The Problem With Inhalers
Bob, a 20-year-old detainee with asthma, begins having trouble breathing during recreation time in the jail. He asks an officer for his inhaler, which is stored in the medical unit, two floors down. By the time the officer retrieves the inhaler and returns, Bob’s condition has worsened significantly. Struggling to breathe and turning pale, Bob collapses and is rushed to the hospital.
Inhalers have a long history of abuse in jail, leading facilities to restrict detainee access and monitor use.¹ However, delayed responses in getting inhalers have led to detainee injury and lawsuits.² Jails should be looking at ways to provide timely access to inhalers without ignoring potential security concerns. At the end of the day, providing inhaler access ASAP is looking out for the detainee, the medical team, and the jail.
Keep inhalers close
Generally, an inhaler should be used immediately at the first sign of a flare-up. Keep inhalers at an officer station on the same floor that the detainee is housed on to ensure timely access. Storing inhalers close to detainees is especially important for jails without 24/7 medical care, as the time it takes to gain access to a rescue inhaler may be increased by the detainee approaching an officer, requesting the inhaler, and waiting for it to be retrieved and brought back.
If an inhaler cannot be brought to a detainee in a timely manner, consider a “KOP” policy. KOP refers to “keep on person” medications that detainees keep with them to use when they feel it is needed. Medical and custody staff should work together to ensure orders for inhalers are appropriate for the jail environment (as a general rule, a detainee who is affirmed to use an inhaler at intake should be allowed, at minimum, a KOP rescue inhaler). Keep inhalers close.
Inspect inhaler usage
It is recommended to have the detainee bring their inhaler for inspection at least once a day at medication pass. At this time, the number of inhalations left can be recorded on the medication administration record (MAR) to track how often it is being used. The MAR should be reviewed by medical staff, and the practitioner should indicate in the medical orders when they are to be contacted based on inspection results.
Generally, using more than 10 puffs per day may indicate a problem. The practitioner should be contacted to determine whether the detainee is sick and in need of additional care, or if the detainee is abusing the inhaler. If abuse or damage is suspected, custody should intervene to address security issues and follow up with the practitioner, as appropriate.
Coordinate with medical staff for peak flow monitoring in addition to inhaler inspections, as appropriate. Inspect inhaler usage to identify medical and security concerns.
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1. Medicine: Amphetamine Kicks. (1959). Time Magazine. https://time.com/archive/6829136/medicine-amphetamine-kicks/
2. Barajas, M. (2020). When Asthma in Jail Becomes a Death Sentence. Texas Observer. https://www.texasobserver.org/when-asthma-in-jail-becomes-a-death-sentence
Disclaimer
All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis. When in doubt, send them out!®