ORIGINAL CONTRIBUTION emergency medical services, penitentiary riot; prison, riot, emergency medical services

Medical Consequences of the New Mexico State Penitentiary Riot

On February 2, 1980, a riot broke out among the 1,157 inmates at the N e w Mexico State Penitentiary and 139 people were injured. Of these, 33 died. Survivors had a variety of problems resulting from blunt or penetrating trauma, acute intoxication with drugs, or smoke inhalation. Fourteen per- cent of the casualties arrived at local hospitals in serious or critical condi- tion. A study of the injury patterns revealed a significant difference (P < .00I) in the incidence of severe head trauma in those who had tidied com- pared to those who survived. Most of the seriously or critically ill survivors suffered from acute poisoning or from penetrating wounds. [Price D, Billo- witz E, Lieberman R, Fleming T, Dunn M, Sklar DP: Medical consequences of the N e w Mexico State Penitentiary riot. Ann Emerg Med 12:361-363, June i983.[

INTRODUCTION Shortly before 2:00 AM on February 2, 1980, some inmates of the max-

imum security state penitentiary at Santa Fe, New Mexico, overpowered their guards and took control of the prison) In the 35 hours that followed, prisoners brutally murdered, tortured, poisoned, burned, and in some cases raped other prisoners and guards. Dead, injured, and ill patients were released or escaped from the facility sporadically. National Guard physicians triaged patients to either St Vincent Hospital or the Indian Health Service Hospital, both in Santa Fe. National Guard helicopters and ground ambulances pro- vided transport. The riot ended when police and National Guardsmen en- tered the prison without resistance or further violence.

This report describes the patterns of injury among the 106 prisoners and guards brought to the hospitals, and compares these to the patterns of injury noted in the 33 prisoners and guards who died.

Dennis Price, MD* Philadelphia, Pennsylvania Edgar Billowitz, MD t Richard Lieberman, MD t Tim Fleming, MD t Madelyn Dunn, RN t Santa Fe, New Mexico David R Sklar, MD* Albuquerque, New Mexico

From Temple University, Philadelphia, Pennsylvania;* St Vincent Hospital, Santa Fe, New Mexico; t and the Division of Emergency Medicine, The University of New Mexico School of Medicine, Albuquerque, New Mexico.*

Address for reprints: David R Sklar, MD, Assistant Professor, Division of Emergency Medicine, The University of New Mexico School of Medicine, 620 Camino de Salud, NE, Albuquerque, New Mexico 87131.

MATERIALS AND METHODS All the inpatient and outpatient records of pnsoners brought to either St

Vincent Hospital or the Indian Health Service Hospital in Santa Fe were reviewed. Four charts that contained inadequate identifying information, his- tory or physical examination, or no diagnosis, were excluded. Autopsies were performed at The University of New Mexico School of Medicine on all in- mates who died during this riot, and these records were reviewed.

The illnesses and injuries of patients treated during the riot fell Into three categories: medical, traumatic, and smoke inhalation. In cases in which pa- tients suffered from more than one illness, only the most clinically impor- tant diagnosis was used for analysis; however, when this could not be de- termined both diagnoses were used.

We further categorized the inmates who arrived at the hospital according to the severity of their illness. Those who needed care immediately or within 12 hours to prevent death or major disability were considered to be seriously or critically ill. Others with no life-threatening problems and for whom de- finitive care could have been delayed up to 12 hours were categorized as minor or moderate. Among those patients who died we recorded the primary cause of death as well as factors contributing to death from the autopsy re- ports.

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PENITENTIARY RIOT Price et al

RESULTS A total of 106 patients were treated.

Because of incomplete data, only 102 charts were useful for analysis.

Sixty patients were hospitalized, and 44 were treated and discharged. Two patients were examined and dis- charged initially, but later required hospital admission; these two patients were counted in both inpatient and outpatient analyses (Table 1).

Traumatic injuries accounted for 54 of the patient diagnoses and included stab wounds, lacerations, fractures, and contusions. Half the patients with traumatic injuries required hospital- ization. Eight were judged to be in serious or critical condition and five required immediate surgery: one for stab wounds to the heart; one for lacerations of the vena cava, duode- num, and colon; one for a laceration of the thyroidal vein; one for multiple stab wounds to the face and neck; and one for a neck laceration.

Th i r t een pa t ien ts suffered f rom smoke inhalation but only two re- quired admission; one subsequently developed severe respiratory distress.

Th i r ty - seven pat ients presented with medical conditions (primarily acute poisoning) and 33 required hos- pital admission. Ten of those hospital- ized had been acutely poisoned by drugs from the prison pharmacy and were judged to be in either serious or critical condition; five required me- chanical ventilatory support. Toxico- logic screening detected a variety of drugs, including diazepam, barbitu- rates, phenytoin, t r iamterene, and amitriptyline.

Thirty-three prisoners died in the prison during the riot (Table 2). Head injuries led directly to death in 16 cases. Many of these injuries were ex- tensive and appeared to be the result of forceful striking of the vict im's head against a hard surface, or of blud- geoning. Eight other patients had cra- niocerebral injuries thought to be a contributing factor in their deaths. H e m o r r h a g e due to stab wounds accounted for another seven deaths. One case of exsangnination was due to a fall. Four victims died of carbon monoxide poisoning. One prisoner aspirated tear gas and died, and anoth- er died from asphyxiation due to hang- ing. Excessive thermal injury after death prevented identification of the cause of death in three victims.

Twenty-three of those who died showed evidence of multiple injuries inflicted both before and after death in

TABLE 1. Categorization by type of illness and disposition

No. Type of Illness Patients Admitted

Traumatic illness 54 27 (8 serious/criticalJ (lacerations, stab 5 immediate wounds, contusions, surgery) fractures)

Smoke inhalation 13 2 (1 serious/critical)

Medical illness 37 33 (10 serious/critical, t (poisoning, 5 intubated on infections, chest respirators) pain, etc)

Total 104" 62*

*Two patients counted twice due to discharge and return. Four charts incomplete and patients not counted.

tone patient had both critical traumatic and critical medical illness.

Discharged

27

11

4

42*

TABLE 2. Autopsy results

Cause of Death

Craniocerebral injuries

Exsanguination stab wounds

Carbon monoxide

Other Lacerations of heart (rupture secondary to fall from

a height)

Asphyxia secondary to hanging

Severe pulmonary disease secondary to inhalation of tear gas

Cause not determined

Total

No. Patients (%)

16 (49)

7 (21)

4 (12)

I (3)

1(3)

1 (3)

3 (9)

33 (100)

an apparent pattern of massive in- tentional muti la t ion: decapitation, castration, and the presence of wea- pons forced into the brain through the eyes and ears were noted.

DISCUSSION Unlike most disasters in which a

single force or agent inflicts variable damage on a large number of victims, in the New Mexico State Penitentiary riot many agents, including smoke, sharp and blunt objects, and toxic sub- stances, caused a mixed pattern of in- juries. The large number of patients with acute head injuries and acute in- toxications created a great deal of con- fusion in diagnoses. Fur thermore, many victims were held hostage, had

Annals of Emergency Medicine

witnessed torture, or were raped dur- ing the riot. Their psychological dis- tress reactions added another dimen- sion to an already chaotic situation. 2 Due to rapid identification and treat- ment of the most severely injured pa- tients, however, no victim died after reaching the hospital alive.

Of a total of 135 victims, 18 (14%) were in either serious or critical con- dition. In other disasters in which trauma caused the injuries, patients in serious or critical condition were be- tween 5% and 15% of the total vic- tims, and the dead outnumbered those with serious or critical conditions. 36 In this disaster, serious or critical trauma patients were 6% of the total casualties, and the dead again out-

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n u m b e r e d the ser ious or cr i t ical . These consistent patterns re-empha- size the importance of rapid recogni- tion and treatment of the 5% to 15% ser ious ly or c r i t ica l ly ill pa t i en t s through an effective triage system.

There was a significant difference in the number of dead suffering severe craniocerebral injuries compared to the survivors (P < .001). In 16 of 33 fatal cases, craniocerebral injuries led directly to death. Severe head injury was noted in only one of the sur- vivors, although in several patients a variety of contusions, lacerations, or concussions combined with possible drag intoxication resulted in admis- sion for observat ion for a possible brain injury. This difference implicates severe head injury as a marker for dea th in a p r i son r io t s i t u a t i o n . Whether such injury means that the v ic t im could no t escape or defend himself, or was specifically selected

for this injury by other inmates, is not cleai".

In the New Mexico State Peniten- tiary riot, unlike the riot at Att ica P r i son , 7 t r a u m a due to g u n s h o t wounds and other missiles was absent because these prisoners had no access to firearms and no shots were fired during the retaking of the prison by police and National Guard.

Many factors lead to frustration, an- get, and violence in prison inmates and, unfortunately, many of these fac- tors are not easily controlled. Hospi- tals near prisons should prepare for disasters associated with prison riots while corrections officials continue to strive to prevent future riots. Prepara- tion for the treatment of patients with acute poisoning, smoke inhalation, blunt and penetrating trauma, psycho- logical distress, and male rape should be included in prison riot disaster plans.

REFERENCES 1. Report of the Attorney General on the February 2 and 3, 1980, Riot at the Peni- tentiary of New Mexico, Parts I and II, and Report of Citizens Advisory Panel. Santa Fe, NM, June 1980 and September 1980, p 1. 2. Hillman R: The psychopathology of being held hostage. A m J Psychiatry 138: 1193-1197, 1981. 3. Brismar B, Bergenwald L: The terrorist bomb explosion in Bologna, Italy, 1980: An analysis of the effects and injuries sus- tained. J Trauma 22:216-220, 1982. 4. Members of the medical staff of three London hospitals: Moorgate tube train dis- aster. Br Med J 3:727-73I, 1975. 5. Mandelbaum I, Nahrwold D, Boyer DW: Management of tornado casualties. J Trau- ma 1:353-361, 1966. 6. Miller PJ: The Nuneaton derailment. ]njury 12:130-138, 1980. 7. Williams RW, Bums GP, Murray MA, et al: Mass casualties in a maximum security institution. Ann Surg 175:592-597, 1974.

ABEM Notice On June 30, 1988, the practice option will terminate for those physicians wishing to meet the credential require- ments of the American Board of Emergency Medicine's certification examination. Practice, teaching, or CME accumulated after the above date may not be used to satisfy the practice requirements. Questions should be directed to ABEM, 1305 Abbott Road, Suite 101, East Lansing, MI 48823; 517/332-4800.

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