Signing Intoxicated students

[tskstorm]

FD5 this isn't my thread so I can only make an educated guess that it is somewhere in between drunk and inebriated.

Well there would be a large difference between a college kid who has had one beer, one who had 12 beers and a one who had a keg of beer.

I'm referring to either of the second two when the word intoxicated is involved. I would like to think when we use the word they are at least legally over the limit.

I'm sure we all know one or two people who can have 12 beers, and still be A&O but they are still intoxicated and unable to make an informed decision and should be treated under implied consent.

[firedoc5]

FD5 this isn't my thread so I can only make an educated guess that it is somewhere in between drunk and inebriated.

Well there would be a large difference between a college kid who has had one beer, one who had 12 beers and a one who had a keg of beer.

I'm referring to either of the second two when the word intoxicated is involved. I would like to think when we use the word they are at least legally over the limit.

I'm sure we all know one or two people who can have 12 beers, and still be A&O but they are still intoxicated and unable to make an informed decision and should be treated under implied consent.

Sorry, these long threads can confuse you. I was just too lazy to see who the OP was.

I agree about the difference between a "light weight" who went over board and a "power drinker" that other than his breath you couldn't tell if he/she had anything that night. So that's why I think we do see it more with younger people, especially under aged. Under aged, no tolerance. They'll either ride to the hosp. with you or the police. Either way, they wind up at the PD.

I lived in a large college town and saw way, way too many youngsters guzzling down their beer or whatever, act like idiots, big shots, and some just get real quiet, etc. But I am guilty of taking advantage of that. A buddy of mine and myself would hook up with some of the youn'guns (NOT under aged) and start to play pool. We'd play for drinks, or whatever. We'd sluff off, let them win two or three and buy them their beers. Then we would start to play. I'd take the Beam & Coke, and Johnny would take the Crown either straight or with cola. Those cost more than the little old beers. BUT if we saw them getting too plowed we'd make sure they were cut off. We knew the owner and all the gals that worked there very well. Man, some would get p!ssed. If there were any under agers, they were strictly off limits. They might not have known it, but one could tell. It was a college town so it was sort of a gray area legally to let them in. Plus they had a large dance hall adjoined to the main bar. There were five or six of us that when we knew they were under aged, they might have had half a beer, and we'd escort them out. If they came with someone who was of age, we'd find them and make them take them home, if they weren't too drunk. Sometimes the cops would be called especially if they had a fake ID or had someone buy it for them and give it to them.

I look back now and would have done things a lot different. For one thing, not drank at all. (divorce can drive you to a lot of things) And second, not buy for anybody, unless they were a buddy. :occasion5: I'm so ashamed. :oops:

Now that I've got a 17 yr. old, it's a whole new perspective on underaged drinking.

[jbanagas]

Just follow your local protocol for AMA's, i mean if they are able to be signed out following your protocols what can you do, don't kidnap drunk patients, if in doubt call your med control and or supervisor.

[Arizonaffcep]

I think you are still mixing up the responsibilities given to police officers and those given to us as medical providers.

I don't know of any statute, law, or protocol that regards the legality of an ingested substance as a factor to determine a patient's mental status. Unless they are in the custody of a police officer, there is absolutely no difference between an AxO criminal and an AxO law-abiding citizen as far as their ability to make medical decisions. We are not police officers, and the hospital is not a jail.

Again if they are NOT AxO that is a different story, but forcing underage (adult) drinkers who are AxO to go to the hospital is a recipe for disaster in my opinion. Before you do this, I would be absolutely sure of your local laws/statues and have them ready for the inevitable consequences.

When in doubt, we contact medical control...but that's the standard here...now we don't involve PD unless we have to, because, like you said the hospital is not a jail. But it is a place (because they, under the standard, are unable to make an "unadulterated decision" about their health care) where they can go and get medically cleared, then discharged as Dr's see fit.

[Odorono]

Only problem is, they CAN'T refuse, if they are ETOH + AND underage. They have lost that ability, because the ability lies only with people who are competent to refuse (ie, not under the influence of drugs or ETOH). Now, to an extent, you can remove the ETOH once the person is 21 yo, because at that point, it is a LEGAL substance to engage in the use. It's similar to what happens to a patient if they have an illegal substance, outside of ETOH (meth, pot, coke, etc.). That's the one thing that people seem to forget, if you have been judged by DR's as medically incompetent to make a decision...then you have less rights than if you were in jail. A LOT less. Of course, it doesn't help that UMC is actually on the PROPERTY of the UofA, so PD CAN come in and bust someone without having been "called" by anyone.

On the flip side...the cops don't usually bust a "lone drinker." What I mean by that is...the guy who has had some ETOH, is underage, and does their own thing. Where PD usually gets them is, driving + MVC, driving + ETOH (usually doesn't come into the hospital), or so drunk they have made themselves WAY TOO OBVIOUS. And of course, the PD that cares most for underage ETOH is UofA PD, not Tucson PD.

This is kind of what fiznat and I are getting at; that mere consumption of a substance doesn't necessarily equal intoxication/ inebriation. And legality shouldn't dictate a pt's capacity to consent. Here in upstate NY, it's pretty much up the the cops if they will 22.09 a pt, which is a division of the mental hygiene law which states that a police (or peace) officer may detain a pt if they are determined to be intoxicated and unable to make their own decisions. This is selectively enforced, and seems to depend more on the officer's disposition than the pt's actual condition.

While I still maintain that AZ laws seem particularly harsh, I think we all have statutes which compel us to transport pts under the influence. I think the more interesting discussion revolves around how exactly we determine whether these pts are influenced by their alcohol consumption. I've run into more than a few who have consumed a weekend's worth by my standards but can still maintain a quite coherent conversation. So are they intoxicated or not? Do we rely on field sobriety tests, or just a relative standard based upon our own experience?

[Arizonaffcep]

I think you are still mixing up the responsibilities given to police officers and those given to us as medical providers.

I don't know of any statute, law, or protocol that regards the legality of an ingested substance as a factor to determine a patient's mental status. Unless they are in the custody of a police officer, there is absolutely no difference between an AxO criminal and an AxO law-abiding citizen as far as their ability to make medical decisions. We are not police officers, and the hospital is not a jail.

Again if they are NOT AxO that is a different story, but forcing underage (adult) drinkers who are AxO to go to the hospital is a recipe for disaster in my opinion. Before you do this, I would be absolutely sure of your local laws/statues and have them ready for the inevitable consequences.

Here's the thing though...they take those substances specifically to ALTER their mentation/perception of reality. With that in mind, how CAN they refuse if they are under the influence of them? From my own experience, those who have taken drugs (not specifically ETOH, sorry for the hijack) DO show they are under the influence and are not able to make rational decisions for themselves. Its not a criminal thing, so PD (unless they are already involved) doesn't come into play. We take them to the hospital for observation/treatment (if needed)-nothing goes on a criminal record, so to say we are doing PD's job is bunk.

[reaper]

So, in AZ do you have to take every pt that takes Benadryl to the hospital? It is a mind altering drug and they can not possibly make a rational medical decision while taking it!

[Arizonaffcep]

So, in AZ do you have to take every pt that takes Benadryl to the hospital? It is a mind altering drug and they can not possibly make a rational medical decision while taking it!

Good point, although I was getting at illicit drug use. However, beware AZ DPS (highway patrol)! I have seen them bust people who have taken Pseudofed, and are NOT having a reaction to it, but they crashed into a guard rail anyway. No joke...they carted her away in cuffs to jail. I theory, in AZ you can NOT have ANY substance (even caffeine) while driving. Quite the extreme, and you don't see them caring much for stuff like that...but you do run into the lone "looser" on occasion.

[firedoc5]

Good point, although I was getting at illicit drug use. However, beware AZ DPS (highway patrol)! I have seen them bust people who have taken Pseudofed, and are NOT having a reaction to it, but they crashed into a guard rail anyway. No joke...they carted her away in cuffs to jail. I theory, in AZ you can NOT have ANY substance (even caffeine) while driving. Quite the extreme, and you don't see them caring much for stuff like that...but you do run into the lone "looser" on occasion.

OUCH

[Arizonaffcep]

OUCH

The worst part was, she blew a tire on the interstate, over corrected and took out a portion of the guard rail. Not her fault, but they still arrested her for driving under the influence of Pseudofed. Even though it didn't have anything to do with it (mid-day, windy, alergy strewn day).