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Diligent medical security to save lives
By Gene Nardi , Deputy Sheriff, Broward Sheriff’s Office
Published: 10/22/2007

Hospital sign When we read about a corrections officer gunned down while supervising an inmate who is receiving medical treatment, we try to analyze how that could have happened. Where is the breach of security when an inmate is taken to a hospital for medical treatment? What series of events occur before the officer is in the fight of their life?

The first thing to remember is when an inmate is taken outside of a secure facility; it is the weakest point of custody. Secondly, most hospital personnel consider anyone being admitted as a patient. While that may be the case, if the person is in law enforcement’s custody, they are still considered an inmate, and security should not be compromised. I have experienced different perceptions with medical staff when supervising an inmate admitted into a hospital.

The most important thing is preparation. It is the department’s responsibility to provide sound policies and procedures, along with specialized training, to prepare your staff that will be responsible for taking on these potentially life threatening tasks.

The Transport

Prevention is critical to a successful transport and appointment detail. From the moment it is known that a prisoner is going to be transported to an outside medical facility, there are a series of necessary steps to take prior to the transportation of the prisoner. More than likely, the inmate may know he/she will going to a medical facility. The information on when, where, and how the inmate will be transported to the outside facility must be kept confidential.

Once the appointment has been coordinated, the housing unit can be notified. The only information it needs is the time to prepare the inmate for transport. All phones within the housing unit should be shut off prior to notifying inmates to prevent them from making any calls to plan an escape.

Inmates should also be strip searched prior to transport, and restrained in a manner that will prevent them from becoming a threat to transport officers. At least two officers should be part of transport details to any outside facility. They should review their route prior to travel, along with any other tactics that might be used.

If transport is to an outside doctor’s office, the tactics and number of officers might change. Four officers, for example, might be used for transport, two in the vehicle, and a “rear-guard” car with additional officers.

There are several benefits to having the extra car. True, it may have an impact on manpower, but it will definitely increase the security on the detail. I don’t look at this as extra man-power; I see it as a necessity. As an administrator or supervisor, I would prefer to take the preventative steps to avoid escape and serious injury to my staff.

Having four officers with two vehicles prevents waiting for another vehicle if the first vehicle breaks down while en-route. It also provides additional security in the event officers are ambushed while en-route, and gives officers a chance to clear the offices upon arrival, eliminating the possibility of surprises. Similar procedures can be used when concluding the visit as well.

Officers should also coordinate with the doctor’s office to re-schedule any civilian appointments around the time of the inmate’s arrival; the less people in the office at the arrival time, the better.

Upon arrival, two officers should clear the offices prior to the inmate entering while the other two officers stay with the prisoner. If there are civilians in the waiting area, consider another point of entry. At any time, if the officers feel that the situation is unsafe, they should terminate the visit and return the inmate to the secure facility.

There have been debates on the number of officers needed based on an inmate’s custody level, and whether or not they are “high-risk.” Every inmate is a risk. Remember, the “high-risk” ones had to start sometime to become “high-risk.” Don’t let it start with your officers.

Hospital Admittance

If the inmate is being admitted to the hospital, security is paramount to keeping him in custody. Once they have been admitted, and are occupying the designated room, it is important that no other patients stay in that room.

It is also extremely important to have the inmate admitted under an alias identity. This is critical because the inmate’s family may attempt to make contact with the inmate while in the hospital. They could be trying to contact them for just a visit, or to assist them in escaping.

There may be a victim involved in the case, and they should not be discounted. They or family member may attempt to contact the inmate. Their motives could be in many forms; they may attempt to settle a dispute, or retaliate with violence depending on the nature of the crime.

Since it is not uncommon for information to leak out, it is important that those responsible for the inmate remain diligent in their tactics and awareness while supervising outside the facility. Some family members will call every hospital in the county to determine the inmate’s location. If they are alerted, it usually is in error due to hospital staff not being aware that the person is in custody, and the family member has received the information prior to the inmate getting the alias identity. These challenges are common on new arrests when a prisoner must receive medical attention to be cleared for processing by jail staff.


The use of proper restraints when supervising an inmate in a medical facility is absolutely critical to ensure the safety of officers and the public. Restraints should be secured at all times.

More than likely when the prisoner is admitted, they will be escorted by an officer to the assigned room. They should be restrained at the wrists behind their back, not in front. If the injury is to the arm, and they cannot be restrained from behind, then restrain them in the best way possible.

Do not, under any circumstances, escort them to the room through a hospital without being restrained. Make sure your weapon side is away from the inmate. This concept would seem automatic, but I have seen too many times, officers escorting prisoners with their gun side exposed to the prisoner.

When in the room and on the bed, offenders should be secured to the bed frame. Always make sure they are secured to something before removing any restraints. Avoid using the actual rail to secure a prisoner, unless the rail is part of the bed frame. Some rails are removable from the bed, which can be extremely dangerous for the officer and hospital staff.

Restricting movement is important. If the prisoner must use the bathroom, or has to be escorted for additional treatment, the restraints may have to be removed. Before doing so, remember that the inmate should be secured some other way prior to removing the restraints.

At least two officers should be used for high risk inmate details. Always review tactics when dealing with prisoners in hospitals. Know how the inmate is secured, and plan how you will position yourself in the room. Prisoners, even with restraints, will have some mobility.

Make sure you understand which directions the inmate can move, and where they are limited. Remember to use all the same tactics when the inmate is released form the hospital and transported back to their facility.


Some inmates pose higher risks than others, but one thing is certain, we are never sure of their motives. Preventative measures need to be taken to avoid a critical incident. These are dangerous times, and officers need to remain diligent in their tactics when dealing with prisoners, especially when securing them in a medical facility. Stay safe.

About the author: Gene Nardi is a 17 year veteran Deputy Sheriff with the Broward Sheriff’s Office in Broward County Florida. He is currently assigned to the agency’s training unit as a full-time firearms and defensive tactics instructor. He has worked in corrections and road patrol.


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