what is your county / state / etc protocol for transport for request for detox?

[mrhunt]

Pretty straightforward. Im sure in big cities you have the whole whatever its called unit where the Community paramedic or nurse go on calls with these individuals and take them straight to treatment facilities seperate of an emergency room. Smaller counties im more curious.

and to clarify, just someone with no medical complaint whatsoever who just says "i want to go detox of alcohol"
NOT someone actively detoxing or risk of seizures or medical complications. Just someone who wants help to get it done.

 

[DesertMedic66]

“Well my only option is to take you to the ED and they may be able to supply you with a list of facilities and can help you get placement into one of those facilities as they all have different insurance requirements”.

In my area we are still pretty much stuck in the old days of only being able to transport to the ED. We have just started being able to transport to urgent cares but there are only a couple on the list and none in my area.

 

[EpiEMS]

Unfortunately, stuck transporting to the ED. There's no state protocol nor is their a local protocol.

 

[Tigger]

When detox was run by the county, we had the ability to transport directly to it. The assessment flow chart was in the scope of EMTs to do and as long as they fit the criteria they were good for detox, which did their own medical screenings and would provide Librium and other meds. The ambulance could take them or more commonly we’d call for the EMT staffed detox van and they’d take the patient. PD could call for the detox van as well and that
EMT would do the assessmsent and either take take them or call an ambulance for transport to the ED.

The county got out of the detox business and the private contractor wants everyone going to the ED aside from community paramedic patients so that’s what we do. Two steps back…

Denver has a much better detox program, maybe @Ensihoitaja could elaborate.

 

[FiremanMike]

There is a county run detox intake but it's the local cops who transport there.

There is a limit to what the detox facility will take.. "you know it when you see it" and those folks have to go to the ER..

 

[EpiEMS]

Some interesting work done almost 10 years ago (wow!) by AMR in Colorado Springs. Smallish retrospective cohort, but nice outcomes!
Re: Denver, looks like this is still in the Denver Protocols ("0150 BEHAVIORAL HEALTH WALK-IN CLINIC / WITHDRAWAL MANAGEMENT UNIT ADMIT GUIDELINE").

 

[Tigger]

Some interesting work done almost 10 years ago (wow!) by AMR in Colorado Springs. Smallish retrospective cohort, but nice outcomes!
Re: Denver, looks like this is still in the Denver Protocols ("0150 BEHAVIORAL HEALTH WALK-IN CLINIC / WITHDRAWAL MANAGEMENT UNIT ADMIT GUIDELINE").

The Springs system is what I speak of, it is no more sadly.

 

[Ensihoitaja]

Some interesting work done almost 10 years ago (wow!) by AMR in Colorado Springs. Smallish retrospective cohort, but nice outcomes!
Re: Denver, looks like this is still in the Denver Protocols ("0150 BEHAVIORAL HEALTH WALK-IN CLINIC / WITHDRAWAL MANAGEMENT UNIT ADMIT GUIDELINE").

Our detox transport protocol is different than the Denver Metro protocols. We’re the only agency with the ability to have someone transported directly to detox.

I can’t copy and paste the flowchart, but these are the exclusions to transport by the Detox Van- so anyone intoxicated that doesn’t meet these can be go directly to detox, not pass go, and not collect $200

Intoxicated patient with any of the following must be transported to ED:

Incapacitating Intoxication

• Inability to maintain airway
• Inability to stand from seated position and walk with minimal assistance
• At immediate risk of environmental exposure or trauma due to unsafe location

Acute Illness or Injury

• Abnormal vital signs
• Physical complaints that might indicate an underlying medical emergency, e.g.: chest pain
• Seizure or hypoglycemia
• Signs of trauma or history of acute trauma
• Signs of head injury, e.g.: bruising, lacerations, abrasions

 

[EpiEMS]

Our detox transport protocol is different than the Denver Metro protocols. We’re the only agency with the ability to have someone transported directly to detox.

I can’t copy and paste the flowchart, but these are the exclusions to transport by the Detox Van- so anyone intoxicated that doesn’t meet these can be go directly to detox, not pass go, and not collect $200

How do they get dispatched? By an EMS unit on scene or by LE? Both?

 

[Ensihoitaja]

How do they get dispatched? By an EMS unit on scene or by LE? Both?

EMS, PD, and fire can all request detox. Patients can also call 911 and request detox, but that doesn’t happen very often.

Police can also transport directly to detox, but that generally only happens if the van is unavailable.

 

[chriscemt]

In my area we are still pretty much stuck in the old days of only being able to transport to the ED...

I would think the type of patient who doesn't need to go to an ED doesn't need an ambulance.

 

[EpiEMS]

I would think the type of patient who doesn't need to go to an ED doesn't need an ambulance.

Not necessarily true. Isolated extremity trauma might require an ambulance - but not an ED (an urgent care would suffice). Psychiatric or substance-related issue with no other medical or trauma complaint - a detox center or dedicated psychiatric receiving facility might be best. Or perhaps a taxi isn't an option (something something Medicaid reimbursement for non-medical transportation...) but a PCP visit would be necessary.

 

[sirenman]

we have no local detox facilities and even if we did a pre admission medical clearance is required for all psych/detox patients, sadly ,most spend days in the E.D. waiting for a psych bed to become available.