I have said this many times during my training sessions: Corrections is a people profession. Incarceration aside, it’s about people taking care of people. No matter how they act or what crimes they committed, inmates are entitled to receive medical care. This is in accordance with statute, case law, policies, and procedures.
Yes, some offenders are dangerous. They may assault staff, assault other offenders, and act out in other ways. Many are prone to mental health episodes. When an inmate needs medical attention, though, a professional corrections officer (CO) will call medical staff. That’s a fundamental duty of the job.
The first priority of sworn staff is the safety and security of the facility and those inside. While caring for offenders’ medical needs is critically important, safety and security are always on COs’ minds. It is the way they were trained.
Illness, accidents, and injuries happen inside every correctional facility. Sometimes these incidents begin when inmates refuse medical treatment or from self-inflicted injuries ranging from overdoses of medications to attempts at suicide. No matter the cause of the illness or injury, staff members are duty bound to get them medical attention.
Often, this involves transporting an inmate to an offsite medical facility, which requires a potentially dangerous task known as a hospital run, also referred to as hospital duty.
The Double-Edged Sword
Correctional officers who are assigned to transportation — specifically to hospital duty — are being put in a precarious position. In order to provide legally required medical care, they must take an inmate from the secure confines of the jail or prison and into the outside world. This process is fraught with danger.
The most obvious risk is escape. Inmate are well aware they’re being taken outside and may decide to make a break for it. Whether they try to run or not often depends on the nature of the medical problem. If the inmate has been seen by facility medical staff and is suffering a debilitating condition such as severe pain or unconsciousness (or a broken leg), the risk of running is reduced. But it’s never fully eliminated.
There is a saying that I use in my in-service training classes. I advise officers to always keep in mind that desperate people do desperate things. Unless you can read minds, you’ll never know for sure what an inmate in a hospital emergency room is thinking. In this discussion, we’ll examine three aspects of hospital duty and offsite medical transport of inmates. They include
- Identifying the potential dangers of hospital duty and transport.
- Precautions officers can and should take to ensure their own safety and the safety of their communities.
- Guarding against the inmate manipulating both the officer and situation.
Identifying Potential Dangers
Depending on the medical problem, an inmate in the hospital who is ambulatory and is capable of getting around may try to escape, putting everyone around him — the officers, hospital staff and the public — in danger. In their desperation, they may stop at nothing to get their freedom.
A recent example of this happened in early December of 2025. A 52-year-old Georgia jail inmate was transported to a local hospital after attempting to harm himself. He escaped on foot, stole an SUV, crashed it less than a mile away and fled on foot. The owner of the SUV reported that a Glock semi-automatic handgun was stolen from the vehicle. The inmate was in jail for felony fleeing a police officer, reckless driving, possession of amphetamine and multiple weapons charges.
In another recent 2025 case, a 27-year-old Florida jail inmate who had been arrested for aggravated battery and kidnapping assaulted his correctional officer escort while being transported for a medical appointment. With the help of the sheriff’s office K-9 unit, he was quickly recaptured.
Keep in mind, too, that inmates also may fake or self-inflict an injury, knowing that serious injuries will require hospitalization. In 2022, an inmate in Austin, Texas, faked an illness, was evaluated by jail medical staff, and escaped from a local hospital emergency room after being taken there by emergency medical services. He ran out of the ER while still in restraints but was recaptured after 21 minutes on the run.
Fortunately, there were no fatalities in either of these cases. The potential for serious injuries to officers, bystanders and medical staff is always there. In July of 2025, a federal inmate who was being transported to an orthopedic appointment engaged in a scuffle with the transporting officers. The inmate managed to grab one officer’s service weapon and fatally shot an officer before fleeing. The other officer suffered injuries not related to the shooting. The inmate jumped into a waiting car and took off. He was later recaptured and charged with first-degree murder.
Another tragic example of this occurred in 2006. A 20-year-old inmate who had been assigned to a medium-security facility stabbed himself in the chest with a sewing needle, resulting in hospitalization. During the overnight shift, the inmate overpowered the Maryland Department of Corrections officer who was guarding him, getting control of the officer’s weapon and shooting him to death. The slain officer was the only one guarding the inmate.
“Desperate people do desperate things. Unless you can read minds, you’ll never know for sure what an inmate in a hospital emergency room is thinking.”
Safety Precautions
Knowing the dangers of hospital and medical transport, there are several important things officers must keep in mind:
- Two-deep protection. When taking an inmate outside a correctional facility, security should always be provided by two officers. Of course, this is the ideal; many jails and prisons are short-staffed and can ill afford to send two COs to escort a seemingly gentle inmate/patient. To deter escapes, assaults, and improve officer and public safety, facility supervisors may have to lock inmates down and close posts temporarily to provide additional manpower for those leaving the perimeter.
- Knowledge of transporting procedures. It’s common for COs to be drafted to help out on a hospital run or medical appointment. From basic recruit through in-service training, all officers working institutional security should receive training in safe inmate transportation. They should also regularly receive refresher training and go on transports. COs must know they can be drafted at any time, particularly on weekends and off times (such as overnight shifts) when circumstances require them to help out.
- Loop in additional agencies. It’s important to include hospital security and local law enforcement in your security procedures, especially if there is only one CO doing the transport. If possible, have hospital security or local police greet the inmate when they arrive. Have them stay around, be present and let the inmate see the cooperation and coordination among agencies. Planning ahead is key — use a private entrance and exit out of public view and place the inmate in a private room as soon as possible. Keep in mind that the “inmate grapevine” may inform family members and friends that the inmate was taken to the hospital. While there are no guarantees, an inmate with escape in mind may decide not to try anything after seeing a show of force. Involved agencies should be linked with coordinated communications. Also, it’s a good practice to take a photo and general information about inmates being transported in case something happens.
- Searches and observation. Depending on the nature of the illness or injury, transporting officers should be the last personnel searching an inmate before transport. Searches should include several areas, including the inmates themselves and the area of the hospital or clinic. When arriving at a medical facility, look around and you’ll see equipment lying around all over the place. Medical hypodermic needles, metal items such as scalpels and hemostats, kitchen cutlery and trays provide temptations to inmates. Think about it. If they can distract the COs (even only for a few seconds) what could they pick up? Be sure to clear the room of all items that could be used by the inmate as a weapon, including loose lamps, telephones, etc. Always keep a visual watch of the inmate. Remember, hospital and clinic staff are not trained in correctional security — but you are.
- Officer fatigue. Being short-staffed in a corrections facility leads to fatigue. This can happen when COs work extra hours after a shift or get called in on days off. Long shifts are stressful and tiring, and the inmates know it. Supervisors should arrange breaks and relief.
Guarding Against Manipulation
It is well known among corrections staff that inmates are always watching us; personnel actions are “the best show in town.” Smart inmates know when a facility is short staffed. They know if the transportation staff is undermanned and when the number of officers providing secure escorts outside the facility is reduced. They also know how medical protocols work.
Transport to a hospital or clinic is outside the facility walls, which is a lot closer to freedom than a housing block. Inmates talk among themselves. Inmates see offenders being treated in the facility dispensary, or in an outside hospital, depending on the seriousness of the condition. They’re always gathering intelligence on medical procedures and transport officers — especially those who are complacent or sloppy in how they perform their duties. As a result, inmates may invent scenarios in which medical attention outside the facility is necessary. They may claim to be sick, depressed, or in pain. Like in the Maryland case above, they may even may injure themselves to get beyond the perimeter.
Not all inmates that require outside medical attention are out to escape, but you never really know what they are thinking or what they may try to do. The best defense against manipulation on a medical run is to follow your policies and procedures. This includes the proper use of restraints. Inmates must be properly secured to the hospital bed during examination. Sometimes, a doctor may request restraints to be removed to properly treat an inmate. If that happens, COs should check with their supervisor to determine whether alternative restraints and/or extra personnel are required.
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Medical transport means inmates are still in custody, either in a hospital or doctor’s office. It is an extended area of confinement, still considered part of the jail or prison cell. You may think this is common sense, but offenders may think the rules can be bent while they’re receiving medical care. They may ask COs to grant personal phone calls or allow visits from friends or family. Remember: These things are strictly prohibited! Inmates may also try to elicit sympathy, conjuring up tales of worried parents or spouses. Family members may show up at the hospital, demanding information or requesting to see the inmate. COs on hospital duty should refer them to both the warden and attending physician and report these incidents to their supervisors to be relayed to all COs and hospital security.
Inmates also try to manipulate the environment by attempting to get COs to trust them. They may ask a nurse to close the door because it’s noisy and they are trying to sleep. They may wait for a complacent, tired CO to unshackle them to use the bathroom — instead of a urine bottle or bedpan, the more secure option. They often time their requests during periods when the CO’s partner leaves the room to get coffee. These are just possibilities.
Never Let Down Your Guard
Hospital duty places correctional officers at the intersection of care, custody, and constant risk. While inmates are legally and ethically entitled to medical treatment, moving them beyond secure perimeters exposes officers, medical staff and the public to dangers that can escalate in seconds. The examples above emphasize that medical transport is not a routine errand, but one of the most high-risk assignments in corrections.
Ultimately, hospital duty reinforces a core reality of corrections work, that custody does not pause at the hospital door. Inmates remain inmates, officers remain responsible for security, and environments remain unpredictable. The most effective defense against tragedy is constant alertness, disciplined procedures, and the understanding that the risks are higher and the margin for error is razor thin.
Whether during medical transport or hospital duty, it’s critical to always look, watch, and stay alert. After all, your life depends on it.
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