ETOH but A&O3

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OK what would you guys do if you had a pt with moderate ETOH on board but still A&O3, GCS 15 and refusing transport? There is nothing wrong with this pt at all, vitals stable. He is a little unsteady on his feet but he is sitting at a booth at a local Coney Island drinking a coffee. PD wants the pt transported because they are no longer allowed to arrest for drunken in public for whatever reason.
I signed him off and convinced him to walk back across the street to his apartment. I stayed a watched to make sure he got home safe then left the scene.
 
I think you did the right thing and I think the LOE was shoving the drunk guy off on you as he didn't know what else to do. Why couldn't the LOE take the guy across the street? Did they have another call come in? If the guy didn't want to go then you can't forcibly take them in...
 
MedicAngel said:
I think you did the right thing and I think the LOE was shoving the drunk guy off on you as he didn't know what else to do. Why couldn't the LOE take the guy across the street? Did they have another call come in? If the guy didn't want to go then you can't forcibly take them in...
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In some states ETOH trumps A&Ox4 (3) or decision making. I am not aware of any state that recognizes "clinically intoxicated" though some places in Canada and all of the place I have been in Europe do. So even if I didn't want to take him in, and I am sure the hospital probably didn't want to see him, there might be very little choice in the matter.

In that case the cops usually offer the choice "ER or Grey Bar" and off to the ER you will go.

But no matter what, always carry a high index of suspicion that very bad things happen to intoxicated people. Things you could be held responsible for overlooking.

Not a particularly happy thought, but might be better to "encourage" him to go get checked out. Especially if he is going home alone.
 
Veneficus said:
In that case the cops usually offer the choice "ER or Grey Bar" and off to the ER you will go.
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And the solution to that is to require the officer to ride with you to the ER. ;)
 
Our protocols say that until they are no longer A&O3(4) or make an "irrational decision" they can refuse treatment.

Now what about someone under the influence of a drug like Heroin or Cocaine but still A&O3 and refusing treatment? Would you sign him off or call the cops to arrest him/her? This hasn’t happened to me yet but is only a matter of time.
 
Street Doc said:
OK what would you guys do if you had a pt with moderate ETOH on board but still A&O3, GCS 15 and refusing transport? There is nothing wrong with this pt at all, vitals stable. He is a little unsteady on his feet but he is sitting at a booth at a local Coney Island drinking a coffee.
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There is nothing medically wrong with him, just because LEO wants you to transport a drunk because he can't remove him doesn't mean you should.. that's using up valuable resources that could otherwise been sent to a real emergency. He got home, wasn't in need of tx, transport or doctors... again using up valuable resources (bed, nurses, etc).
 
Street Doc said:
Now what about someone under the influence of a drug like Heroin or Cocaine but still A&O3 and refusing treatment? Would you sign him off or call the cops to arrest him/her? This hasn’t happened to me yet but is only a matter of time.
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Are his/her vitals stable. Is he/she allowing you to check him/her out? Is he/she acting irrational, aggressive etc.. is there any possibility of self harm or harm to others? (Friends, family, public) If this is just a person who has shot up or w/e.. doesn't necessarily mean we have to immediately transport or have arrested. Each situation is different and will present in different ways.. you just gotta use your training to make the best decision you can at the time. If you have them transported or arrested because it didn't feel right to you.. you won't get in trouble. Maybe some looks from the docs and nurses.. but there's nothing wrong with being safe than sorry.

Hope this helped some.. :)
 
Street Doc said:
PD wants the pt transported because they are no longer allowed to arrest for drunken in public for whatever reason.
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No longer can arrest drunks? That sounds like a load of croc from the cop, who was following a perversion of our mantra "ABC" (ambulance before cruiser).
For a second lets assume the cop was right, and in Michigan, Police can't PC anybody? Christ I know where I'm gonna advocate some of the homeless population over here migrate to...

Seriously though, maybe the cop was afraid the pt was a diabetic? Did he provide any rationale beyond "we don't enforce public intoxication laws anymore"? Just trying to see from the LEO's point of view.
 
I had this earlier this month... College kid passed out in his car, Dorm Security found him outside the front door at 4am and couldn't wake him up. We got called for the unresponsive subject.

The university first response EMS was onscene and hemming and hawing... I recalled the ALS, as Pt. was CAOx4 with no medical history, and only had "a few" drinks. He said he was a sound sleeper, and that's why he didn't wake up when the security officer knocked on the window. He was woken up by University EMS and PD, and was CAOx4 on my arrival. I tried to talk him into transport multiple times, in multiple ways... without success.

University PD wanted me to take him because he was drunk, and they don't/can't/won't do medical monitoring of drunks, and can't release them until they are sober enough to not be a harm to themselves or others. So they are stuck in the middle... once he passes out, and/or throws up, they've got to send him to the ED... and that means waking me up in an hour to come get him.

PD also said that he wasn't going to be transported in custody.

I called OLMC - The Doc at the ED. She said that if Pt. was CAOx4 and refused transport, I couldn't take him. I know this... but documenting the call on a recorded line with the doc covers everyone. Doc said if the PD wanted him at the hospital, they could bring him up themselves.


Ended up that he got pulled out of the car and arrested for underage and drunk in public... he tried to play street lawyer, and it was pointed out that they WERN'T busting him for DUI... so he should just ACCEPT the right to remain silent, and not fight right now. I think he went up to the ED by LEO... and I went to bed.


So... long story short - What are your refusal protocols? Mine say if ETOH is onboard, I need to call command before I can get a refusal. So long as Pt. is CAOx4, understands the situation, and understands the risks of refusal, I can't force him to go to the hosptial.

There can be complicating factors, like potential head injuries, and/or danger to himself/others... but as you present it, my protocols call for me to call the doc. End result would be same as you - Try to ensure that they are going someplace safe, and hopefully where they will be with someone who can monitor them.
 
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In Texas, under my protocols, if AOx is <4, or ETOH present, I don't care what the pt wants, they are going if I decide so. ETOH throws any and all legal consent out of the window as far as the pt is concerned.
 
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Our refusal forms have a check box for ETOH onboard. If yes, we have to contact medical control for concurrence with the refusal. From the description given, they most likely would have said accept the refusal.
 
During my clinicals at a large university, it was common for the campus police to bring suspected ETOH to the ER. They would be assesed, rehydrated with a large bore IV, and monitored while they sleep it off. One question they usually asked before leaving "Are you going to tell my parents?" Our answer was always "No, we don't do that." We just didn't tell them that they would have some explaining to do about the ER bill.:P
 
If you want to get into the legality of it, i know that on the back of our PPCR's where the pt. would sign a refusal it explicitly states that the pt. is not under the influence of ANY drug or narcotic, and explicitly states alcohol as one of them. Now granted, we don't transport every ETOH pt. that we come across to the hospital. That would just be ridiculous. I think it all comes down to how the pt. presents, and your judgement as to how severly intoxicated they are, and if they have the ability to take care of themselves.
Just always make sure you document thoroughly, and perform a very detailed exam to make sure there was no trauma in combination with the ETOH, as the alcohol could cover up the effects of the trauma.

-z
 
I checked into it more, the reason the police can’t arrest for Drunken in Public is because sometime last summer they arrested one and let him sit in the cage. In the morning he was dead. Oops:unsure: Just a department policy. I don’t want to give out names but I’m sure it wasn’t the first and wouldn’t have been the last time that would happen without this rule.
Good idea about calling the Doc, Ill be sure to do that from now on.

Thanks
 
In Minnesota we cannot legally take an A/Ox4 (3) pt regardless of how intoxicated they are. If we want to transport them against their will a hold must be signed. The simple fact that they have ETOH on board does not give us the right to decide for them as someone in Texas implied it does for them.

If the pt is in public it's much easier to get a hold signed by a doctor or PD. We have to take the safety factor of them getting home into consideration in this situation. However, if the pt is at home, even a pt who isn't A/Ox4, it can be exceedingly difficult to get a hold signed without a more specific problem.

For example, I had a pt who 'tripped' and had rug burn on his face. Wife calls 911 because she is concerned. On our arrival pt is obviously intoxicated, admitting to drinking "at least a 12 pack and some vodka". He is unable to stand without bracing himself against the wall.

He's not normally a heavy drinker, but went out with some old college buddies tonight. He denies any complaints. He is A/O x2 (Person/Place). Refuses to go to hospital. Called a Doc to see if they'd place a hold, doctor asked us to check a sugar and then declined to sign a hold.

This is common place here. I technically wouldn't even have had to call the doctor to sign that patient, but I like to have a CYA in place with that kind of call.
 
Juxel said:
The simple fact that they have ETOH on board does not give us the right to decide for them as someone in Texas implied it does for them.
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I hope you mean for your state, and not as a whole.


ETOH is automatic implied consent here in Texas.
 
Linuss said:
ETOH is automatic implied consent here in Texas.
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Got that in writing?
I am curious to review.

Only time drunks get picked up around here is when they are too intoxicated to function on their own. Otherwise, they get a boot in the ***, and sent on their way.
 
Linuss said:
For some reason my protocols are not on my CD so I'll have to find my paper copies for further clarification.


But here's a JEMS article on the matter.

http://www.jems.com/news_and_articles/articles/Patient_Refusal_What_to_do_medical_treatment.html
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You know what I saw?
A lot of might, can, may.
Not will, shall, directed to.

I can't wait for an ETOH person with half a brain who gets picked up against their will to sue the pants off an overzealous EMT or Medic, their system, medical director, and finally the state for trampling all over their rights.
 
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