Tag Archive: robert o’block

Robert O’Block reports that for almost nine months 16-year-old Skylar Neese of  Star City, West Virgnia, was missing.  She had vanished without a trace.  Friends and family posted fliers all over town, at gas stations, on utility poles, and even in tattoo parlors.  There was nowhere you could go in this small town without seeing Skylar’s face.

One night last summer she sneaked out of her bedroom window, and was spotted by a security camera getting into a car, willingly, at the end of the block.  While there were some in this town of fewer than 2,000 people who thought she ran away, others never believed that theory.

The police investigated many leads, but to no avail.  Finally, nearly nine months after she disappeared, one of Skylar’s friends came forward and confessed that she and another girl had plotted to kill her.  This confession stunned everyone, including the investigators who had spent many hours working on the case.

Based on court documents, the two girls were charged with luring Skylar out of her family’s apartment in the middle of the night, stabbing her to death at a moment that was previously agreed upon by the two girls, and then concealing her body under some branches in a Pennsylvania township approximately 30 miles away from her own home.

The pair not only spent time with Skylar’s mother after the murder, but they even assisted in the search.  One of the two assailants, now identified as 16-year-old Rachel Shoaf, has now pleaded guilty to second-degree murder, and is currently in a juvenile detention center waiting for her sentencing.

The other girl’s name has not yet been released due to the confidentiality of juvenile court.  At this time, they are unsure whether the second girl will be tried as an adult, as Shoaf was, or as a minor.

In the court file on Shoaf, prosecutors advise that they plan to request a 20-year prison sentence, but it’s possible that she could get as many as 40 years under the law.

Local barber BJ McClead is astonished that two teen girls could keep up this type of deception from July to January.  McClead went on to say that “some of the criminals that are locked up for life aren’t that hard.”

Brought to you by Robert O’Block

Source:  http://www.foxnews.com/us/2013/05/25/wva-town-transfixed-by-teen-girls-plot-to-kill-friend-but-biggest-question/?test=latestnews

Robert O’Block announces the Certified in survival Mindset, CSM credential. Earn the Credential that Could Save Your Life!

The newest release for ACFEI Members is a credential essential to surviving a violent encounter, Certified in Survival Mindset, CSM!  Subject matter expert Lt. Col. Dave Grossman is an internationally recognized scholar, author, soldier, and speaker who is one of the world’s foremost experts in the field of human aggression and the roots of violence and violent crime. The course materials cover each of his books, On Killing, On Combat, and Warrior Mindset and will prepare you for the physiological and psychological aspects of violent encounters and equip your body and mind to survive disastrous events.  View the course trailer

Published by Robert O’Block


Robert O’Block presents this quote by John Douglas:

“There are certain crimes that are simply too cruel, too sadistic, too hideous to be forgiven.”
John E. Douglas (Journey Into Darkness)

Published by Robert O’Block


Robert O’Block and the ACFEI/ICBS would like to invite you to join the top professionals in the fields of forensics and behavioral science at our 2011 National Conference.  Our conference will be held October 12-14, 2011 in Branson, Missouri.

Published by Robert O’Block


Article written by Shirley McCann and brought to you by Robert O’Block

Article written by Shirley McCann and brought to you by Robert O’Block. Officers Don Craig and Jack Alberts were on patrol when they received the call about a robbery at Gorman’s Fine Jewelry. Hal Tinker, the skinny, nail-biting sales clerk, was beside himself with worry when he unlocked the front door and allowed them entry.

“I didn’t know what else to do,” he told the officers, while trying to block the mass departure of the customers he’d locked in. I’ve only been on the job for a week, and the owner is gonna go ballistic when he finds out I’ve lost a valuable emerald pendant. I’ll probably lose my job over this!”

Once the officers were inside, Tinker quickly locked the door behind them.

“Have any other customers been here and left since you opened up this morning?” Craig asked. “Not a chance,” Tinker answered defiantly. “As soon as I noticed the necklace missing, I rushed over and locked the doors. No one got out, which means that one of these people had to have taken it.”

“This is insane!” barked an older gentleman with a wooden cane. “Surely you don’t suspect us? My wife and I have been loyal patrons of this store for years.”

“And you are?” asked Officer Alberts.

The man huffed and wrapped an arm around his wife. “We are Mr. and Mrs. John Trimble.” He pointed a bony finger at the clerk. “And let me assure you, young man, once Mr. Gorman hears about how my wife and I have been treated like common criminals, this will be your last day on the job.”

Alberts put both hands in the air and made a suggestion. “Why don’t we just start off by having everyone tell us what they were doing here.”

A tall, leggy blonde with a large shoulder purse offered her explanation. “I’m Claire Winters,” she spat out. “I work part-time at the insurance office two doors down. I had planned to just run in here and find something nice for my boss’s birthday. But I doubt my boss is going to be too pleased with me now, since I’m already thirty minutes late.”

“Under the circumstances, I’m sure your boss will understand,” Alberts insisted.

Next on the list of suspects was a nervous young blonde mother with a baby stroller.

“I’m Sara Bealls,” she offered, with a tremble in her voice. “Little Jimmy and I just came in to use this $10 coupon I received in the mail. I thought I might find a good bargain, but I never dreamed we’d be accused of theft!”

Officer Craig turned to the Trimbles.

“Oh very well,” Mr. Trimble huffed, nodding toward his wife. “We might as well cooperate so we can get this over with quickly. But I can assure you that your boss is gonna hear all about this, Mr. Tinker.”

Mrs. Trimble wiped a tear from her eye. “Our niece is graduating in a few weeks. We thought we might find something special for her in here. Mr. Gorman always has some unique selections on hand.”

The two officers exchanged glances. “Mr. Tinker, are you positive no one could have left before you locked the door?” Craig asked again.

“Absolutely not. These people were the only customers in the store when I brought out the locket. And no one came in after that.”

“What about a security camera,” Detective Craig suggested. “Maybe we could view that and see if the theft was caught on camera.”

Hal Tinker laughed. “Are you kidding? Mr. Thomas is so cheap he didn’t even bother to change the name on the door when he bought it two years ago. There’s no way he’d spring for any kind of a security system.”

“Well, this obviously isn’t helping anything,” Mr. Trimble said. “I’ve never been so insulted in all my life. It wouldn’t surprise me if Mrs. Bealls pulls this kind of stunt all the time. After all, it would have been easy for her to slip the necklace from the counter into the stroller. No one would be the wiser.”

“You’ve got a lot of nerve!” Mrs. Bealls screamed. “I’ve never stolen anything in my life!”

She spun around and pointed an accusing finger at Claire. “Why don’t you show everyone what’s in your bag?” she suggested. “You could have easily stashed the pendant in that huge purse of yours.”

“You’ve gotta be kidding, lady,” Claire said. “I would never want anything that gaudy. I prefer diamonds.”

Officer Craig turned to his partner. “It appears that everyone here had the opportunity to steal the necklace,” he said. “We could settle this quickly if everyone would just submit to a search of their belongings.”

“You go right ahead,” Mr. Trimble shouted, leaning his cane against the counter and putting his arms out. “I have nothing to hide.”

“Well, neither do I,” Mrs. Bealls exclaimed.

“Neither do I,” Claire stated firmly. “Although I can assure you that if you lay one hand on me, you’ll be hearing from my attorney.”

“There’s no need to call your attorney,” Alberts said. “Although a search would make things a lot easier, I think we can narrow down the list of suspects by starting at the beginning.”

Officer Craig scratched his head. “You’ve got a suspect?”

“I do,” Alberts said. “And if you’d been paying attention, you’d know who the thief is too.”

The suspects exchanged worried glances. Claire started for the door. “I’m not staying around here for this witch hunt,” she exclaimed.

“Me neither,” shouted Mr. Trimble. “I demand you open that door right now.”

Alberts caught Mr. Trimble’s arm and removed his cane. “Not so fast,” he said. He unscrewed the tip, turned it upside down and watched the necklace fall to the floor.

How did Detective Alberts know that Mr. Trimble was the thief?

For the solution, visit www.acfei.com.

–Published by Dr. Robert O’Block


Article written by James DiGabriele, DPS, CPA/ABV/CFF, CFSA, FACFEI, Cr.FA, CVA and brought to you by Robert O’Block

Article written by James DiGabriele, DPS, CPA/ABV/CFF, CFSA, FACFEI, Cr.FA, CVA and brought to you by Robert O’Block. Influenced by business, government, regulatory authorities, and the courts, there is evidence that a higher level of expertise is now required to analyze present day complicated financial transactions and events. As a result, forensic accounting has emerged in the forefront of the crusade against financial deception.  Currently, universities and colleges are offering forensic accounting courses or are considering adding them to their curriculum; this evolution has revealed a void in the significant skill set outcome that should be developed.


There is continuous validation that preventing fraud and uncovering deceptive accounting practices is in strong demand as companies respond to closer scrutiny of their financial activities by shareholders and government agencies. In recent history, the Federal Bureau of Investigation estimated that white collar crime costs the United States more than $300 billion annually. Many of these crimes are difficult to identify because the perpetrators have concealed their activities through a series of complex transactions. Usually, large volumes of financial information are involved, and the complexity of these investigations can be a strain on a company’s resources.

In addition, according to an AICPA discussion paper, the use of forensic accounting procedures to detect financial reporting fraud should be increased. The paper argues that forensic accountants and financial statement auditors have different mindsets. Hence audit teams need to be trained to incorporate more forensic accounting procedures into their audit practices as well as retain more forensic specialists to help detect problems.

Forensic accountants currently apply their unique expertise to an array of diverse assignments and are often hired to determine whether there has been any intentional misrepresentation associated with a company’s financial records. A fraud examination can range from overvaluation of inventory and improper capitalization of expenses to misstatement of earnings and embezzlement

Organizations also hire forensic accountants for guidance when evaluating potential business transactions. Forensic accountants assess a company’s true worth during a merger or acquisition, ensuring that a purchaser is knowledgeable of a target firms financial situation and value while simultaneously searching for suspicious accounting activity. Forensic accountants often provide accounting expertise during existing or pending litigation. This work is primarily focused on quantifying damages in cases of personal injury, product liability, contract disputes, intellectual property, and uncovering hidden assets in complicated matrimonial law cases. These types of services may ultimately culminate in providing expert witness testimony.

Forensic accountants also play an important role in government. They work for agencies such as the Federal Bureau of Investigation, Central Intelligence Agency and Internal Revenue Service. Forensic accountants in this role look for signs of suspicious financial activity and fraud by individuals and businesses. In addition, forensic accountants have assumed a more visible role in helping the government evaluate accounting and banking records of suspected terrorists.

Preparing Future Forensic Accountants to Meet the Demand

There have been many indications that the demand for forensic accounting services will continue to increase; that demand requires proper training to meet market challenges. The National Institute of Justice has prepared a model curriculum guide for education and training in fraud and forensic accounting to aid academic institutions, public and private organizations, practitioners, faculty and prospective students. Practitioner articles have identified specialized skills and technical abilities of a forensic accountant. A forensic accountant is usually familiar with criminal and civil law, understands courtroom procedures and expectations, and embodies investigative skills that include the methods of recognizing fraud abuse. A forensic accountant thinks creatively in order to consider and understand the tactics a fraud perpetrator may use to commit and conceal fraudulent acts. Additionally, a forensic accountant needs to clearly and concisely communicate findings to various parties, including those with less knowledge of accounting and auditing. Successful forensic accountants must have analytical abilities, strong written and verbal communication skills, a creative mindset and business acumen. A forensic accountant must be able to interview and elicit information from potentially uncooperative people and possess a strong amount of skepticism.

Forensic accountants are distinctively positioned to be able to uncover financial deceptions. The prominent skills are; an in-depth knowledge of financial statements with the ability to critically analyze them and a thorough understanding of fraud schemes. A forensic accountant should have the ability to comprehend the internal control systems of corporations and also be able to assess the risks. Finally, the knowledge of psychology helps forensic accountants to understand the impulses behind criminal behavior that motivate and encourage financial deception. Interpersonal and communication skills which aid in disseminating information about the company’s ethics, an understanding of criminal and civil law, as well as of the legal system and court procedures are also skills that aid forensic accountants. Rezaee, Crumbley & Elmore (2006), surveyed opinions of practitioners and academics regarding the importance, relevance, and delivery of forensic accounting education. The results indicate that the demand and interest in forensic accounting will continue to increase. Both groups of respondents viewed accounting education as relevant and beneficial to accounting students.

A View from the Field

The results from a recent survey further validate the importance of a specific skill set inherent to forensic accountants. A questionnaire submitted to forensic accounting practitioners and accounting academics asked about their views of what skills are deemed necessary and important to a forensic accountant. Participants were e-mailed using www.surveymonkey.com and were asked the extent to which they agreed with the statements addressing each of nine competencies that were deemed important skills of a forensic accountant. The agreement ratings were made on a five-point Likert scale ranging from “strongly disagree” to “strongly agree.” The following scores were assigned to each response: strongly disagree, 0; disagree, 1; neither, 2; agree, 3; strongly agree, 4.

Ten questions were asked to practitioners and academics that pertain to their views of what skills are deemed inherently important to a forensic accountant. The first question was; “An important skill requirement of a Forensic Accountant is deductive analysis – the ability to take aim at financial contradictions that do not fit in the normal pattern of an assignment.” In consideration of the barrage of recent financial reporting scandals this skill appears to be necessary and essential for a forensic accountant to meet the objective of uncovering a potential financial fraud. Forensic accounting courses taking aim at financial misrepresentations should incorporate course objectives to meet this ability. Both groups agreed.

The second question was; “An important skill requirement of a Forensic Accountant is critical thinking – the ability to decipher between opinion and fact.” The essence of the role of expert witness is the ability to perform the task of discerning fact from fiction in order to maintain a credible testimony. Courses developed in this area should emphasize to students the ability to remove any non corroborated opinions from expert reports and testimony. Both groups agreed.

The third question was; “An important skill requirement of a Forensic Accountant is unstructured problem solving – the ability to approach each situation (inherently unique) prepared to solve problems with an unstructured approach.” Accounting education has been based around concentrating on compliance with rules and procedures. This skill is a direct contradiction to this concept. It can be argued that a shortcoming of auditors is not seeing the proverbial forest beyond the trees. Again, practitioners and academics did not differ.

The fourth question was; “An important skill requirement of a Forensic Accountant is investigative flexibility – the ability to move away from standardized audit procedures and thoroughly examine situations for atypical warning signs.” Practitioners and academics agreed on the importance of this skill, further emphasizing the need in accounting for a more open minded skill set.

The fifth question was; “An important skill requirement of a Forensic Accountant is analytical proficiency – the ability to examine for what should be provided rather than what is provided.” Considering the post financial fraud regulatory environment, solving a financial puzzle with less than a complete set of pieces appears to be the direction the current business forum is heading. Practitioners and academics agree on the importance of this skill.

Question six was; “An important skill requirement of a Forensic Accountant is oral communication – the ability to effectively communicate in speech via expert testimony and general explanation the bases of opinion.” Both groups strongly agreed that oral communication is an important skill of a forensic accountant

The seventh question was; “An important skill requirement of a Forensic Accountant is written communication – the ability to effectively communicate in writing via reports, charts, graphs, and schedules the bases of opinion.” All groups strongly agreed on the importance of this skill.

The eighth question was; “An important skill requirement of a Forensic Accountant is specific legal knowledge – the ability to understand basic legal processes and legal issues including the rules of evidence.” Academics and practitioners agreed that specific legal knowledge is an important skill of a forensic accountant.

The ninth question was; “An important skill requirement of a Forensic Accountant is composure – the ability to maintain a calm attitude in pressured situations.” The respondents did not differ in opinion of this skill, agreeing strongly that this is an important proficiency. The most prevalent area where this is necessary is expert testimony in either deposition or court. The composure of an expert can be an integral component to the ultimate case outcome.

The tenth question asked the participants to identify themselves as a forensic accounting practitioner or academic.

The results also illustrated two distinct areas of competency based on the items with high loadings in the principal component analysis knowledge/ability and performance. The knowledge/ability component relates to whether an individual has the background knowledge and thinking skills to be effective, while the performance component relates to the individual’s ability to turn this knowledge/ability into an effective presentation. The groups agreed on all six knowledge/ability items; deductive analysis, critical thinking, unstructured problem solving, investigative flexibility, analytical proficiency and specific legal knowledge. Both groups agreed on the performance items; oral and written communication and composure. Forensic accounting educators may also consider segregating course content based on these two distinct areas.

The essence of an effective forensic accountant/expert witness is the ability to discerning fact from fiction in order to maintain a credible testimony. Survey results indicated that this skill was rated as one of the more important proficiencies. Forensic accounting courses developed in this area should emphasize to students the ability to remove any non corroborated hearsay opinions from expert reports and testimony.

Accounting education has concentrated on compliance with rules and procedures. Forensic accounting is different in that problem solving becomes more of an improvised approach rather than a structured plan. This skill type is a direct contradiction to traditional accounting skills; it can be argued that a shortcoming of auditors is a narrow approach. Survey results indicate that practitioners and academics agree on the importance of a forensic accountant to move away from a narrow approach and apply a more holistic technique. These findings further illustrate the need in accounting for a more open minded skill set.

The appropriate skills of a forensic accountant illustrated in the results of this study contributes to the progress of the the literature in forensic accounting education by identifying the necessary proficiencies to be integrated in the course content.


The increasing demands in the current regulatory, legal and, business environments should serve as a stimulus for accounting programs to emphasize and embrace further attention to forensic accounting. The survey results indicate that practitioners and academics agree that critical thinking, unstructured problem solving, investigative flexibility, analytical proficiency, legal knowledge, oral communication, written communication, and composure are important skills of a forensic accountant. The survey results show that there is an importance of skills that are relevant to the outcome of forensic accounting education. These skills can be used as a guide to direct academic curriculum with the proper outcome objective. Future research in this area could progress to classifying skills to specific courses. For example; a course on forensic legal knowledge would be more likely to have an objective of written and oral communication rather than analytical proficiency.

–Published by Dr. Robert O’Block


Article written by Heidi Bale, RN, CFN, brought to you by Robert O’Block

Article written by Heidi Bale, RN, CFN, brought to you by Robert O’Block. At some point in your correctional healthcare career, you may be asked to accompany a forensic patient. The definition of forensic, in this context, refers to the patient who is in the custody of law enforcement or a correctional system. It may be from your institution to another facility, or a return to your institution from another location. For those correctional medical staff that have not practiced outside the clinic or treatment area, this can produce anxiety. The stable, secure environment of the clinic or infirmary becomes an unpredictable and mobile one, and help is not always readily at hand.

This article will discuss pre-transport planning, potential interventions during transport, and delivery of the patient. This information will equip staff to confidently develop the skills needed to safely escort the forensic patient, whether they are based in a jail facility or prison institution. These techniques can apply to intra-system transports as well.

Your Mission, Should You Choose To Accept It
Patient transfers begin with a request for patient movement. This contact may be initiated by transportation staff or a facility. Data to gather immediately includes the name of the patient, nature of the illness or injury, why the need for medical escort staff, the location of the patient and intended destination, date to be moved, current treatment plan, and any follow up care needed. If the patient is incarcerated in your correctional system, print out a “snap shot” of his or her care while incarcerated, and note the demographics. If the medical record is stored at your location, it is helpful to mail it to the receiving facility prior to the patient’s arrival.

Patient Placement
Placement is determined after reviewing data submitted by the sending facility (hospital, prison, jail, or mental health facility), and in speaking with the appropriate correctional transportation staff. A good rule of thumb is to routinely request a copy of the booking sheet (if moving from jail to jail or jail to prison), a copy of the medical records, and medication administration record (MAR). A decision is made based on the patient’s needs: inpatient or infirmary care, outpatient care, mental health services, or acute offsite care. These necessities can include services as diverse as dialysis, obstetric care, cardiac surgery, and physical therapy. The need for a major medical center to be nearby will also factor into the equation. Keeping these factors in mind will assist you in placing the patient in the appropriate facility for continued care.

Plane, Van, or Automobile?
If the transportation will be within your region, a car or van will generally suffice. You may need a van that is wheelchair accessible instead of the usual passenger van. The patient must be able to sit up and wear a safety restraint. Also keep in mind the terrain to be covered (such as desert, mountain, or the possibility of inclement weather), route to be followed (EMS accessibility, rural roads versus interstate highways), and any planned stops for a restroom break or care interventions.

Out-of-state transportation generally involves air transport, either commercial or small plane. Air transport involves both altitude and space constraint considerations. Despite cabin pressurization, the aircraft cabin environment is different from that at ground level. Commercial aircraft cabins are pressurized for 6,500 to 8,000 feet depending on the aircraft; smaller aircraft can alter their cabin pressure with a bit more leeway as needed. (Keep in mind that flying lower will generate more fuel stops, which increases barotraumas from more take offs and landings.) Due to the flight environment, there is virtually no water vapor or moisture in the air, and the partial pressure of oxygen is reduced, which can cause relative hypoxia. The reduced barometric pressure can exacerbate or create acute complications for those patients with respiratory or cardiac ailments, head injuries, and orthopedic conditions.

Contraindications for Flight
The patient must always have a physician’s approval to travel, especially by air. Escorting a forensic patient is not comparable to an aero medical transport by a professional service. There are medical contraindications to flight, especially for those not traveling by a professional air medical transport. These contraindications include recent myocardial infarction; significant surgical procedures; cerebral vascular events; head injury, including cranial and facial fractures; blood clots; being acutely ill or non ambulatory; fractures, including compartment syndrome; having a contagious illness; and anemia. Medical staff would be wise to also consider acute mental health illness and dental conditions that can be affected by barotraumas. If these conditions are present, the options are to refer them to a professional transport company, or wait until the patient is recovered sufficiently to fly or travel by ground.

Keep in mind that the elevation of limbs for casts and splints is prohibitive in commercial aircraft and challenging in smaller aircraft. Drainage bags, catheters (both should be emptied before flight), and complicated dressings are challenging in small spaces or tiny restrooms (private aircraft may not have a restroom). Decreased oxygen saturation at higher altitudes creates more cardiac workload on a patient who may already be stressed from a medical condition.

Bridging the Gap
Ensuring continuity of care is a primary concern. Gathering data from the sending facility and relaying it to the receiving facility can be challenging. Document all contact persons, dates, fax and phone numbers, and information received. After gathering a snapshot of the patient to be transferred, contact the facility that is the most appropriate for receiving the patient. If your healthcare or correctional system has an electronic health record, this makes sharing information easier. Make sure that medical records are exchanged according to HIPAA standards. Whenever possible, speak with the healthcare manager, onsite physician or psychiatrist, and nurse manager for direct patient information. A staff to staff report is encouraged, and the numbers and contact information are shared with both institutions. Upon acceptance of the patient, the planning for transport moves forward. During this entire process, communication is ongoing with transportation staff regarding the destination, patient’s needs, and information related to their safety. It is a good idea to document who accepted the patient at the facility and any reference numbers for contact during transport.

Whether by Land, Sea, or Air…
The patient’s medical issues will dictate the equipment carried, but there are some basic items that should be carried during each trip. A rescue mask, gloves, antiseptic wipes, etc, are carried in a fanny pack or small bag. A larger, more inclusive bag may include a stethoscope, blood pressure kit, penlight, duct tape, scissors, pen/paper work, cell phone with contact numbers, and a bottle of water. Other items may be added depending on the patient’s needs. These can include a glucometer and supplies for a diabetic, with a sugar source like a tube of frosting or honey; a urinal (for small aircraft), zip ties, plastic baggies; moisture proof pads; and a pulse oximeter (borrowed from a facility). An oxygen cylinder, nasal cannula, and facemask can be borrowed for special transports as back up, making sure that the oxygen cylinder is flight certified.

An example of a patient-designed transport bag includes items needed for a patient with a fractured, wired jaw: wire cutters (sent through airport screening with transportation staff), biohazard bags, gloves, airway maintenance supplies, airsickness bags, straws, and plastic spoons. Small packets of wipes are also a good idea. These supplies can easily be incorporated into an existing transport bag.

“The Bird Is in the Air.”
When transporting a patient, a few small details should be kept in mind. How is the patient going to get from the facility or hospital bed to the plane? How are they going to get from the curb, through the terminal, to the gate, and on to the plane? You may need to rent a vehicle on arrival in order to travel to the patient’s location, and transport you and your patient from the facility to the plane, when you are traveling on commercial flights. For smaller aircraft, arrangements should be made to have transportation available at the airfield (perhaps through a local service), or have the patient delivered to the aircraft. (These arrangements are made by transportation staff with input from medical staff.) Consider requesting a van or small sports utility vehicle, as they are easier to transfer a patient into and out of, especially for a patient with restraints and in a wheelchair.

After check-in at the terminal, you will accompany your transportation staff and patient to the screening area. It is a good idea to have a small blanket to drape over the patient’s lap in order to shield the restraints from the public. Due to their law enforcement status, your group will be screened in a different area. At the gate, transportation staff will generally speak to the gate agent to explain their status, and you will board first. At the completion of the flight, you may deplane last.

“De Plane! De Plane!”
Now that your patient is settled in his seat, it is a good time to look around and see where the emergency equipment is stored and introduce yourself to the flight crew. When necessary, advise the flight attendants of any possible medical issues that may arise during the flight. On a smaller aircraft, talk with the pilots about any concerns; they are more than happy to assist. An oxygen cylinder, AED, and medical supplies are usually located in First Class and near the rear galley on commercial aircraft. The pilots on a small aircraft will show you how to exit in an emergency and where emergency equipment is located. Depending on the needs of your patient, have a plan in mind for emergencies before you leave for the airport. Do you need a snack for a diabetic patient? Medication, oxygen, or wire cutters for that wired jaw? Play with a few scenarios in your head before the day arrives to make sure you are ready to handle an event during transport. The patient will be seated next to security staff, but you will generally have line of sight.

“The Eagle Has Landed.”
After the plane has landed, contact the receiving institution with an update on the patient’s status, and an updated ETA. Upon arrival at the destination, deliver any medical records you have transported, give onsite medical staff a report, and provide contact information for the sending facility in case they have questions.
Many physicians and hospital staff are unwilling to discharge patients to a correctional environment, feeling that the patient will be returning to a cell, without medical care or medical supervision. It is up to you, the liaison, to communicate the level of care and quality of correctional healthcare given at the receiving facility. This information should include details regarding inpatient care, outpatient clinics, visiting specialists, and services provided, such as physical therapy or dialysis. As a rule, encourage a physician to physician communication prior to transport.

Thoughts for the Road
Be prepared. Communicate. Remember that you are a team member with the correctional transportation and security staff; work with them hand in hand. Have fun. Be safe.

Special thanks to: Transportation Unit, Washington State Department of Corrections; Aviation Section, Washington State Patrol; Executive Flight, Inc.

–Published by Dr. Robert O’Block