Signing Intoxicated students

[Arizonaffcep]

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.

This can lead to problems. If you transport a person against their will, then you run the risk of a kidnapping charge against you and your company. Now...that assumes that the "intoxicated" person is A&O x4, and is able to answer questions appropriately. If they aren't then maybe. If they are totally inebriated, so be it.

[Arizonaffcep]

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 agree, but then you run into the whole "its not legal for them to have ETOH, so by that token, they can't refuse." Much as if a person has cocaine/meth/pot etc. My mearly using those, they (at least in Southern AZ) have lost the ability to refuse because the law has described it as "mind altering substances" or (insert favorite saying), which of course means they don't have the mental capacity for a refusal.

[Odorono]

I agree, but then you run into the whole "its not legal for them to have ETOH, so by that token, they can't refuse." Much as if a person has cocaine/meth/pot etc. My mearly using those, they (at least in Southern AZ) have lost the ability to refuse because the law has described it as "mind altering substances" or (insert favorite saying), which of course means they don't have the mental capacity for a refusal.

You're making two distinct arguments here. Your first statement implies that by breaking the law (possessing alcohol while under 21), a pt is suddenly unable to make decisions regarding their medical care. While to a certain extent this applies to a subject under arrest, I've never heard of anyone being arrested for underage drinking. I would be surprised to find your above statement supported in case law.

The second argument is more variable, and I would be curious to read the actual AZ statutes. I can't imagine they would lump alcohol, a legal beverage, into the same category as those other illicit substances, since by that reasoning anyone who has had a drink has suddenly lost the capacity to make medical decisions.

Capacity is not a static thing, and we should consider that when we speak with all of our patients. Capacity should be judged on a case-by-case basis, specific to a particular pt at a particular time concerning a particular treatment.

DISCLAIMER: The above assumes we aren't talking about somebody who's totally gorked. The decision then is obvious. I am referencing those patients who have "ETOH on board" but are otherwise coherent.

[katbemeEMT-B]

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

The drunks even drunker roomate

[Arizonaffcep]

You're making two distinct arguments here. Your first statement implies that by breaking the law (possessing alcohol while under 21), a pt is suddenly unable to make decisions regarding their medical care. While to a certain extent this applies to a subject under arrest, I've never heard of anyone being arrested for underage drinking. I would be surprised to find your above statement supported in case law.

The second argument is more variable, and I would be curious to read the actual AZ statutes. I can't imagine they would lump alcohol, a legal beverage, into the same category as those other illicit substances, since by that reasoning anyone who has had a drink has suddenly lost the capacity to make medical decisions.

Capacity is not a static thing, and we should consider that when we speak with all of our patients. Capacity should be judged on a case-by-case basis, specific to a particular pt at a particular time concerning a particular treatment.

DISCLAIMER: The above assumes we aren't talking about somebody who's totally gorked. The decision then is obvious. I am referencing those patients who have "ETOH on board" but are otherwise coherent.

For underage drinkers though, it IS an ILLEGAL substance. Free invitation for you to come out to UMC/Southern AZ and watch how many people get "tagged" for underage drinking. No joke...if UofA PD catches any UofA students with ANY amount of ETOH in their system (AZ state law says the hospital is allowed to reveal contents of a tox screen, including BAL to PD without breaking HIPAA, but only that info), they can (and occasionally do) get kicked out of the University (if they are in the dorms, they at least loose their student housing) and a few times I've seen them revoke full scholarships for it. The UofA has a ZERO tolerance for ETOH in underage drinkers. PD doesn't have the authority to actually revoke the scholarships themselves, but if they (the ETOH + student) falls under a certain category of offence in relation to ETOH, once the arrest is forwarded to the UofA then it's revoked by the financial aid people at the UofA (built into the "contract" for financial aid).

Also, just FYI, because the legal drinking age of Mexico is 18 (I think, I know it's lower than AZ), AZ DPS (AKA Highway Patrol) actually does set up check points for people returning from Mexico to bust underage drinkers (regardless if they are driving or not). God help them if they are driving...that's a LOT of charges (according to DPS, can be minor in possession of controlled substance, reckless endangerment, DUI [even if their BAL is 0.01 or less, because it's illegal for them to be consuming ANY ETOH], plus any speeding, or MVC related charges, if applicable)!

For people 21 or older, if you have some ETOH but are still "competent" to make a decision (A&O X 4, without OBVIOUS signs of intoxication), then by all means, refuse. But for minors (under 21) who have consumed ETOH, they have lost the right to refuse, because for them, ETOH is an illegal substance, whose abilities to alter mentation have been well documented throughout time (at least several thousand years).

[tom5706]

We really dont have that problem here. The village only has one bar and the woman who runs it runs it with a tigh control. If you appear to have had to many.. you are DONE..period. Most drinking is done behind closed doors of a private residence. I take back what I said about one bar.. there is the VFW, but they are tighter controled then the public drinking establishment.

[Odorono]

For underage drinkers though, it IS an ILLEGAL substance. Free invitation for you to come out to UMC/Southern AZ and watch how many people get "tagged" for underage drinking. No joke...if UofA PD catches any UofA students with ANY amount of ETOH in their system (AZ state law says the hospital is allowed to reveal contents of a tox screen, including BAL to PD without breaking HIPAA, but only that info), they can (and occasionally do) get kicked out of the University (if they are in the dorms, they at least loose their student housing) and a few times I've seen them revoke full scholarships for it. The UofA has a ZERO tolerance for ETOH in underage drinkers. PD doesn't have the authority to actually revoke the scholarships themselves, but if they (the ETOH + student) falls under a certain category of offence in relation to ETOH, once the arrest is forwarded to the UofA then it's revoked by the financial aid people at the UofA (built into the "contract" for financial aid).

Also, just FYI, because the legal drinking age of Mexico is 18 (I think, I know it's lower than AZ), AZ DPS (AKA Highway Patrol) actually does set up check points for people returning from Mexico to bust underage drinkers (regardless if they are driving or not). God help them if they are driving...that's a LOT of charges (according to DPS, can be minor in possession of controlled substance, reckless endangerment, DUI [even if their BAL is 0.01 or less, because it's illegal for them to be consuming ANY ETOH], plus any speeding, or MVC related charges, if applicable)!

For people 21 or older, if you have some ETOH but are still "competent" to make a decision (A&O X 4, without OBVIOUS signs of intoxication), then by all means, refuse. But for minors (under 21) who have consumed ETOH, they have lost the right to refuse, because for them, ETOH is an illegal substance, whose abilities to alter mentation have been well documented throughout time (at least several thousand years).

Holy crap! I didn't realize how draconian they made it down there. -5 for me thinking the Northeast was heavy on the legislation. Where I grew up, having it in your system wouldn't get you an MIP, only possession of the booze itself (same reasoning used by the idiots who eat their whole dime bag when they see a cop). Kids went to Canada all the time for exactly this reason. I absolutely understand and condone the DUI checkpoints at the border, but it doesn't seem sensible to penalize someone who has consumed alcohol legally in another country and isn't currently doing so. Does this lead to more kids staying in tacoland for the night to sleep it off, and does that lead to more trouble? Are these laws/ practices considered acceptable by the public?

And while I am very familiar with alcohol's ability to alter mentation :wink:, my point earlier was only that it is dose-dependent, and more so than other illicit substances. No offense, but I'm glad I didn't go to college in AZ. Although one of the coolest sunsets I ever saw was outside of Scottsdale...

[Arizonaffcep]

Holy crap! I didn't realize how draconian they made it down there. -5 for me thinking the Northeast was heavy on the legislation. Where I grew up, having it in your system wouldn't get you an MIP, only possession of the booze itself (same reasoning used by the idiots who eat their whole dime bag when they see a cop). Kids went to Canada all the time for exactly this reason. I absolutely understand and condone the DUI checkpoints at the border, but it doesn't seem sensible to penalize someone who has consumed alcohol legally in another country and isn't currently doing so. Does this lead to more kids staying in tacoland for the night to sleep it off, and does that lead to more trouble? Are these laws/ practices considered acceptable by the public?

And while I am very familiar with alcohol's ability to alter mentation :wink:, my point earlier was only that it is dose-dependent, and more so than other illicit substances. No offense, but I'm glad I didn't go to college in AZ. Although one of the coolest sunsets I ever saw was outside of Scottsdale...

Ya...AZ has the BEST sunsets around. Ya, as a minor, if you have CONSUMED ETOH, even though you may not have a drink around you, you are still MIP.

[reaper]

Ya...AZ has the BEST sunsets around. Ya, as a minor, if you have CONSUMED ETOH, even though you may not have a drink around you, you are still MIP.

All they have to do is refuse the test, then they have no proof. Not very prosecutable!

[Arizonaffcep]

All they have to do is refuse the test, then they have no proof. Not very prosecutable!

Actually, in cases where they do "refuse" the test, PD gets a search and seizure warrant from a judge to draw blood. Now...there is a point to where they will walk away if it starts to be too much of a hassle, but also in AZ, in the ED, if we have a medical order to draw blood, the cops are ENTITLED to a sample, if they need. Otherwise, they need a warrant.