Handling drunk patients: 6 rules for medics

When the patient becomes that intoxicated, there is psychologically nothing to keep that person from staying in control

By Art Hsieh

Is there anything more frustrating than a drunken patient?

Chicago paramedic Brandon M. Santiago filed a lawsuit last week claiming he was punched by a doctor while trying to assist a patient.

The suit alleges that Santiago was called to the house of Dr. Kishor G. Ajmere, who was throwing a party where several people were inebriated. The call was for a choking victim who reportedly might have also been having a heart attack.

While en route to the hospital, the patient became upset and tried to remove his seat belt. Ajmere, who smelled heavily of alcohol and was riding in the passenger seat, allegedly said to Santiago, "You are a horrible EMT and I am a doctor and I am going to make sure they take your license away."

After arriving at the hospital the patient once again tried to remove his seat belt, and after Santiago tried to keep him seated Ajmere ran forward and punched the EMT in the jaw.

Alcohol is such the great equalizer — it makes everyone act goofy. Ethyl Alcohol is classified as a sedative/ hypnotic, with effects similar to barbituates. It is probably one of the world's oldest, most-often used, legalized recreational drug.

I've been assaulted by drunken patients more often than any other type of patient. Sometimes there are warning signs; occasionally there are not. When the patient becomes that intoxicated, there is psychologically nothing to keep that person from staying in control. It really creates an unfair situation for EMS providers who are charged with managing the patient and prevent further harm from occurring.

Of course, that's small consolation when you are on the receiving end of a screaming, punching, biting and spitting drunk patient. It's all too easy to lose momentary control and become angry.

The next time you're in this situation, take a deep breath and remember these key points:

1) The patient is drunk, not you. You're the professional, not him.
2) Don't take it personally. The patient doesn't know you from Adam in his/her drunken state, and doesn't care.
3) Physical restraints are important, for your protection as well as his. If you use them, make sure his airway is protected.
4) Because of (3), suction, emesis bag, and being alert will keep that vomit contained.
5) Because of (1), make sure there are no medical conditions that might be mimicking that drunken state.
6) When in doubt, he's a patient, not a prisoner.

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. In the profession 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 published textbook author, has presented at conferences nationwide, and continues to provide patient care at a rural hospital-based ALS system. Contact Art at Art.Hsieh@ems1.com.

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