180 COMMUNITY HEALTH
or be nearly free of symptoms yet spread the infection to
other inmates via sputum droplets that contain live tuber-
culosis bacteria. The customary elements (volume, rate of
change, direction, etc.) in ventilation and air flow in prison
cells, hospital suites, recreation and dining areas, need care-
ful attention to minimize the spread of tuberculosis and other
respiratory infections from patients with unrecognized dis-
ease to other inmates. Health suites should provide for tem-
porary isolation of tuberculosis patients in the early phase
of therapy. Longer term isolation may be required rarely but
can be needed if the disease is advanced. Moreover, some
tuberculosis infections are being increasingly recognized
as due to “multiple drug resistant” (MDR) bacilli and the
usual anti-tuberculosis drug regimes are not effective. New
and expensive drugs, carefully administered, are needed to
achieve successful treatment of stubborn MDR infections.
Although AIDS is believed transmissible only through
body fluids like blood or semen, isolation may be needed to
provide special care for persons who are critically ill with
AIDS. These patients are at high risk of severe illnesses from
“opportunistic” infections due to organisms that opportunis-
tically take advantage of AIDS patients whose resistance to
infections is compromised. These organisms may be bacteria,
viruses, or even fungi and other parasites that are normally
part of a prison environment. Management of patients with
advanced HIV disease can be difficult and requires that the
health staff be aware of the continuing advances in therapy
that may be available. Medical or administrative protective
isolation may be needed to remove AIDS patients from cell
blocks where they might be exposed to physical danger from
other inmates.
Health services for governmental employees are simi-
lar to those of industry and vary in size and complexity
with the jurisdiction served. Pre-employment examinations
and on-the-job injury care follow customary standards, and
worker’s compensation claims are processed in accord with
state or federal regulations. Medical advisory programs
(MAPs) for employees whose on-the-job performances are
thought to be due to emotional disorder or substance abuse
helps guide affected workers to appropriate care and permit
continued employment. If existing buildings are to be
altered for use as employee health clinics to include a wide
range of health services, special attention must be given to
shielding staff workers from x-radiation. A surgical suite
should be available for initial care and follow-up of injured
workers, and adequate soundproofing provided for rooms
where psychiatric counseling is to be delivered.RESCUE AND PROTECTIONAmbulance services have become an important part of any
medical care system, with marked expansion after the mid
1970s. Although turn-of-the century horse-drawn ambu-
lances had long been replaced by hospital-based motor
vehicles, only major cities provided this vital emergency
transport. The city of Baltimore, for example, had provided
a crude transport that used canvas litters in police patrolwagons (paddy wagons) until 1928. At that time several
limousine-type ambulances were purchased to be based in
and operated by the Fire Department. Fire fighters who vol-
unteered for this duty received basic first aid training and
were assigned permanently to this service for better patient
care of citizens who could not afford a private ambulance.
Commercial ambulance services, many being operated by
funeral directors who used converted hearses and personnel
with little or no training in patient care, were not supervised
or licensed until federal funding was assured with the pas-
sage of Medicare in 1965. Local governments developed
regulations to assure that patients being transported would
have emergency care immediately available and that they
would be secure. Regulations specified the training that
should prepare ambulance attendants, as well as the medica-
tions and patient care equipment to be carried in ambulance
vehicles.
Today, municipal or county ambulance services are usu-
ally based in fire departments, to take advantage of a commu-
nication network that is already in place. Fire houses provide
ambulance bases that are open around the clock, staffed by
fire fighters who are a uniformed and disciplined corps, and
who have a tradition of rapid response to emergencies. Air
ambulance services using helicopters are operated by state
police departments, in the absence of functioning fire depart-
ments. Some local governments may contract with private
ambulance companies to provide both emergency and rou-
tine medical transport, and hospitals may also be used both
as bases and to provide quick and ready access to medical
critical care specialists for urgent consultations.
An ambulance is a sick-room on wheels for urgent care.
Whereas once these emergency vehicles and staff operated
simply in a “scoop and run” format, providing rapid tran-
sit for critically ill or injured persons, today’s ambulances
have state-of-the-art design and equipment, and their
crews have expert training in the provision of immedi-
ate and effective responses to life-threatening conditions.
Communities have quickly recognized the value of highly
trained attendants who can stabilize critically ill or injured
persons prior to careful transport to hospital centers for
definitive care. Radio two-way communications for voice
and electronic equipment, like electrocardiographs, enable
attendants to administer initial medical care beyond usual
first aid, and provide hospitals with information that helps
them have ready any special equipment or staff for prompt
attention on arrival of the ambulance.
Ambulance attendants, or emergency medical techni-
cians, ambulance (EMT-As), are the first-responders in any
emergency transport system. To be designated an EMT-A,
each applicant must undergo special training, pass a stringent
examination, and be certified by an official body of the local
or state jurisdiction before being permitted to care for patients
with medically emergent conditions. Ambulances dedicated
to critical emergency care are stocked with approved medi-
cations for use by EMT-As in the field. Technical equipment
is readily available to reestablish damaged airways or stop
dangerously irregular heart action by electrical defibrilla-
tion,^14 immobilize fractured bones, or provide intravenousC003_002_r03.indd 180C003_002_r03.indd 180 11/18/2005 10:17:42 AM11/18/2005 10:17:42 AM