regarding EMS and LEO documenting alcohol use

[emt seeking first job]

I brought up this issue in my EMT-b class. My instructor had 20+ experience so I did not question him.

I dropped the issue in class, waste of class time, but this would make a good forum discussion.


With NYS (at least), for DWI Enforcement, LEOs are not to write "odor of alcohol" since alcohol has no odor. LEOs are trained to write "odor of alcoholic beverage" since it is the other stuff put it that gives it the smell.

EMTs apparantly will write odor of alcohol.

LEOs dont because a lawyer would trip them up and have them read a websters entry of alcohol being tasteless and odorless.

Has anyone come across or have thoughts on this issue?

 

[akflightmedic]

All I ever documented when necessary was behavior consistent with ETOH use and then listed what I observed or direct quoted what I was told.

I guess along those same lines you could say odors present consistent with alcoholic beverages but then they will say so does mouthwash and other things...which is why your documentation of unsteady gait, slurred speech are more relevant especially when you have ruled out low BGL or CVA.

 

[WolfmanHarris]

We document variations on
"Pt. reports HBD." (Has been drinking)
"Bystanders reports HBD."
"Evidence of alcoholic beverages."
"ETOH-like odor on breath."

Other than that I just document behaviours and physical findings free of comment.

 

[emt seeking first job]

All I ever documented when necessary was behavior consistent with ETOH use and then listed what I observed or direct quoted what I was told.

I guess along those same lines you could say odors present consistent with alcoholic beverages but then they will say so does mouthwash and other things...which is why your documentation of unsteady gait, slurred speech are more relevant especially when you have ruled out low BGL or CVA.

Yes, LEO , doing DWI enforcement records more than the odor.

I was just asking only about wording:

odor of alcohol versus odor of alcoholic beverage

 

[BLSBoy]

the pt had on (or about him) the odor not unlike that of an alcoholic beverage.

 

[medicRob]

I always document what was said with quotes by bystanders (if anything), facts about the person's behaviour (pt staggering, slurring, etc), and slap on a blood glucose if the patient agrees to it.

 

[46Young]

"ETOH-like odor on breath."

Other than that I just document behaviours and physical findings free of comment.

That's what I use. You're not saying that it's alcohol, only that the odor resembles it. I also like to use "pt advises" rather than "pt states" unless I'm quoting them verbatim.

 

[Tone]

it doesnt smell like alcohol, its the keytones!

 

[Akulahawk]

I've always just documented physical findings, bystander statements, environmental findings... stuff like that. If I note any specific odors, I'll note it with something like "odor consistent with beer, mixed beverage..." or whatever the odor smells like to provide a reference for the odor, not necessarily that there was ETOH on board. Why? There are non-ETOH beers and mixed beverages can be made without the ETOH... and then there's the ketone odor...which can smell similar too. Then I'd try to get blood glucose check too... Normal BGL and an "odor" could easily mean no ketones...

While the documentation wouldn't necessarily be for law enforcement/prosecution purposes, it could become evidence later.

 

[sir.shocksalot]

I'm guilty of stating that the pt had the odor of etoh on his breath. What you have to keep in mind is that your job and the LEO's job are very different, he has to convict criminals with substantial, irrefutable evidence, we are simply reporting assessment findings. I would tend to agree with other posters here and use a different phrase. But honestly if you take someone against their will because they are intoxicated and the only thing you have to work with is the odor of etoh, then you have made a mistake somewhere. Odor of etoh shouldn't come into that decision process at all, they should have clinical presentations of intoxication, nystagmus, slurred speech, ataxic gait, ALOC, etc.

 

[reidnez]

"Smell of alcohol" vs. "smell of alcoholic beverage" seems like a pretty academic distinction to me. OK, you may not be strictly, scientifically correct...but what's the difference? And how many people out there are drinking 100% pure, lab-grade, odorless ethanol?

I'm fairly certain everyone is going to understand what you mean either way...

 

[Akulahawk]

It may make a difference down the road in a court of law. If you transported someone under implied consent because the patient was injured AND seriously drunk... your documentation can help get your backside out of a wringer because you were able to document that the patient was so seriously impaired, that he or she couldn't give or deny consent. It's also possible that your PCR could be subpoenaed in an attempt to corroborate or refute a law enforcement officer's report in a criminal case.

 

[Aidey]

I guess along those same lines you could say odors present consistent with alcoholic beverages but then they will say so does mouthwash and other things...which is why your documentation of unsteady gait, slurred speech are more relevant especially when you have ruled out low BGL or CVA.

The right mouthwash will get you just as drunk as any alcoholic beverage out there, so that argument goes out the window if you properly document the behavior as AK said.

I try to refrain from using "ETOH" in my written reports since that is a very specific chemical, and prefer to just say "alcohol" or the specific name/type of drink. Pt admits to drinking 4 alcohol based mixed drinks or whatever.

 

[reidnez]

It may make a difference down the road in a court of law. If you transported someone under implied consent because the patient was injured AND seriously drunk... your documentation can help get your backside out of a wringer because you were able to document that the patient was so seriously impaired, that he or she couldn't give or deny consent. It's also possible that your PCR could be subpoenaed in an attempt to corroborate or refute a law enforcement officer's report in a criminal case.

I agree with that completely, I'm just not convinced that in an otherwise perfectly-written narrative, the difference would come down to "alcohol" vs. "alcoholic beverage." I know lawyers are capable of some pretty impressive twists in logic, but nonetheless it would be a pretty lame argument.

Regardless, I suppose there's nothing wrong with trying to be totally correct (especially on a legal document.) But as the others have said, I think I would prefer to focus on the Pt's behavior and statements..."smell of ETOH on scene" is subjective and could end up being your word against another's. Behavior and statements can be verified by witnesses, ED doctors, etc who probably don't know what the scene smelled like.

 

[medic farva]

One of my favorite ways to document this issue is "pt had the odor of an alcoholic beverage emanating from his/her breath that continued to linger throughout our entire contact." I realize that's a bit wordy, but gets the point across and you're not just saying 'odor of alcohol'. Alcohol gets metabolized in the body as ethanol, so that's what the blood tests check and also what the breath tests check for in exhaled breath.
If your pt has no odor but still acts as though they may be intoxicated... I would just document AMS and physical findings rather than odors etc.

 

[mcdonl]

You will find that instructors like to puff up their chests and use little known, and little cared about technicalities to show how "smart" they are.

 

[emt seeking first job]

One of my favorite ways to document this issue is "pt had the odor of an alcoholic beverage emanating from his/her breath that continued to linger throughout our entire contact." I realize that's a bit wordy, but gets the point across and you're not just saying 'odor of alcohol'. Alcohol gets metabolized in the body as ethanol, so that's what the blood tests check and also what the breath tests check for in exhaled breath.
If your pt has no odor but still acts as though they may be intoxicated... I would just document AMS and physical findings rather than odors etc.

Thank you for your reply.

May I ask if you were told to do that ?

Does anyone else in your agency do that ?

As I said in my OP, in my basic class, they just said to write odor of alchol, during a break, I did not want to split hairs in front of the class, I was genuinely curious.

They tell LEO to write odor of alcoholic beverage because lawyers were (in DWI cases) having them read report, then read from dictionary, where alcohol is written as a tasteless odorless substance, in order to discredit them.

 

[FLEMTP]

In my EMS reports,( and this is coming from a crosstrained Medic/LEO)

are worded like this:

The patient had an odor of an alcoholic beverage on or about their person. They had slurred speech, horizontal gaze nystagmus was present, and he/she had an unsteady gait. Their eyes were also noted to be red and glassy. Pt also appeared to be lacking fine motor control when asked to perform simple motor tasks. Pt did admit to drinking "at least 4 bud lite beers" over the course of the last 2 hours. Pt denies any previous or current medical conditions that could cause similar impairment. They also deny the use of illegal drugs, or other precription medications that would also cause such impairment.


The State Attorney's here LOVE me for this, because even though I cannot always go over to the LEO and tell them exactly what Ive written in my report, the SAO will subpoena my PCR, and when they read that statement, its a slam dunk as far as establishing that they did, in fact, appear to be under the influence of alcohol ( or whatever they took)

I DO NOT state they are drunk, or appear to be drunk or intoxicated.

YOU DO NOT WANT TO SAY "smell of alcohol" or ETOH. (Abbreviations are NOT A GOOD THING IN COURT, and bad practice in the current day and age of ePCR's when space is not an issue for the narrative, and you dont have to worry about poor penmanship.)
Alcohol does not have an odor, but beer does, mixed alcoholic drinks do. You DO NOT want to state they are drunk, as I said above, but you do want to clearly and carefully document ALL of your observations about the exam, the patient's behavior, and anything they say and do during your time with them, because the totality of the circumstances will point out loud and clear to a jury or a judge, or an attorney, that the suspect/patient did exhibit several signs consistent with alcohol or drug intoxication, and coupled with an admission of consumption of an intoxicating agent, its very easy to see the conclusion one would draw in the situation.

Id also like to point out that even in a situation where EMS will not be transporting the patient, a very very thorough examination and point of care diagnostic testing (blood glucose levels, 12 lead ekgs, Stroke assessment, cranial nerve exam, etc) is VERY IMPORTANT. Not only does it assure you that your patient is exhibiting the signs and symptoms of alcohol intoxication (or drug intoxication) but it also establishes redundancy and corroborates the LEO's DUI examination. On the other hand, if they are not drunk or under the influence of drugs, your thorough examination may be what helps the defense attorney prove that their client's innocence.

You also need to be impartial... and sometimes this can be very very hard, especially if you're doing your exam on a suspected DUI that just killed an entire family... but it is essential that you remain impartial, and do your job. Interjecting personal assumptions and opinions can cloud the PCR, and even allow the defense attorney to establish a pattern showing that you're biased toward or against a suspected DUI... and they can use that in future DUI's to help their client beat the charge. Just some food for thought.

This is the same advice given to the EMS crews by the State Attorney's Office, and the same advice given to LEO's during DUI training
and if you follow it correctly, and carefully, and choose your statements and words carefully, they are pretty darn near airtight.

Hope this helps.