Know your system's protocols

Editor’s Note:

Editor's note: This story is in response to the recent news piece, "Canadian medics told head trauma trumps intoxication." Read about the B.C. Coroner's recommendation that where there is both intoxication and possible head injury, the paramedic must default to head injury.

Like the dead patients who are resurrected, patients who die while in police custody after an EMS evaluation are reported regularly.

I'll reiterate: It's likely that there is a clinical protocol that addresses the issue of evaluating someone who is experiencing altered mental status.

The reality of the street, where EMS has to evaluate intoxicated patients routinely, has us taking clinical shortcuts that generate risk — to the patient as well as ourselves. If you find yourself in this situation, remember:

1) Your system protocols will save or hang you. Know them well.

2) There are many etiologies or causes of altered mental status (can you name at least five?) The smell of alcohol should not distract you from the differential process.

3) If in doubt, transport for further medical evaluation. While some folks may not be happy about it, chances of being sued for making the wrong decision goes way down.

About the author

EMS1 Editorial Advisor 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

  1. Tags
  2. Medical / Clinical
  3. Trauma

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