(Cooperative, inter-agency communication and training can solve a lot of these issues)
Drunk is not sick, sick is sick.
Being intoxicated with no other medical complaint is not in itself a medical emergency.
Related Post: “You can either go with them to the hospital or go with me to jail”.
In nearly every class DT4EMS-EVE I teach, experienced EMS/Fire or other healthcare providers believe that they should not flee an intoxicated individual that intends to harm them. There is a “belief” that just because a person is “intoxicated” that the person has an “altered mental status” and can’t refuse treatment or commit a criminal act (such as assault).
Actually the answer is easy, but implementing it is not. Because of the “culture” of many EMS agencies, providers feel if they back away from a violent person who has been drinking, they will anger law enforcement, their administration or medical control. So, they stay engaged where they should not, and sometimes get hurt as a result.
Question: If just being drunk is so dangerous, why do we not stage an ambulance in front of every bar in the country, with a triage nurse next to the guy checking ID’s?
READ for yourself a legal rendering of a case of DRUNK IS NOT SICK
Many healthcare providers are erroneously taught that “drunk” means “altered beyond capacity,” however that is not true and not as simple as “if: then.”
Practically, what the provider has to ascertain is, “Is it safe for me to treat this patient?” This is a simple yes or no question. If the answer is no, it is a police matter or or a matter for a physician or psychologist licensed to order involuntary commitment.
Obviously, before you restrain someone, sufficient numbers of trained and capable personnel must be available. Contemporary guidelines call for five, but more may be necessary. While waiting for the team to assemble, there is no obligation for an individual EMT/Paramedic or Nurse to put personal safety at risk by remaining too close to the intoxicated person.
If the person is not a threat, it must be determined if they can in fact make a rational informed decision. Most people, despite having been drinking, actually can.
Think of how many times you may have had a few adult beverages. Most of the time you were probably capable of determining you shouldn’t drive, go home with some stranger from the bar, fix your electrical socket, etc. Despite your intoxication, you were able to make rational decisions for your own basic safety. You did not immediately have to be taken into the ED or protective custody.
If you feel that the person you have been called to care for cannot be left alone, law enforcement, not EMS, should deal with subduing the person.
Think of it this way, if a drunk guy had a gun would an EMS or healthcare provider be obligated to subdue and take it from them? Of course not.
What if they had a knife?
Empty hand?
None of these are safe scenes and the average EMS/Fire or healthcare provider has no obligation to intervene.
If the person made threats to themselves or others, that is its own issue, just like any other psych.
But most people who are so intoxicated they cannot make reasonable decisions will either react to a stranger like a diabetic or hypoxic person or they will be so inebriated, they will be unconscious.
Think of chronic alcoholics. They don’t function and can’t make a reasonable decision unless they have alcohol.
If a provider thinks a drunk is a threat to themself or others, they should be treated exactly like a psychiatric patient threatening their well being. Individual medics or nurses should not attempt to deal with these people alone.
Let’s look at what the signs and symptoms are of acute alcohol poisoning are (to which a person is a danger to themselves and risk death due to the alcohol consumption)
Signs and Symptoms of Alcohol poisoning may include:
- Confusion
- Vomiting
- Seizures
- Slow breathing (less than eight breaths a minute)
- Irregular breathing (a gap of more than 10 seconds between breaths)
- Blue-tinged skin or pale skin
- Low body temperature (hypothermia)
- Unconsciousness and can’t be aroused
Source of those signs and symptoms: Mayo Clinic
So if the person is standing, walking around, yelling at you, cursing at you or threatening to harm you… how altered is their mental status? Are they in such need of medical attention that you should risk your personal safety?
Many of the assaults that occur to EMS/Fire and ED staff are due to intoxicated persons. If they are not exhibiting the dangerous signs listed above…how badly do they really need your emergency medical treatment right now?
To look for yourself how many intoxicated individuals assault EMS/Fire and healthcare providers, look at our Assault on Staff Log.
READ for yourself a legal rendering of a case of DRUNK IS NOT SICK
To put it best, I need to quote an anonymous experienced EMS leader… “Drunk is not sick, sick is sick”.