HSA will establish procedures for monthly

inspections of all AEDs, as well as other mechanical equipment such as battery-operated

gurneys, and is responsible for maintenance and supplies in accordance with the manufacturer’s

recommendations. The plan for periodic reevaluation, contents, locations, and maintenance will

be detailed in the required Institution Supplement described below.

c. Urgent Care. Urgent care is for minor illnesses or injuries that are not life-threatening but

should not be deferred until normal business hours. If clinical staff are not available to triage the

inmate, custody staff should contact the on-call provider to determine the next steps.

d. On call. Except for MRCs, institutions will not have clinicians on site 24 hours. All

institutions have clinicians on site 8–16 hours per day based on the needs of the inmate

population.

 Institutions will establish on-call schedules that best meet the unique needs of inmates at

the institution. Refer to the Continuous Health Care Coverage Section in Program

Statement Health Services Administration.