Blood Alcohol Vs. IV Therapy

[paramedix]

Unfortunately we respond to numerous accidents where the drivers of the vehicles involved are under the influence of alcohol.

If and when required, an IV is sited on the patient. :excl:Can Blood Alcohol Levels Still Be Tested by the police?:excl:

Recently we had a celebrity invloved in an accident and two people were killed. An interview with one of the local radio and television stations had it that "the patient could not be tested for alcohol as paramedics had to put a drip on the patient". All good if the patient requires it, but doesn't this open a whole new area for "helping" someone out of trouble.

I am sure there is a way of testing patients after an IV was sited?

 

[Ridryder911]

Someone was thoroughly confused. The only reason one would not obtain an ETOH level is through the IV site if they used an alcohol prep. Blood samples can be obtained upon the opposite arm, etc.

In regards of "diluting" them down is also hogwash. Doubtful, the amount of fluid given prehospital would cause such changes in the variable ranges of ETOH levels.

There are many services in the U.S. that actually "draw" the ETOH level while establishing the IV. Again, as long as a substitute wipe and no alcohol was utilized.

R/r 911

 

[Ops Paramedic]

Blood alcohol levels

As paramedix is good friend of mine and i know which call he is referring to it would be difficuilt to comment on. I am by no means a pathologist, thus my opinion would mearly by from what i have heard or experienced.

Once again we are the subject of resources. There is no sobriety test performed by the police (Or any authority) out here. The only way to prosecute a ? drunk driver for us is perform a blood alcohol level test, which we as medical personell may not perform. The blood kits are are carried by the regulating authority. These kits are hard to come by and are more often than not expired. There is also a time limit in which the the blood sample is to drawn after the accident, and that is 2 hours, otherwise, it is nul in void. How about a breathliser test?? Those are just as scares and do not really have any weight in the court.

Otherwise all I can say is: welcome to Africa!!

 

[Grady_emt]

Someone was thoroughly confused. The only reason one would not obtain an ETOH level is through the IV site if they used an alcohol prep. Blood samples can be obtained upon the opposite arm, etc.

R/r 911

Rid, why is this? I have had several medics tell me this, but none have know the patho-physiology of why-not...

 

[MedicPrincess]

Rid, why is this? I have had several medics tell me this, but none have know the patho-physiology of why-not...

I asked about this after an MVC one night. The LEO I was talking to indicated it has to do with the pts lawyer arguing the sample was "contaminated" by the alcohol on the skin when the needle puncters the skin. According to him, it wouldn't take even a very good lawyer to have the sample thrown out d/t the possibility of contamination and skewed ETOH results....however remote it may be.

 

[Ridryder911]

As paramedix is good friend of mine and i know which call he is referring to it would be difficuilt to comment on. I am by no means a pathologist, thus my opinion would mearly by from what i have heard or experienced.

Once again we are the subject of resources. There is no sobriety test performed by the police (Or any authority) out here. The only way to prosecute a ? drunk driver for us is perform a blood alcohol level test, which we as medical personell may not perform. The blood kits are are carried by the regulating authority. These kits are hard to come by and are more often than not expired. There is also a time limit in which the the blood sample is to drawn after the accident, and that is 2 hours, otherwise, it is nul in void. How about a breathliser test?? Those are just as scares and do not really have any weight in the court.

Otherwise all I can say is: welcome to Africa!!

It's a same that it occurs. Here in the U.S. we have an active volunteer group that got a laws and increased legislation to change things, called Mothers Against Drunk Drivers (MADD). It actually started from mothers (families) of victims of drunk drivers.

I do not know the reason of why your officers cannot be trained to perform sobriety test or even why there is a problem obtaining blood alcohol veinapuncture tests kits? Obviously, the outcry of the public has not made a change yet. Maybe your EMS Associations could assist in changing laws and policies.

Rid, why is this? I have had several medics tell me this, but none have know the patho-physiology of why-not...

From what I have been told by lab and while in Police academy is even the possibility of sticking a needle through the skin of alcohol saturated area may produce a false reading. Albeit it might be minute, it would be reason enough for a "false reading" thus enough for defense to cry out a technicality. The same about the same arm is not to be used for drawing labs, especially if distally draw it may be "diluted" sample.

R/r 911

 

[MSDeltaFlt]

Then there is the continuity of custody thing. Everything has to be signed and documented and never left around and yadda, yadda, yadda.

I won't draw in the field. Our lab where I work part time won't accept a sample if your name/date/time is written in your handwriting on the tubes. If they need it that bad and there are no more adequate places to stick IV, then they can call RT go arterial if need be.

 

[paramedix]

Media vs. Paramedics

I brought this topic up a couple of days ago after the accident where a celebrity was involved in a mva on one of our highways. The whole thing turned sour and all to blame is directed towards the paramedics that treated the patients on the scene.

Some of our major news agencies reports that the patient sustained minor injuries and hint in the direction that paramedics 'protected' the patient from further legal prosecution. I have included the article's direct link for your reading, it is actually a major concern!!!
:excl:http://www.news24.com/News24/South_Africa/News/0,,2-7-1442_2280964,00.html
I did not treat the patient so I cannot say that he was slightly injured, but according to the media releases done by the paramedics and the hospital where he was NEVER admitted and only treated for soft tissue injuries....

Will a pathologist be able to clarify this somehow... this opens a huge flaw in our EMS and Legal system.

Corrupt paramedics or LEO's can 'help' drunk people and possibly prevent prosecution! I already had the question posed to me on an accident scene by a patient why he can't have a drip. Quickly followed by, 'because I'm not a celebrity, is that why!?'

Another article posted by the news agency... :excl:http://www.news24.com/News24/South_Africa/News/0,,2-7-1442_2280770,00.html

My company's PRO department were stomped with calls from the press trying to speak to paramedics to get the correct protocol when to initiate IV therapy. This is stupid, they waiting for someone to contradict and trying to nail the paramedics and completely forget the situation at hand.

 

[MMiz]

Around here it is very common for EMS to draw blood at the local jail for ETOH readings. Our lawyer, the city's lawyer, and Medical Control all approved the procedure. It is a very clear procedure that describes the process step-by-step. The jail provides the kit, and we provide the service.

 

[Jon]

Around here, the PD brings their "guests" through the front door of the ED. They go to registration, and then go into a triage room, where eirher an ED tech or RN does the blood draw, using a PD supplied kit if they have it, otherwise they use a hospital-supplied blood tube (gray top, I think). They get the sample, and the "guest" walks/stumbles out the door with the PD and they drive away. It is a fast process, taking 10-15 minutes at most. We are less than an hour from this hospital: http://cbs3.com/topstories/Officer.Shot.Bucks.2.295141.html where 2 LEO's and an ED tech were shot by a DUI suspect, killing one of the LEO's. This was over 2 years ago, but most of us remember this, and most of the local hospitals like to have these "guests" in and out ASAP... the less time they are in the ED, then the fewer problems we have.



As for the dilution thing.. I'm not sure about that... but as with using an alcohol prep pad - couldn't a decent lawyer confuse a jury about it, even if it didn't really matter?

 

[Grady_emt]

Around here, Grady Memorial Hospital has the areas detention ward and is contracted by nearly 100 citys/countys to provide healthcare to prisoners. The State of Georgia requires a certain procedure for blood draws and supplies its own kit with all needed supplies which is then mailed off to G.B.I for testing. The kit has three tubes I think, and is stocked by the Atlanta Detention staff located in the ER at Grady where any LEO can go and pick one up. There are no field draws approved that I know of anywhere around here.