What ‘Palcohol’ legalization means for EMS providers

4 intoxicated patient assessment reminders for EMS providers

Palcohol – powdered alcohol – was recently approved for sale in the U.S.

Since liquid alcohol remains relatively cheap and easy to consume it remains unclear why someone looking for a buzz or to satiate their addiction would select Palcohol, but rest assured there will be those who come up with creative ways to ingest, inhale, inject, or absorb it (such as an initial suggestion from the company that it be “sprinkled atop guacamole”). The biggest concern from lawmakers seems to be Palcohol’s potential impact on underage drinking, specifically the fact it would be easier to consume and conceal.

It remains to be seen whether Palcohol will have a noticeable impact on the volume or severity of intoxication calls, but it merits a reminder about some key things EMS providers should keep in mind when assessing an intoxicated patient.

(Image Palcohol.com)
(Image Palcohol.com)

1. Being drunk can be an emergency

EMS is frequently called to assess patients who are under the influence of drugs and alcohol. How the patient got drunk should be of less importance than the impact of the intoxication. A patient that has a reduced level of consciousness, due to alcohol intoxication, is unable to manage their own airway and at risk of respiratory depression. This is a medical emergency that at the least requires monitoring and may require ventilation with basic and advanced airway management techniques.

2. Look for injury secondary to intoxication

Many calls for EMS assessment of an intoxicated patient are the result of a traumatic incident like a fall or vehicle collision. Conduct a thorough physical exam to identify other injuries. Perhaps the patient's altered mental status is the result of a head wound and not alcohol intoxication.

3. Expect anything from experimental mixologists

Powdered alcohol is mixed with water for consumption, but EMS providers know that the experimental mixologists in our communities are willing to mix anything with just about anything else. A patient that is "high" could mean a patient that has ingested a liter of vodka, snorted a handful of Palcohol, slapped on a couple of fentanyl patches, and chased it all with an injection of heroin. Don't tunnel vision on one potential cause and risk missing evidence of other types of intoxicants.  

4. Expect violence from any intoxicated patient

Since we assess and transport intoxicated patients regularly we may become complacent about the very real risk of violence. Nearly every news report of a paramedic assaulted by a patient includes a mention that the patient was high or intoxicated. Expect the patient to be unpredictable, follow local protocols for restraining or sedating patients, and plan with local law enforcement the joint response to a violent patient before the encounter happens.

What do you think about Palcohol? Will it impact EMS differently than other drugs and alcohol?

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