Advice needed from the vets re: inoxicated patients

[jjnner]

Hi everyone,

I am need of some input on calls for intoxicated patients.

I work in a town where 80% of our calls have alcohol involved in one way or another, and I am not exaggerating. (as a note we have no ALS)

Our protocol for decreased LOC in an NYD patient includes a CBG check, D10W if necessary, normal saline, and Narcan if suspected OD with airway compromise.

It seems like the police want to bring in the “man found down behind a dumpster, unconscious” to the drunk tank. The patient checks out fine to me, but he is hard to rouse with pain stimulus and he has slow respirations. I get heck from the police if I bring them to the hospital and I get heck from the hospital if I they don’t go to the drunk tank.

The conflict here is the amount of drunks that we bring to the hospital. The hospital staff get annoyed as these people take up beds in their 5 bed ER. They especially don’t want to see a line in these patients because that means they “have to put them in a bed, because they are having medication administered”

The hospital tells me they see these people daily, putting on “shows” to get out of jail, and get free meals……


I am conflicted because I have brought in a VERY intoxicated 17 year old female, ( decreased LOC, able to take an OPA) known opiate and alcohol abuse that night, and have been asked “why is she here and not the drunk tank” ( this is after I administered Narcan and a IV N/S....... I'm feeling dumb)

I am new to this station, and I am used to calls for elderly sick patients with medical problems. Do you have any suggestions to how to keep a happy balance between the police/hospital/ and ambulance in regards to intoxicated patients?

(as a note, we are protocol driven, and need no contact with and EMD for med admin approval/advice)

Thank you

[AZCEP43]

Get your medical director involved. This is what he gets paid for.

If the hospital doesn't like you treating patients appropriately, perhaps they should take down the 24 hour emergency room sign. Yes, drunks are a burden on the system. It only takes one to have a subdural bleed or hypoglycemic event that isn't recognized.

[jjnner]

We have no EMD (Emergency Medical Director) It is a serious epidemic in this town, a social economic issue that has been around since this towns conception.

I have been told to joke with the ER staff and say “but Henry told me you were his favorite ER nurse”….. but that’s good for a one time only ease of tension.

I see how it has run some of the Paramedic staff at my station down, and I see it affecting all aspects of the health care system and community.

The call volume is 1900 calls a year. 80% involving alcohol, 60% involving solely heavily intoxicated individuals.

The last thing I want to do is release these individuals to the police when I know the repercussions if they truly are sick. But do you have any advice on coping mechanisms to stay strong, in a town were the system has no more patience.

[AZCEP43]

You don't have a medical director for your service? Who approves your protocols?

Failing that, you might consider reminding them that whether they like it or not, they are obligated to evaluate the patients that come through their doors by a little thing called EMTALA.

[emt161]

Wait a minute.

I work in a town where 80% of our calls have alcohol involved in one way or another, and I am not exaggerating. (as a note we have no ALS)

I see how it has run some of the Paramedic staff at my station down, and I see it affecting all aspects of the health care system and community.

So... which is it?


Get your medical director involved. This is what he gets paid for.

What happens in your area doesn't happen everywhere. There's only one service in my entire state that gets paid for filling that role, and I highly doubt with their call volume that it's a full-time position. All services do have a medical director, but it's hardly an active role in most cases.

You don't have a medical director for your service? Who approves your protocols?

If his area is anything like mine, the answer is something similar to "The state medical director."

[jjnner]

We have 1 President of Medical Programmes to over see 3500 or so paramedics and he has a council in which creates and manages our protocols. Within that council there are 4 more Regional Medical Directors.

We do have a licensing board that examines, regulates and licenses paramedics but they only answer black and white questions as they pertain to our protocols (as protocols are not meant to be deviated from). Within that there are 2 doctors and one expert on labor law.


We have 4 full time staff members and 16 part time

[hydrotech]

OK how to cope, how to cope...well for one thing you can ask the cops what they went to school for? ems or criminal justice? as far as the hospital staff goes they have a valid reason i mean you spend five minutes in the back of the bus with these "drunks" and they have to spend five hours in a (as it appears to be) small ER, and they probably a cop there to. now that we have an understanding of their reasoning we can come up with a good reasoning solution. let it roll of your shoulders not everyone who is in or outside of this field understands what we do. IMO cops always see these "drunks" come out fine in the end but don't always realize that the only reason they are fine is do to our intervention. as far as the hospital staff goes once the intoxicated individual is in their hands they can do as they please with them its no longer your liability.

[jjnner]

I guess I should be more specific, this is in a Canadian System, and there are no police at the hospital.



My calls today

1st call Someone knocked at the door to our station, they told me a women is laying down in an alleyway. Upon arrive we see a woman laying supine moaning and swearing. She was just released from the hospital, from being drunk the previous night, and was still to drunk to make it all the way home

2nd call 14 year old female panic attack

3rd call heavily intoxicated male found on a walking trail

4rd call to Police cells, Fight involving intoxicated male.

[jbrescue]

In the States if they released someone who was still drunk that would be malpractice. If that is the way you guys are being treated, you have a serious uphill fight. Somehow, someone needs to have a very PC talk with the PD and enlighten them on your job. As far as the hospital, that is jsut such a foreign concept to most of us, that it is unfathomable. Small ER or not, they have to treat those who come through the doors. Last time I checked, none of us go around and look for patients. We get called for them.

[Engine58]

Hmm...in my area where I work BLS...we had a notorious group of low income or homeless men which constantly are being picked up in town near the train station or there homes, we do it so much in the summer or the really cold days in the winter that we get to know them on a first name basis...some are nice guys who just got a bad break in life and now just cant kick the alcohol habit, frustrating when you gotta pick them up you bet ya! Well point to my post is...the cops make us take the drunks to the local ER where they got the detox center. If they committed any type of crime or disturbance then they will arrest them and if any charges are filed they make us pick them up at hte jail and bring them to the detox in police custody. Hospital usually is a little upset that we are filling up the Physch Unit/Detox unit with homeless guys just lookin for a sandwhich and a shower...but what can ya do...rarely do any of these guys get any charges by police. We never call ALS unles the ABC's are affected somehow or if they have OD'd on some type of drug otherwise...BLS to the detox for the night for a shower and sandwhich....