Signing Intoxicated students

[fiznat]

There might be 50 camp beds set up in a tent filled to the brim with drunks, I’d imagine a very minor majority (if any) of people admitted to this area receive medical treatment.

This contrasts quite a bit with the system we have here. My service has a contract with a local concert venue that holds a number of very large shows over the year which often top 15 and 20 thousand people. We dedicate usually 10 or 15 ambulances to this venue and the crews are always absolutely swamped with drunks who, our supervisors mandate, all get transported to the hospital. It isn't unusual to take out triple digits of patients from this place and fill up the hospital hallways with drunk after drunk after drunk. Unsurprisingly we aren't too popular with the ED nurses those days...

I wonder what the difference is between our environments that promotes such a clear difference in protocol. Is my service more worried about getting sued than yours? Does my service care more about reimbursement than yours? Are our patients simply sicker? (hah)

[Arizonaffcep]

We dedicate usually 10 or 15 ambulances to this venue and the crews are always absolutely swamped with drunks who, our supervisors mandate, all get transported to the hospital.

That's stupid. They turn into "social" transports which needlessly clog the ED. Now...if the Pt legitimately needs to go, nuf said. But if they are alert (maybe not A&O X 4) but able to maintain...and they aren't driving and going home with SOBER family/friends, then why not? Happens all the time in the ED. Send the patient out with a responsible person who WILL be with them until sober. Now...if they are unconscious, etc. then it kinda rules that situation out. But you get the picture. You could even go so far as to write in the narrative that "XYZ, Pt's friend, has stated he will take responsiblity for Pt's welfare, and will be with him/her throughout the night" and have that person sign the form after the statement. Does it take away YOUR liability? I doubt it, but it at least off sets it to a degree.

[Odorono]

Especially if they are college students under the age of 21... If they refuse to go to the hospital, police should be involved.

Big problem with this statement. Are you implying that you coerce patients under the age of 21 to go to the hospital for fear of LE involvement? If you have a patient who you feel must go to the hospital, or does not have the capacity to consent, then LE is a definite consideration for your own safety. But I fail to understand why this should apply any more to an underage drinker than another patient. If the kid is CAO x4, normoglycemic and the circumstances of the evening are clear there's no reason to call the cops just because he's under 21.

I'm with fiznat on this one, and I think blanket statements or protocols specifying transport in the mere presence of alcohol provide a great and unnecessary burden on the entire system.

[tskstorm]

Big problem with this statement. Are you implying that you coerce patients under the age of 21 to go to the hospital for fear of LE involvement? If you have a patient who you feel must go to the hospital, or does not have the capacity to consent, then LE is a definite consideration for your own safety. But I fail to understand why this should apply any more to an underage drinker than another patient. If the kid is CAO x4, normoglycemic and the circumstances of the evening are clear there's no reason to call the cops just because he's under 21.

I'm with fiznat on this one, and I think blanket statements or protocols specifying transport in the mere presence of alcohol provide a great and unnecessary burden on the entire system.

If your legally intoxicated at any age and not driving or giving anyone a hard time NYPD will leave you be as long as you go to the hospital.

If they refuse PD will say " you can go to the hospital or you can go to jail"

My poor grammar may have lead you to believe that what I stated was only for underage drinkers but it is for everyone.

Anyone who refuses to go to the ER who is intoxicated or impaired by any substance will have me calling PD, If i can not not talk to patient into going.

Intoxication is a medical condition and should be treated as such. On a side note, If PD arrives on scene before we do, and the person who is intoxicated doesn't want to go to the hospital and is capable of ambulating they will tell them to get up and keep moving, most of our regular drunks know this and when they see us get up and walk away when we approach them.

I'm certainly not chasing them down, but I will write up paperwork to document what happened and move on with my tour!

[zippyRN]

This contrasts quite a bit with the system we have here. My service has a contract with a local concert venue that holds a number of very large shows over the year which often top 15 and 20 thousand people. We dedicate usually 10 or 15 ambulances to this venue and the crews are always absolutely swamped with drunks who, our supervisors mandate, all get transported to the hospital. It isn't unusual to take out triple digits of patients from this place and fill up the hospital hallways with drunk after drunk after drunk. Unsurprisingly we aren't too popular with the ED nurses those days...

I wonder what the difference is between our environments that promotes such a clear difference in protocol. Is my service more worried about getting sued than yours? Does my service care more about reimbursement than yours? Are our patients simply sicker? (hah)

on this side ofthe pond you would lose that contract in a hertbeat , because the venue would be told change provider or you will not get the event licence and your alcohol licence will not be reviewed

however the national guidance i nthe Uk says that events have to minimise impact on regualr health services ...

the approach taken in the Uk to this kind of event would be to have a Senior Emergency Medicine / Immediate Care doctor on site supported by one or more additional doctors and a team of both Nursing and Paramedic staff in addition to first aiders for the crowd and circulation areas and 'EMTs' ( both ETA and QAT ) and paramedics for the 'pit' and to crew a limited number of ambulances ...

we can run 4 day 80 k attendance festivals with at most a couple of hundred off site transports over the event and fewer if we can get the necessary licences for an on site Plain film X ray facility

[Odorono]

If your legally intoxicated at any age and not driving or giving anyone a hard time NYPD will leave you be as long as you go to the hospital.

If they refuse PD will say " you can go to the hospital or you can go to jail"

My poor grammar may have lead you to believe that what I stated was only for underage drinkers but it is for everyone.

Anyone who refuses to go to the ER who is intoxicated or impaired by any substance will have me calling PD, If i can not not talk to patient into going.

Intoxication is a medical condition and should be treated as such. On a side note, If PD arrives on scene before we do, and the person who is intoxicated doesn't want to go to the hospital and is capable of ambulating they will tell them to get up and keep moving, most of our regular drunks know this and when they see us get up and walk away when we approach them.

I'm certainly not chasing them down, but I will write up paperwork to document what happened and move on with my tour!

My apologies if our signals got crossed. I may have been projecting several situations which have recently happened to me onto your statement, although I still stand by mine. I think the issue is really how to define intoxication and who decides if the patient goes to the hospital. At the risk of hijacking, I'll stop there, although cops giving pts the choice between the hospital or jail is probably not good pt care.

[fiznat]

My poor grammar may have lead you to believe that what I stated was only for underage drinkers but it is for everyone.

I also misunderstood you but it was probably more than half because that IS how my service works. If you are under the legal drinking age and you even admit to (not even show signs of) drinking, that patient will be coerced into going to the hospital. This applies mostly at the large concerts but it does rear it's head in the street sometimes as well. Its an awful policy in my opinion which is not rooted in the patient's best interests at all.

however the national guidance i nthe Uk says that events have to minimise impact on regualr health services ...

There is also a difference here in that I work for a private service that has a contract with this concert venue. There is no "impact" on the regular 911 service in the city because these are extra shifts/crews/ambulances specifically assigned to the facility. The number of trucks on the road to answer emergencies does not change. Usually. That doesn't mean that these patients should be transported, imho, though.

[Dungan362]

Our policy is to transport. We don't give an intoxicated person the opportunity to say no. If we are called they go! Once we didn't transport an intoxicated person and we wound up back there in an hour, picking up a person who had a head injury due to getting up from the floor, falling back to the floor striking a table and knocking himself out... We then had to transport him by copter to the nearest trauma center only to have him start seizing before the copter arrived. We also had him vomit blood in the ambulance and all over us! We now transport any one who is intoxicated to the hospital... they then become the hospitals responsiblity.

[Dustdevil]

I don't disagree, that is why I am looking for opinions on the subject. So let me ask you this, would you transport these students ALS or BLS? On a medic/EMT-B truck, would you put the medic in back or the EMT?

I don't get it. If you put the EMT in back, who is going to drive the ambulance? :?

[tskstorm]

I don't get it. If you put the EMT in back, who is going to drive the ambulance? :?

FF or LEO ?