transporting drunk people

[DrParasite]

I know this has probably been debated before, but I'm curious how many people who transport a drunk person ALS, and how many would transport them BLS? my reason for asking is because I've seen paramedics release very drunk people to a BLS crew, and also have seen BLS crews unhappy that the ALS didn't treat the call as an overdose.

from what I've seen (and I'll admit, that's not everything), most paramedics will let someone who is drunk, even borderlining on alcohol poisoning, be transported BLS.

however, if they have taken other stuff, or alcohol and some other type of drugs, then they will transport ALS.

any other opinions?

 

[karaya]

I wish your question was a bit more objective. These subjective threads that pertain to ALS and BLS do nothing but fester ALS vs. BLS feuds. Just like Paid vs. Volly. Something that is growing tiresome on EMTLife from my perspective.

Anyhow, I'm not trying to piss on your poll, just something I thought I would bring up early in this thread before salvos start getting launched.

 

[DrParasite]

ok I guess I can't edit the original post, but it really wasn't meant to be offensive. I actually copied it from an old thread from another board, and didn't properly review it all. So I will apologize for any offense that I caused.

Let me rephrase this topic: PD calls you for an intoxicated individual. should they be transported ALS or BLS?

 

[karaya]

I'm not at all offended by your poll or it's topic. I just thought you could be a bit more objective with your query. More specifics about the patient. Your post leaves a lot of room for opinion and little for facts since the question itself presents no facts about the patient other than he or she is drunk. This in turn leads to a lot of opinions and because the base of the topic is ALS or BLS, this in itself has a history here of feuding.

But hey, this may turn out just fine; so let's see how the responses turn out!

 

[eveningsky339]

Unless alcohol poisoning is possible, it's a BLS call. However, my company runs medic/basic trucks, so there's always a medic on scene when we have to go pick up a drunk college kid. The poor guy has to push Narcan according to protocol, and then there's a vomit party all the way to the hospital.

In a BLS truck the patient remains happily inebriated.

 

[medicdan]

Point of contention here for me, as a college EMS Crew Chief.

It's inherently based on the patient's condition and mental status. Simple, case, by case basis. For many intoxs there is no reason not to get the line early, start getting some fluids, and maybe some zofran (if only to save cleaning the truck).

OTOH, there are some patients that have had 2 drinks, and just dont need to go, but need to go. If there is no need for a line on the patient, I see no reason they cant go ALS.

 

[EMSLaw]

If the patient has drunk themselves into an unconscious stupor, and are unresponsive, that's probably a call worthy of ALS attention. If they're responsive, have a good airway, and are, for lack of a better way to put it, just drunk, then BLS can easily handle it. Have we not suction? Have we not e. basins?

I voted BLS, since that's the routine case, but it will vary depending on the situation.

 

[JPINFV]

People who use e basins need more experience. Take a red biohazard bag, put a hole in one side near the top. Put the patient's head through that hole. Now you've got a catch basin that won't splash and won't move away from the patient.

 

[Sasha]

Until we can do BALs in the field, and you can know for sure that the patient is drunk and there's not something else going on, ALS.

 

[Epi-do]

Like others have said, it really depends upon the condition of the patient when we get to them. My partner is a basic at the moment (he's in medic class, then we will be a dual medic truck) so there are times he has teched a drunk into the ER. If they are unresponsive, there is an airway issue, or any other circumstance that would warrent a higher level of care, then I take it in. There isn't a hard and fast rule about this type of run always going one way or the other. It's just like anything else - evaluate your patient and do what is best for them at that time.

 

[Aidey]

I'm going to say that if the person is so drunk they need to go to the hospital, they should probably be monitored by an ALS provider. In my area people who are simply intoxicated and need to sleep it off can go to a detox holding center. If they are too drunk for detox they are pretty dang drunk and we have to start worrying about airway issues and such. I also have a personal rule that any patient who has consumed alcohol and isn't acting right gets a blood glucose check. I've see people get bit in the butt by not checking, and I refuse to be that medic. I've saved my butt (and my patient's) a few times because of that. I would never send a intoxicated pt with a BLS crew until this had been done and it was confirmed that the pt did not need glucose (that is assuming the BLS crew can't do IVs and give Dextrose).

 

[Shishkabob]

(And possibly thiamine)

 

[Seaglass]

Like everyone else, depends on the patient. But if they're drunk enough so that they should go to the hospital rather than the drunk tank, I'm probably calling a medic, especially in the county where I can't check blood glucose.

 

[wyoskibum]

If the patient is conscious and their only problem is intoxication, then BLS all the way. If they are unresponsive, then ALS.

Most drunk people don't need to go to the hospital, they need to go home and sleep it off. When I worked out West, anybody who was drunk in public went to jail for public intoxication and put in the drunk tank. Here in CT, they don't do that. Too much liability (or too many lawyers). So they have to go to the hospital via ambulance just because they had too much to drink. CRAZY!

 

[emtfarva]

It all depends on whats going on and the patient.

If I think other drugs are involved, maybe.
If the Pt is alert and has a patent airway, I would say, BLS.
If the Pt is unresponsive, I am going to say ALS.

I have seen a person, just today, that had a BAL of over 500 and it was just like she was buzzed.

And Sasha, some services have Breathalyzers on the trucks. There is a hospital in Boston that has them in the triage area.

But, I am not able to take a CBG (not by my choice), I could see that you would want an ALS truck around just to rule out hypoglycemia.

 

[medicdan]

It all depends on whats going on and the patient.

If I think other drugs are involved, maybe.
If the Pt is alert and has a patent airway, I would say, BLS.
If the Pt is unresponsive, I am going to say ALS.

I have seen a person, just today, that had a BAL of over 500 and it was just like she was buzzed.

And Sasha, some services have Breathalyzers on the trucks. There is a hospital in Boston that has them in the triage area.

But, I am not able to take a CBG (not by my choice), I could see that you would want an ALS truck around just to rule out hypoglycemia.

Oh trust me, I know that hospital, and that equipment well. Do you not have a glucometer on your BLS truck?
I rely on a 911 contract by your company to transport patient off the college campus I work at, and however much I'd like to have a choice, more often then not I get ALS when it just isnt necessary. Of course, when I need them, they are out of town.

 

[mycrofft]

Metacommunicationally speaking...don't get hung up on ETOH.

Every pt needs assessment. That "drunk" might be DKA. Could also just be drunk...with a GSW or angina or erosive esophagitis about to become a massive bleed or maybe just a killer headache.
Safety, vitals, eval, support and transport.

The question is too vague because it pivots the ALS versus BLS question on an irrelevancy, or at best only one facet of diagnosis. It also implies ALS turfs off obnoxious inebriates on BLS..which might be true, but someone's looking for a willfully negligent manslaughter charge on the ALS truck if the pt was not evaluated correctly and fails to make it.

 

[medicdan]

mycroffit, it could (and often is) ETOH, but there are other factors. It's important (at least on a college campus) to get a solid history, from the patient and friends. Where were they drinking? Where are they now? How did they get from point A to point B? Any trips/falls? When was the last time they ate something (not only to gauge glucose, but also absorption of ETOH). When was the first drink? The last? Any carbonation of ETOH (ie champagne and wine are absorbed at different rates). PMH? Coexisting meds?

 

[mycrofft]

There needs to be a whole thread about the campus alcohol subculture.

The niceties of which flavor and brand/varietal of ETOH is more armchar baloney slicing, except that tequla gets people fighting or try to kill themselves, and peppermint scnappd and Southern Comfort mak for th nastiest puke.
I WHOLLY agree alcohol is just one aspect of eval, and not the pivot point of ALS versus BLS.
Unless they've been drinking peppermint schnapps or So Comfort. NIMR*!



* "Not In My Rig!!" :glare:

 

[Seaglass]

It is a bit different in college. Policies are often really different from the real world, and you're more likely to have to deal with law enforcement/campus police because your patients are likely underage. You're also more likely to have first-timers, which can get messy.

The niceties of which flavor and brand/varietal of ETOH is more armchar baloney slicing, except that tequla gets people fighting or try to kill themselves, and peppermint scnappd and Southern Comfort mak for th nastiest puke.

I beg to differ. Jungle juice makes for way nastier... and for extra fun, you usually can't find out what they used to make it in the first place.