transporting drunk people

Would you transport a drunk ALS or BLS?

  • ALS (with Paramedics)

    Votes: 10 41.7%

  • BLS (EMT only)

    Votes: 14 58.3%
  • Total voters
    24
emt.dan said:
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.
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Nope, not in region 5.

As for the ALS/BLS thing, ask your dispatch when they call to ask for ALS or BLS. That way the ALS crew doesn't use their god-like powers to just take the young drunk person to the hospital. I forget what college you go to. (that is just a dig on the crews up in that area, not a paramedic thing)
 
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Interesting no one considered head injury thus far.

We have seen an increasing number of 'drunks' presenting who have had varying degrees of head injury. Serious enough for us to receive memos about it.

Just cause they smell drunk doesnt mean you can count out a head injury.
 
downunderwunda said:
Interesting no one considered head injury thus far.

We have seen an increasing number of 'drunks' presenting who have had varying degrees of head injury. Serious enough for us to receive memos about it.

Just cause they smell drunk doesnt mean you can count out a head injury.
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I think the whole issue is all about "covering you a$$". Of course you need to do a complete assessment and Hx of the patient. However, if you assessment finds that there is no Hx of trauma, no PMHx ie: diabetes. If their only problem is that they have had too much to drink. Do they really need to be transported to the hospital?
 
Is there any other toxin we would leave on the curb obtunded?

Little tipsy, sure, especially if they have someone to keep them off of and out of the streets. Unable to walk, lowered LOC, unable to determine what's going on objectively, off to the hospital.

(Side track question...If you are treating a "drunk" and a police officer arrests the pt and insists on taking them to jail, what could you do? What have you done? One way to keep them out of your rigB)
 
At least in my protocols, once the patient/subject is in Police Custody, I am free from liability. If PD takes control of my patient, it is unsafe for me to be involved, and they take responsibility for the patient. All I need to do is note the badge number of one of the officers involved, and I list that as my disposition.
 
Cool!

When Fred Barney and I were working downtown Bedrock, the police were very amenable to keeping drunks out of their cars and in our ambulances ubnless there had been a fracas.
You know, bashing each other with big clubs?;)
 
emt.dan said:
At least in my protocols, once the patient/subject is in Police Custody, I am free from liability. If PD takes control of my patient, it is unsafe for me to be involved, and they take responsibility for the patient. All I need to do is note the badge number of one of the officers involved, and I list that as my disposition.
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Not necessarily.

A couple years ago in Southern CA a neonatalogist was stopped by PD on suspected DUI. EMS was called just to make CYA but the Paramedics allowed the LEOs assessment and their own bias against drunks to skew their assessment. They left the doctor with the LEOs. Luckily for the doctor a nurse who had just worked the shift with him (yes the doctor was still in his scrubs) at the hospital stopped when she saw him alongside the road. Another ambulance was called and today the doctor is disabled with a great case against the Paramedics who left him at the side of the road. Hopefully that includes getting their license revoked.

Forming attitudes against drunks or drug addicts can skew your assessment. You may already be planning on calling yourself back in service before you get to the scene. Thus, you are useless to the patient as you will fail to see even an obvious injury.
 
Like every one else has said, it depends on the pt... and what BLS providers are allowed to do. I could go on and on, but it comes down to the condition of the pt. Case-by-case bases.
 
VentMedic said:
Not necessarily.

A couple years ago in Southern CA a neonatalogist was stopped by PD on suspected DUI. EMS was called just to make CYA but the Paramedics allowed the LEOs assessment and their own bias against drunks to skew their assessment. They left the doctor with the LEOs. Luckily for the doctor a nurse who had just worked the shift with him (yes the doctor was still in his scrubs) at the hospital stopped when she saw him alongside the road. Another ambulance was called and today the doctor is disabled with a great case against the Paramedics who left him at the side of the road. Hopefully that includes getting their license revoked.

Forming attitudes against drunks or drug addicts can skew your assessment. You may already be planning on calling yourself back in service before you get to the scene. Thus, you are useless to the patient as you will fail to see even an obvious injury.
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Okay, I'll bite - what was it that he had?
 
transporting AOB

Frankly, that question is much more complex than it seems on the surface. I've worked with a *LOT* of drunk patients while support special events such as football. It comes down to a number of factors in deciding if their are BLS, ALS or even just POV with a sober friend to home.

1- How drunk are they? If you can, get a cop to do a breathalizer to give you some ball-park idea.

2- What's their LOC? If they are in and out or just plain out, consider going to ALS.

3- Sex, age and body mass? All three factors should be considered. I see a lot of younger female students trying to keep pace with their larger boy friends. Drink for drink, she'll be intoxicated long before he is and could get to dangerous levels of intoxication faster.

4- What's the weather like? If it's too hot, the alcohol will metabolize faster and deydrate the body. If it's cold, "alcothermia" (my new word), or alcohol-induced hypothermia, could be a problem.

5- What else is in their system? Unfortunately, EMS professionals are seeing more and more where people are combining alcohol with other street drugs.

6- What are their vitals doing? If stable and improving, probably home with a sober driver via POV is fine. If stable, but no improvement, BLS to the ER may be a good way to go. Obviously if the PT is getting worse and vitals/LOC are deterriorating an ALS assessment and possible transport may be needed.

7- Is the PT alone or with someone who is able to help (of age and not intoxicated themselves)? Sometimes, we have transported BLS because POV just wasn't an option.

As with most of what we EMT's do, it comes down to a holistic evaluation of the situation. Given all of the factors that you can determine, what's the best call for the PT?

As one final point: document, document, document!

We sent a mildly intoxicated guy home in a cab one time and he never made it home. PD called us because his wife called them. We had failed to note the cab compnay's name and number and LIC#. After a lot of searching, another LE agency found him asleep in his vehicle at a park and ride. For us, it was a dumb mistake and not up to our professional standards. Fortunately it turned out OK, but I have never forgotten that lesson. Remember the *4* T's for patients: Triage, Treatment, Transport and TRACKING.
 
VentMedic said:
Not necessarily.

A couple years ago in Southern CA a neonatalogist was stopped by PD on suspected DUI. EMS was called just to make CYA but the Paramedics allowed the LEOs assessment and their own bias against drunks to skew their assessment. They left the doctor with the LEOs. Luckily for the doctor a nurse who had just worked the shift with him (yes the doctor was still in his scrubs) at the hospital stopped when she saw him alongside the road. Another ambulance was called and today the doctor is disabled with a great case against the Paramedics who left him at the side of the road. Hopefully that includes getting their license revoked.

Forming attitudes against drunks or drug addicts can skew your assessment. You may already be planning on calling yourself back in service before you get to the scene. Thus, you are useless to the patient as you will fail to see even an obvious injury.
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This case I referred to is from couple years ago involving Dr. Mohamad Harb, a 58 y/o neonatologist, Bakersfield PD and Hall ambulance.

That case may not be well know but there is one that is practically world famous now. That is the one of New York Times reporter David E. Rosenbaum and Washington D.C. EMS. I hope some would have learned a little something about the importance of assessment from that highly publicized case. Although, it has been fairly obvious that Washington D.C. has not.

Of course these are only the ones that make the news. Many other screwups don't get national attention but they do cost some EMT(P)s their jobs and certifications.
 
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VentMedic said:
This case I referred to is from couple years ago involving Dr. Mohamad Harb, a 58 y/o neonatologist, Bakersfield PD and Hall ambulance.
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I'm familiar with the Rosenbaum case, but can't seem to turn up anything about Dr. Harb beyond a few professional listings. Would you happen to have any links to that story?
 
The biggest problem is not at events such as sporting events, but in the early hours of the morning where the person is alone or with their obnoxious also drunk mates who are unable to tell you properly what happenned.

I heard of a case here where the patient, who although 'legally drunk', ie withing the range to be classed as having consumed enough alcohol for a court to say he was drunk, fell asleep on the floor of a friends house. EMS was called as he started vomiting.

With
no obvious signs of trauma
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 he was transported to hospital for observation. The intensivist that was on that night had a funny feeling in his gut. Sent him for a CT & found a sub arachnoid haemhorrage.

Turns out the pt was involved in a fall at work 3 days prior that had initiated the bleed. The fall was approx 1m. Left no signs of trauma & he did not seek immediate medical advice. After 18 days in ICU, this young man departed hospital with no further problems thanks to the Intensivists gut.

The debate is mute. There is no way, not even a breathalyser will help. Use your head, dont take to great a risk.

Head injuries & ETOH intoxication, CVA's, & Hypoglycaemia all (can) present in a similar way.
 
He pulled a Natasha, eh?

We slap "spinal precautions" on people falling off the couch, but we see an unconscious person who has been drinking and say "drunk " and play negligent brinksmanship. Our cultural attitudes towards alcohol are interesting, and much more observable if you don't drink, and even better if you take a good college level class about alcohol treatment and counseling with a historic component. I highly recommend them both, the class AND going to college.



Oh, teetotalling...it has its upside too!! Cheers!
 
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