BLS transport of the ETOH patient
- Thread starter chri1017
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Assuming there are no other abnormal findings that would indicate the need for ALS, and alcohol is the only KNOWN problem (NO patient is ever "just drunk"), I make the determination based on how responsive/A&O the person is. If they are able to answer questions well (maybe not perfectly, but pretty decently), are non-combative, and are able to follow commands, I'm pretty comfortable letting BLS take it.
That being said, I will ALWAYS have an officer follow us to the hospital when I'm transporting anybody who is under the influence of just about anything.
That being said, I will ALWAYS have an officer follow us to the hospital when I'm transporting anybody who is under the influence of just about anything.
JPINFV
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Always be careful with "intoxicated" patients. We had a patient who appeared to be intoxicated with meth (scratching, pulling at lines, talking to himself, etc) and while, yes, his urine drug screen was positive for meth, his free T4 was 11 (almost 3 times the normal open limit).
Ewok Jerky
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if you are drunk enough for an ambulance ride, aren't you probable "altered mental status"? in my old system, basics could not check a blood sugar so any drunk required an ALS assessment.
but if they are A&O, no neuro deficits, BS alright, and vitals stable I will take them...but then why are they in my ambulance in the first place?
but if they are A&O, no neuro deficits, BS alright, and vitals stable I will take them...but then why are they in my ambulance in the first place?
JPINFV
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...because you can't say no, and that officer over there gave the "patient" the option of going to jail or going to the hospital.
In my area it's because several years ago law enforcement initiated a traffic stop on a possible DUI, just assumed the guy was drunk (slurring words, having a hard time staying awake, etc). Turned out he was diabetic and was rather hypoglycemic. Patient put in the drunk tank and wasn't given any attention until he "wouldn't wake up" 10 hours later.
Obviously this scared the PD brass...and now virtually any drunk that is being arrested first gets a trip to the hospital.
Edited to add: I should have mentioned in my first post, EMTs in my state/system are able to check blood glucose (and are damn well expected to).
Perhaps I was stupidly gun shy...but I tended to shy away from having my Basic partner transport these patients. To me there's too much potential for airway comprise and I've only run into a couple EMTs that can manage an airway at the BLS level with any level of skill.
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EpiEMS
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To this point, what constitutes an airway that can be managed in the conscious or semi-concious patient at the BLS level? Profound emesis, say, would be better suited to ALS, no?
teedubbyaw
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You don't trust your partner to log roll and suction? You're not going to be intubating an EtOH pt. with no associated illnesses.
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False. This could, and sometimes does, happen.
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There are times that you will need to tube these pts.
teedubbyaw
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We're talking simple "intoxicated pt" per OP.
unleashedfury
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Intoxicated pt. with no other clinical findings, its a BLS call
Being intoxicated impairs your judgment so allowing the pt. to refuse is unacceptable as they cannot express consent
the simple just a little drunk should be transported or evaluated and cleared by an ED. Pts can appear drunk and could be hypoglycemic, having a bleed. or another medical emergency that's being masked by the "hes just drunk"
Its a judgment call based on your findings location to the closest facility and if you can get a good assessment along with medical history on the pt.
Being intoxicated impairs your judgment so allowing the pt. to refuse is unacceptable as they cannot express consent
the simple just a little drunk should be transported or evaluated and cleared by an ED. Pts can appear drunk and could be hypoglycemic, having a bleed. or another medical emergency that's being masked by the "hes just drunk"
Its a judgment call based on your findings location to the closest facility and if you can get a good assessment along with medical history on the pt.
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Oh, nonsense. Firstly, patients can absolutely refuse even if they have had something to drink. A beer passing your lips doesn't automatically take away your competence. Also, what is our purpose if we can't even tell the difference between simple hypoglycemia and intoxication? Seriously, we carry a really simple test for hypoglycemia, and it's definitive. There are some gray areas that need further investigation, but we've gone WAY too far down the EMT textbook pipeline of "No one is just drunk." In reality, no one should be looked past as "just drunk," but full evaluations can reveal that many people are. Trauma adds a different element, as does severe intoxication leading to unconsciousness or airway issues. Run of the mill drunk who has sober friends, no trauma, may or may not have puked, and has no complaints besides "alcohol?" If they wish to refuse, it isn't my place to tell them they have to go sober up in an ED bed. That's an absolute waste of everyone's time.
unleashedfury
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Whilst I agree that if you wanna go home and sleep it off after an assessment reveals your just drunk.. and your right a beer or two with dinner dosent make you incompetent. However my medical director insists otherwise.. I think its so his ED gets its census goals.
teedubbyaw
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Taking a competent person against their will is illegal, regardless of medical direction.
Errr, your medical director or your training officer's fourth hand interpretation of what the OMD said?
You think everyone who has a beer or two gets a full body CT? Do you have any idea how potentially harmful that is? What about anyone who takes opiates on a daily basis?
I think it would be wise to investigate this matter a bit further for your sake.
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Frankly, no. I've run into far too many PARAMEDICS who are afraid to aggressively suction, much less EMTs.
DrParasite
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I've transported more than my share of drunks in a BLS ambulance.
Are they arousable with external stimuli? can you wake them with minimal effort? sure, take them BLS, esp if they are maintaining their own airway.
Now when they cross the line from drunk to alcohol posioning is when you have to think about having ALS M+T them.
The majority of our drunks will be perfectly fine once they sleep it off. in the ER, they usually aren't tubed, they are put in a bed with an IV running (banana bag) and they are allowed to sleep it off.
There is a rare few that will need additional interventions, but they are the vast minority of all the drunks you will ever pick up.
Are they arousable with external stimuli? can you wake them with minimal effort? sure, take them BLS, esp if they are maintaining their own airway.
Now when they cross the line from drunk to alcohol posioning is when you have to think about having ALS M+T them.
The majority of our drunks will be perfectly fine once they sleep it off. in the ER, they usually aren't tubed, they are put in a bed with an IV running (banana bag) and they are allowed to sleep it off.
There is a rare few that will need additional interventions, but they are the vast minority of all the drunks you will ever pick up.
Jambi
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These sorts of patients and calls can run a fuzzy gray line and require good assessment and strong clinical judgement. The problem is that protocols provide a warm fuzzy blanket of removed accountability (hyperbole I know, but it makes the point). Many providers don't have the knowledge and experience to make consistent and reliable clinical judgements, so these get referred to ALS and to ED for evals. All it takes is one bad outcome, preventable or not, to result in cookie-cutter one-size-fits-all policies for these situations.
I personally never approach a patient assuming he or she is drunk. I start from the point of ALOC and start investigating reasons with AEIOTIPS, and in the presence of overwhelming evidence of ETOH consumption, make a judgement that ETOH is the most likely culprit. A former partner of mine instilled this approach in my some time ago, and he's caught a few patients that were having strokes, low BGL, etc because of it.
I don't think the problem is ever deciding a patient is drunk, but rather having it be predetermined.
I'm not sure I actually added to the thread's OP questions, and I hope I don't sound like a blathering idiot, but there you have my approach to "drunks."
I personally never approach a patient assuming he or she is drunk. I start from the point of ALOC and start investigating reasons with AEIOTIPS, and in the presence of overwhelming evidence of ETOH consumption, make a judgement that ETOH is the most likely culprit. A former partner of mine instilled this approach in my some time ago, and he's caught a few patients that were having strokes, low BGL, etc because of it.
I don't think the problem is ever deciding a patient is drunk, but rather having it be predetermined.
I'm not sure I actually added to the thread's OP questions, and I hope I don't sound like a blathering idiot, but there you have my approach to "drunks."