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Inebriated patients will not go away

EMS1.com News

August 24, 2010


EMS News in Focus
by Arthur Hsieh

Inebriated patients will not go away

Editor's note: This story is in response to the recent news piece, "UK drunks spark emergency call crisis." In the UK, crews are being forced to respond to an alcohol-related problem every eight and a half minutes — the highest level since licensing laws were relaxed in 2005. Tell us what you think in the member comments.

In some ways, it's comforting to know that in other parts of the world, EMS folks experience the same issues that we do in the states — managing events that we have little real ways to resolve.

Up until the late 80s, so — called "drunk tanks," usually in jails, were used to keep public inebriates in some type of custody, until they were sober enough to be considered "safe."

I'm not sure how it happened — poor outcomes? Inhumane treatment? But over time intoxicated people became patients, and more are being transported to hospital emergency beds, where it becomes far more expensive to manage. Even then, there can be poor outcomes; patients can be shuttled off to a corner of the department where it is difficult to monitor them.

Inebriated patients will not go away, since alcohol is widely accepted drug in our society.

In larger systems, "sobering centers" have been developed as a way to monitor patients in a more clinical setting than a jail cell, while not expending expensive emergency department resources.

In at least one of those systems, EMS units can transport directly to the sobering center if the patient meets a stringent set of criteria that minimizes the risk of sending a clinically unstable patient to the center.

What if you are working in a system without a sobering center resource? If it is an option not to transport the patient to the emergency department, be very cautious in doing so.

Remember that a multitude of serious medical conditions can mimic an inebriated individual, such as brain injury, metabolic disorders, diabetes, stroke, and even seizure disorders.

Carefully and thoroughly evaluate the patient, just as you would with another patient with another medical condition. If in doubt, transport for further evaluation.

About the author

EMS1 Editor in Chief Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
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