For the past 40 years, Doerhoff Surgical Services has provided surgical care for the inmate population of Jefferson City Correctional Center. Patients who require surgical care are transported by ambulance to a nearby hospital. Stab wounds are the most common type of injury requiring operative intervention.
The injured patient is typically a young male who is in excellent physical condition from lifting weights and is quite capable of fending off a single attacker. Therefore, stab wounds usually are the result of an attack by two or more assailants. Two kinds of weapons are used: a long, icepick-type instrument (e.g., sharpened screwdriver), which penetrates deeply but only creates a pinhole injury, or a significantly shorter instrument (less than 2 inches), which is used to maim rather than kill the victim. Since reinstitution of the death penalty, there are fewer stab wounds from long instruments.
Stab wounds to the chest result in a small pneumothorax. Chest X-ray is used for diagnostic evaluation, and these injuries can be treated by chest tube insertion alone. Direct stab wounds to the heart can be treated through mediastinotomy with direct closure. Unfortunately, patients with such injuries are unlikely to survive transportation to the hospital.
Stab wounds to the abdomen are briefly triaged. Unstable patients are taken directly to the operating room. In a stable patient, the wound is explored in the emergency room. If the peritoneum has not been traversed, local wound care is provided and the patient is returned to the Correctional Center. If the peritoneum has been traversed, the patient can be observed overnight, if he has no abdominal tenderness, or can be taken to the operating room and examined laparoscopically. Laparoscopy has proved very useful, because the short weapons seldom penetrate the back or injure the diaphragm. Ultrasound is not readily available in the emergency room. Peritoneal lavage has not proved to be a useful tool in these well developed, muscular men, who are reluctant to allow procedures to be performed while they are awake.
In short, most stabbings among prison inmates do not create life-threatening injuries. However, patients with direct stab wounds to the heart may not survive transportation by ambulance to the hospital. Abdominal injuries are explored locally in the emergency room, or in the operating room with the use of laparoscopy.
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