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Alcohol-related calls: 7 reminders for EMS providers

Keep the following tips in mind when you encounter a patient who went out of his/her way to overindulge this holiday

An alcohol intoxicated patient unable to control their own airway requires EMS care and monitoring.

Holidays are a challenge for EMS providers who are serving their community. No doubt more than a few of us EMS providers will also partake in the traditional celebration, perhaps with a glass or two of champagne or other alcoholic beverage. But for those of us who will be working, celebrations fuel a potentially greater-than-usual number of alcohol-related illnesses and injuries in our call volume.

When it gets especially busy, it becomes tempting to triage intoxicated patients and leave them in the care of well-meaning, but unprepared family and friends. Keep these seven following tips in mind when you encounter a patient who went out of his or her way to overindulge during a holiday celebration, event or party:

1. Intoxication behavior begins before legal limit

While intoxication when driving legally occurs at 0.08 g of ethanol per 100 mL of blood, that’s merely the definition. An individual may feel euphoric and engage in risky behavior much sooner than that.

2. Gender and alcohol difference

Women do tend to become intoxicated sooner than men. For example, a 140-pound male can reach the 0.08 limit within three bottles of beer, glasses of wine or shots of hard liquor, while a 140-pound female can hit the same limit in just two drinks.

3. Alcohol effects lag consumption

Alcohol takes about 45 minutes to hit its peak limit. In other words, the intoxicated individual weaving in front of you may become even more altered over time, even in the absence of more alcohol consumption.

4. Ethanol has emetic properties

Alcohol can trigger the vomiting effect without warning. Laterally positioning the patient will go a long way in keeping the patient’s airway patent. It makes sense to rest the patient facing away from your lap in the ambulance, but you must be able to continuously monitor the patient’s breathing during transport.

5. Adolescent males are at greater risk

Alcohol ingestion begins in the middle school population, sometimes by parents who condone drinking within their homes. The adolescent body is not as well prepared to handle alcohol poisoning and can alcohol intoxication can cause respiratory failure on its own.

6. Drugs and alcohol are a lethal mix

Alcohol and drugs often go together. Remain vigilant for the use of stimulants that may mask the effect of alcohol or depressants that can amplify intoxication.

7. Drunk or diabetic, know the difference

Finally, there are several conditions that can mimic alcohol intoxication, such as diabetic ketoacidosis or an evolving brain injury. Do not be lulled into a snap judgment about alcohol being the culprit; perform a consistent, reasonable assessment for each patient to differentiate drunk from diabetic. No matter how drunk the patient may appear to be.

The most important responsibility of an EMT or paramedic is to identify an alcohol intoxicated patient unable to control their own airway. Those patients are at risk of aspiration and require constant EMS monitoring and care during transport to the hospital.

This article, originally published December 27, 2011, has been updated .

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor 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 writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board.