BLS transport of the ETOH patient

chri1017 said:
Where do people draw the line when it comes to transporting intoxicated patients BLS or ALS.
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As a medic student I transport them with ALS or BLS Intervention depending on how drunk or their LOC. Always with a medic in back though.

Reasoning is that EMT's cannot check a glucose in my state and im not about to get burned cause I dont feel like taking 10 mintues to write the report.
 
In CA, altered is altered, which is ALS. Lots of ETOH's are shipped out BLS because they "seem to be okay." But, I've definitely seen ETOH's go completely unk/unresponsive and had to upgrade/divert.

Although, at least in CA, if they can answer your A X O questions appropriately and you put them through a Glasgow assessment and they come up as 15, then they would be considered "Alert/non-altered" and can be BLS'ed (as long as there are no other complaints that would fall outside of BLS).

When in doubt, call ALS. I'd rather have a grumpy medic and keep my license than the opposite.
 
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AmeriCare Supervisor said:
In CA, altered is altered, which is ALS. Lots of ETOH's are shipped out BLS because they "seem to be okay." But, I've definitely seen ETOH's go completely unk/unresponsive and had to upgrade/divert.

Although, at least in CA, if they can answer your A X O questions appropriately and you put them through a Glasgow assessment and they come up as 15, then they would be considered "Alert/non-altered" and can be BLS'ed (as long as there are no other complaints that would fall outside of BLS).

When in doubt, call ALS. I'd rather have a grumpy medic and keep my license than the opposite.
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That's an accurate description of what does happen here in California with these sorts of patients...but the question remains: Is that was should happen.

My contention is drunk is drunk and there is no need for ALS interventions. The hard part is making the judgement call between drunk vs something else. The average Paramedic isn't equipped to make that knowledge let alone an EMT thus we get a colossal waste of resources.
 
Jambi said:
My contention is drunk is drunk and there is no need for ALS interventions. The hard part is making the judgement call between drunk vs something else. The average Paramedic isn't equipped to make that knowledge let alone an EMT thus we get a colossal waste of resources.
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I bed to differ. This is a true horse vs zebra call. 25 year old make comes out of a bar, no traumatic events, puking and altered. That's BLS all day long. If he was in a fight in the bar or he can't be roused or his sugar is low or he seizures ... Then he gets a medic. But really, in most cases drunk is drunk. It's BLS.
 
DEmedic said:
I bed to differ. This is a true horse vs zebra call. 25 year old make comes out of a bar, no traumatic events, puking and altered. That's BLS all day long. If he was in a fight in the bar or he can't be roused or his sugar is low or he seizures ... Then he gets a medic. But really, in most cases drunk is drunk. It's BLS.
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I agree with you. I didn't mean to come off so dismissive is my post. My point is that if they're drunk, barring nothing else outstanding, then BLS all the way.

I would like to refer to my previous post

These sorts of patients and calls can run a fuzzy gray line and require good assessment and strong clinical judgement. The problem is that protocols provide a warm fuzzy blanket of removed accountability (hyperbole I know, but it makes the point). Many providers don't have the knowledge and experience to make consistent and reliable clinical judgements, so these get referred to ALS and to ED for evals. All it takes is one bad outcome, preventable or not, to result in cookie-cutter one-size-fits-all policies for these situations.

I personally never approach a patient assuming he or she is drunk. I start from the point of ALOC and start investigating reasons with AEIOTIPS, and in the presence of overwhelming evidence of ETOH consumption, make a judgement that ETOH is the most likely culprit. A former partner of mine instilled this approach in my some time ago, and he's caught a few patients that were having strokes, low BGL, etc because of it.

I don't think the problem is ever deciding a patient is drunk, but rather having it be predetermined.

I'm not sure I actually added to the thread's OP questions, and I hope I don't sound like a blathering idiot, but there you have my approach to "drunks."
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Jambi, I agree wholeheartedly. And we need to teach our initial responders, either BLS or ALS, this mindset and assessment pathway. Do I check a BG on drunks? Yep. Do I ask a lot of questions? You betcha. Do I have to be a paramedic to do that? Nope. Assessing a patient to determine the appropriate response is a skill that seems to be lost and is dumbed down to either "transport on a long spine board with 15 LPM of O2" or "call for ALS". Maybe I was better trained or came from a system that expected more from the basics. Either way, I learned how to reach the conclusion of probable ETOH intoxication rather than "ahh, he's just drunk"
 
I think it depends on mentation, differential diagnosis, airway management, any other complaints. Anything cardiac, possible stroke or if the pt is unable to manage their airway and it's ALS. If they have a low blood sugar it is BLS unless D50 or oral glucose has no effect, they deteriorate, etc... But usually if there are no other complaints, they are just intoxicated we can either just hand them to PD for transport to detox (if they can walk with minimal assistance and have stable vital signs) or take them BLS to the hospital.
 
chri1017 said:
Where do people draw the line when it comes to transporting intoxicated patients BLS or ALS.
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When the medics have been grumpy all day and treating BLS like :censored::censored::censored::censored:

Altered Mental Status is ALS criteria.....MUHAHAHHHAHHAHAHHAHHA
 
chri1017 said:
Where do people draw the line when it comes to transporting intoxicated patients BLS or ALS.
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Not hypoglycemic, intact airway, adequate breathing, and without another potential cause for the change in mental status that could be treated by a paramedic. I'd probably add a GCS component, some like a score ≥12.
 
FIVE is FOUR

chri1017 said:
Where do people draw the line when it comes to transporting intoxicated patients BLS or ALS.
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again and again and again and again…assess, follow protocols.
 
ATFDFF said:
NO patient is ever "just drunk"
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I have proven that statement incorrect a few times in my life.

Then again, no one has ever had to call 911 because of it.
 
In my area, most intoxicated patients don't even get BLS transport unless they're passed out. Left at scene or sent to a sleep off center in a special van or by taxi.

If they're just drunk, they're not a patient.
 
yowzer said:
In my area, most intoxicated patients don't even get BLS transport unless they're passed out. Left at scene or sent to a sleep off center in a special van or by taxi.

If they're just drunk, they're not a patient.
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http://emedicine.medscape.com/article/155050-overview


I think one of my admits last night had this actually... and yes, he came in as a drunk dude fall down, go boom.
 
usalsfyre said:
You MIGHT want to check with David Rosenbaum's family about how well that attitude works in EMS systems.
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So someone badly screwed up an assessment. Does that mean everyone who is drunk needs full ALS and priority 1 designation?

Many cities have drunk tanks where intoxicated folks are taken to sleep off their drunk rather than to ED's. It seems to work quite well and you rarely hear about problems with people being taken to one when they should have been taken to the hospital instead. I don't think that would be the case if there were some inherent problem in under-triage of people who are simply intoxicated.
 
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usalsfyre said:
You MIGHT want to check with David Rosenbaum's family about how well that attitude works in EMS systems.
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That's that reporter who got clobbered on the head and died, right? If so, he wasn't just drunk, he had an actual complaint. That's why you assess people. That doesn't mean every person you see who's drunk needs a trauma center just in case.
 
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JPINFV said:
http://emedicine.medscape.com/article/155050-overview


I think one of my admits last night had this actually... and yes, he came in as a drunk dude fall down, go boom.
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Interesting. Sounds like a pretty benign condition for non-addicts.

I have been seeing a lot of people with tachycardia lately, but the drunk ones don't exactly fit the profile of that article. When your normal daily intake is enough to kill most people...
 
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