Assessing jails' use of community-based emergency care in the US South

美国是世界上监禁率最高的国家。在美国，监狱每年监禁1200万人， 这些人大多数不是在等待判决，就是在服短期徒刑。有色人种是 被监禁的比例高得不成比例，作为一个阶层，被监禁者的健康状况比 其他美国居民。监狱囚犯承担着沉重的心理健康负担（64%），化学 依赖（68%），传染病（14%）和其他慢性病（45%）。在监狱里的拘留可能是一个 时间的高度身体和情绪压力，实际上心肌梗死和自杀是两个 最常见的死亡原因是监禁。健康问题的沉重负担和这种大规模的 人口与一般短期监禁和有限的医疗资源相结合 解决监狱囚犯医疗保健需求的艰巨挑战。这些挑战可能特别困难 对于南方监狱来说，这些监狱通常规模较小，位于农村、资源有限的社区， 与美国其他地区相比，贫困和残疾人口的比例相对较高。 近年来，监禁期间发生的死亡事件引起了人们对监狱的高度关注 2011年，对监狱囚犯自我报告的健康状况进行了广泛的全国调查。 然而，广泛的囚犯调查没有反映出急性护理需求，并且容易受到自我报告偏见的影响， 而报告的死亡是罕见的事件，只能有限地了解囚犯的健康和医疗保健。 由于各种各样的障碍，很少有研究审查了监狱囚犯的医疗保健服务。 囚犯即时医疗保健需求的强有力指标-以及他们的需求超出监狱的程度 保健资源-可用于有针对性的干预，以改善监狱保健和降低成本。一 新的和潜在的强大指标，表明囚犯的医疗保健需求超过监狱医疗保健 资源是监狱使用社区紧急管理服务（EMS）救护车的程度， 急诊室（ED）提供护理。列举健康状况的普遍程度，特别是 导致EMS/艾德护理的创伤和非卧床护理敏感条件可能反过来发现机会 修改监狱政策，包括监管和健康政策，以减少暴力，改善健康，减少医疗保健 成本因此，结合前瞻性调查结果和全州紧急情况分析， 在美国南部5个州的医疗数据库中，我们将检查县监狱中可用的医疗资源， 描述监狱依赖EMS和艾德护理来补充其 卫生服务，并估计通过防止对EMS，艾德和 对不能走动的情况和创伤进行住院治疗。这些发现将是一个关键的工具， 加强监狱医疗保健，改善囚犯健康，降低成本，最终保护囚犯的健康。 囚犯返回的家庭和社区

The US has the highest incarceration rate in the world. Each year in the US, jails incarcerate 12 million people, most of whom are either awaiting sentencing or serving out short sentences. Persons of color are incarcerated at disproportionately high rates, and as a class, incarcerated persons have worse health than other US residents. Jail inmates shoulder a heavy burden of mental health conditions (64%), chemical dependency (68%), infectious diseases (14%) and other chronic conditions (45%). Custody in jail can be a time of heightened physical and emotional stress, and indeed myocardial infarction and suicide are the two most frequent causes of death during incarceration. The heavy burden of health problems and large size of this population in combination with generally short incarcerations and limited healthcare resources present formidable challenges addressing jail inmates’ healthcare needs. These challenges may be particularly difficult for southern jails, which are often small-sized and located in rural, resource-limited communities whose populations have relatively high rates of poverty and disability compared to other US regions. In recent years, deaths occurring during incarceration have created heightened attention regarding jail health services, and in 2011 there was a broad national survey of jail inmates’ self-reported health conditions. However, the broad inmate survey did not reflect acute care needs and was susceptible to self-report bias, while reported deaths are rare events that provide only limited insight into inmates’ health and healthcare. Because of a variety of barriers, few studies have examined the delivery of healthcare for jail inmates. Robust indicators of inmates’ immediate healthcare needs—and the extent to which their needs exceed jail healthcare resources—could be used to target interventions to improve jail healthcare and reduce costs. A novel and potentially powerful indicator signaling that inmates’ healthcare needs exceed jail healthcare resources is the extent to which jails use community Emergency Management Service (EMS) ambulances and emergency departments (EDs) to provide care. Enumerating the prevalence of health conditions, particularly traumas and ambulatory-care sensitive conditions, resulting in EMS/ED care may in turn identify opportunities to modify jail policies—both custodial and health—to diminish violence, improve health, and reduce healthcare costs. Accordingly, using a combination of prospective survey findings and analyses of statewide emergency care databases in 5 southern US states, we will examine the healthcare resources available in county jails, describe the frequency and types of conditions for which jails rely upon EMS and ED care to supplement their health services, and estimate the cost savings that jails could accrue by preventing the need for EMS, ED, and hospitalization care for ambulatory-sensitive conditions and traumas. These findings will represent a key tool in strengthening jail healthcare, improving inmate health, reducing costs, and ultimately, protecting the health of the families and communities to which inmates return