# Guide on dealing with drunk patients.



## ThirtyAndTwo (Feb 10, 2013)

Hi, I am a new EMT-B and will be working on a college campus where most of our calls are for people who drank too much. Since we aren't taught to deal with this in class, what are your experiences dealing with drunk people and what is the best way to handle these calls (i.e. stay and play or load and go).

I'm sure I'll learn a lot on the job, but since we aren't formally trained for this I would like to hear some different perspectives.


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## rwik123 (Feb 10, 2013)

If they are actively vomiting we take them to the hospital. If not they get detoxed. It's important to differentiate the substance involved (drugs or alcohol) or whether the cause it an actual medical condition. PFA is important too. The load and go or stay and play doesn't really apply here. What are you gunna play with? They're drunk.


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## abckidsmom (Feb 10, 2013)

rwik123 said:


> if they are actively vomiting we take them to the hospital. If not they get detoxed. It's important to differentiate the substance involved (drugs or alcohol) or whether the cause it an actual medical condition. Pfa is important too. The load and go or stay and play doesn't really apply here. What are you gunna play with? They're drunk.



pfa?


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## rwik123 (Feb 10, 2013)

abckidsmom said:


> pfa?



psychological first aid. talking to them. 

Alot of college age kids will freak out especially if its their first ambulance ride. And they generally 100% of the time will think they don't need to go.


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## DeepFreeze (Feb 10, 2013)

rwik123 said:


> psychological first aid. talking to them.
> 
> Alot of college age kids will freak out especially if its their first ambulance ride. And they generally 100% of the time will think they don't need to go.



I'll parrot this advice. Most of the time they'll be dramatic or argumentative (thinking they can argue out of it). I worked in a state (on a college campus) where they could be arrested for "internal possession". This made it pretty easy to tell them they either get in the ambulance or go with the cops. But be prepared to do some negotiating. 

Of course I was also a student where I was an emt (yay college ems) so I tried to  be fair (aka not a ****) because chances are I'd see them again.


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## Bullets (Feb 10, 2013)

Kid gloves.  

Drunk people are irrational and in college, scared. Best thing is to be a friend to them when they are hurting. Hands off until they go hands on.

A lot depends on your state and local laws and the relationship the college has with the local smokeys, campus security or campus PD. Some states or towns allow the LEOs to cite them for Minor in Possession, arguing that your body is a container and therefore in possession.  I had only a campus security, the local PD didnt get involved in drunks unless they were violent. In those cases i have RMA'd patients to other parties who assumed responsibility for the patient.


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## the_negro_puppy (Feb 10, 2013)

Drunks are some of the easiest calls to go to.

For us it is a quick assessment, finding out how much (roughly) they have had, any drugs, medical conditions or injuries.

The typical drunk shouldn't really be taking up ambulance space or an ED bed; society has become worse in that friends no longer look after each other and just call an ambulance to take their friend away so they can continue to party.

I use my judgement to determine whether the patient is SO intoxicated that they are at rsik or injuring themselves, aspirating etc. If not I try to get a responsible friend or family member to collect them and 'look after them' if this cannot be achieved or the patient is to intoxicated its a hospital trip.

Easy though; put them in the lateral position on your stretcher, facing your seat. Catch their vomit. Thats about it.

If a drunk can actively resist and walk way (in the absence of something like a head injury or other drugs) then they probably don't need to go to hospital anyway. The drunks that are passed out and vomiting won't be able to resist. I see far more females in this state than males; they are easy to lift.


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## mycrofft (Feb 10, 2013)

Check your campus's policy. If there is any question what is on board (and it can be multiple), then they need to go to a medical facility and pay the bill. You cannot determine in the field what all someone has taken, just take a history . If you find evidence of recent use of something bad (fresh tracks,  non-tobacco pipes, scorched foil, etc) call LE and treat the medical aspect until they drive and let them call the shots. 

If you can meet your protocols and release a case of simple mild beer intox to the residential assistant or whatever, get them to sign that they will check the pt or stay with them for a few hours. I'd be very wary.

Also, is there a medical necessity or is the person just being a jerk and someone wants you to take them away?

Don't try to jolly them along, don't start barking orders, be civil and speak softly unless they are having trouble taking your seriously, then firm and  clear.


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## mrg86 (Feb 10, 2013)

Is there a sober person that can look after them? That is one of my litmus tests when I decide whether or not to transport. Of course this is after I am sure that there are no other drugs, trauma or anything else that would cause me to take them in. If they are protecting their airway and have a sober and responsible person there with them I let them stay on scene. As a general rule, we call medical control any time we leave someone at scene.


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## Handsome Robb (Feb 11, 2013)

There's already pretty good advice in this thread. Until recently I worked nights in one of, if not the drunkest, cities in the U.S (Didn't get fired haha swapped to days). I'd be willing to say that more than two thirds of our patients at night if not more than that were under the influence of something, may grossly intoxicated to the point where I've seen a few get intubated just to protect their airway. 

The best thing you can do is be friendly. You have to be authoritative but let the cops, if they're involved be the mean ones. With that said, sometimes you have to put your foot down. My partner and I had it pretty dialed both started out friendly but if necessary I'd become the "bad cop" while my partner would remain the "good cop" unless things got way out of hand. 

Their destination is going to depend on local laws and protocols. Whether that be jail/the drunk tank or the hospital. Intoxication is generally a LE problem, not healthcare but there are requirements for who can go to detox and who has to go to the ER. Those requirements included vitals, medical complaint outside of being too drunk, active vomiting, and ambulatory/non-ambulatory. There's also no reason you can't release the patient to a responsible party and save the jail and hospital space except in really severe cases. Sure they'd *probably* be ok sleeping it off in a bed, on a couch or on the bathroom floor but I'm not willing to take that risk with my livelihood and own mental health just to save the ER bed in questionable cases that LE wont take custody of. 

The ones that are out and vomiting need to be in left lateral or sitting up, I prefer sitting. Bio bags make great bibs, tear a hole near the rim on one side and pop it over their head so you can just hold the other side of the rim up and way from their face if they start vomiting rather than holding a tiny emesis bag to their face. Plus most unconscious, vomiting drunks will fill up a liter emesis bag pretty quickly.

Rarely is a drunk going to be a load and go unless there's some sort of underlying medical problem, severe traumatic injury, or you're unable to protect their airway but proper positioning and suction in real bad cases goes a long way. One thing I will say is NPAs in drunk people can be a real bad idea unless they're tongue is occluding their airway (ie profound snoring respirations). In my experience if they aren't already vomiting NPAs do a great job of starting the process. As much as they say they don't stimulate the gag reflex it's not true since often they are sized incorrectly and everyone's anatomy is different. Take it from someone who's had an NG and an NPA for :censored::censored::censored::censored:s and giggles, the NPA made me gag more than the NG did. 

If you have more questions feel free to PM me, like I said, I've dealt with a TON of intoxicated patients in my short career.


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## the_negro_puppy (Feb 11, 2013)

Interesting. I know some cities have alternative solutions to lockup or the hospital for drunks.

We have once place where we can take Aboriginal / Indigenous intoxicated people where they can safely sober up.

I did read an article where London Ambulance Service has a 'booze bus' operating thu-sun nights. Its a multi seat, multi stetcher vehicle designed to take EtOH pt's to a special LAS 'sober up' unit / area


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## MSDeltaFlt (Feb 11, 2013)

Let's not forget the ethicolegal aspects either.  If your patient is showing signs of not acting normally then "he" is crazy.  And when you're faced with a crazy person you have to ask yourself these two questions.  1. Is he crazy because he's sick?  2.  Or is he crazy because he's crazy?  Crazy because you're crazy requires choice.  Crazy because you're sick is a chemical or mechanical problem: concussion, stroke, hypoxia, hypoglycemia, hyperglycemia (fruity breath can smell like alcoholic drinks), infection, schizophrenia, bipolar disorder, dementia, drugs, alcohol.

And if you are so drunk that you are not alert, oriented to person, place, time, and events; and even verbally appropriate, then legally you must be evaluated and treated by a licensed medical professional.

Yes it's frustrating seeing these same kinds of patients over and over, but it does require a thorough assessment and proper documentation.


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## Veneficus (Feb 11, 2013)

the_negro_puppy said:


> Easy though; put them in the lateral position on your stretcher, facing your seat. Catch their vomit. Thats about it.



Cut a hole in one side of a biohazard bag, put it around their neck like a bib, and let them catch their own vomit. (pictured above)

Otherwise use that kidney shaped basin as an "emisis deflector" (you know it always goes back and out the sides when people vomit into it) and have it point back at them.


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## DrankTheKoolaid (Feb 11, 2013)

Just a quick tip on making this bag trick work better. Put a long strip of 2in tape on the inside and outside of the bag. When you cut your hole do it in the middle of the tape. This way when the patient starts messing around grabbing stuff while puking he won't rip tuw bag off and dump its contents all over. 

I use these all the time and they work great!


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## bahnrokt (Feb 11, 2013)

When dealing with drunks and druggies on scene I always find it useful to clear the room out.  Get their friends out, get all the other responders away. Keep your partner just outside the door or LEO near by if they show signs of violence. But the more 1 one 1 you can make it, the calmer the situation gets.  Act motherly, which I know is hard for the majority of EMTs who are young men.


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## MSDeltaFlt (Feb 11, 2013)

bahnrokt said:


> When dealing with drunks and druggies on scene I always find it useful to clear the room out.  Get their friends out, get all the other responders away. Keep your partner just outside the door or LEO near by if they show signs of violence. But the more 1 one 1 you can make it, the calmer the situation gets.  Act motherly, which I know is hard for the majority of EMTs who are young men.



Enhancing everyone's calm is definitely important.  However, I generally don't clear out the room unless bystanders are confrontational.  I have been known to sit down not saying a word and turn off each and every artificial noise maker: TV, radio, etc.

Guess my age, glasses, voice, tone, posture, and demeanor tend to encourage them to pay attention.


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## Michael M (Feb 20, 2013)

First of all I try to figure out if there is any real danger for the patients health and if not, if there is anyone else who can look for the person to make sure he or she is nor going to sleep in the middle of an higway. If there is no vital danger and no one to take care, then in germany the police does for one night. 

My advice is to treat (most) of the drunk people like any other patient. It is important to be serious and not choking them. If you can talk them down a little bit, the tramsport is not very stressful (except they vomit in your ambulance, that makes a little stress :glare


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