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Discussion

Do you hold drunks against their will?

Something happened over the holidays that really bothered me. I work in an ER. A very intoxicated pt was brought in by EMS after passing out at home and having family member call 911. The pt was cleared medically. Nothing wrong but being drunk. This patient did not want to be at the ER and had initially refused transport from their home. This patient wasn't doing anything illegal; just drank too much at home. Once at the ED, the pt refused to stay in bed, so pt was placed in our psych room. Windowless room with no equipment in it, just a concrete block with a mattress secured to it so there is nothing a pt can hurt themselves with. When the pt refused to remain in the room and instead was walking around the unit, the mid-level provider seeing the pt ordered the door to the room shut and locked which is considered restraining the patient.

So, because this patient was minding their own business at home drinking during the holidays and ended up in the ED where they did not want to be, they basically were restrained. The pt was oriented to name, location, time, and situation and repeatedly voiced a desire to leave. Wouldn't have been driving as there was no car at the hospital. Was this false imprisonment or warranted for the pt's safety? Not my pt but I was nearby and heard everything.

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    We keep them (in med/surg) from ED until they're at least sober ...especially if they've been given anything like ativan. We don't lock them up or tie them down, we just waste our time chasing them all night and encouraging them to stay until the morning. They usually leave AMA at that point, which is fine with me. I hate that they end up at the hospital, but once they're there, I'm not comfortable letting them wander out into traffic.

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    • Experts

    A Patient with a high BAL may be held against their will, but a Certificate for Involuntary Admission needs to be completed.

    Locked Seclusion is a Restraint and requires a Notice of Restriction of Rights with continuous direct observation.

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    Yeah they need to sleep it off because if they walk in front of a car you're screwed. We put them on a stretcher in the hall in direct view of the nurses station. They preferred that to going to jail.

    I used to have a cardboard calculator for the weight based time frame for a drunk to sober up. Is there an app for that now?

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    why did the amb. crew bring him in??

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    why did the amb. crew bring him in??

    Liability. Family was concerned about the amount of alcohol consumed, drunk patient didn't want to go to the hospital. Whose side do they stand on??

    Well, there are a few instances where ambulance crews cannot accept a refusal from a patient: if they are minors, if there are psychiatric issues, and if there is impairment (alcohol or drugs). Pretty much if they are unfit to make decisions for themselves, you treat and transport under 'implied consent'. You assume that any reasonable person under similar situations would want medical care and treatment.

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    Liability. Family was concerned about the amount of alcohol consumed, drunk patient didn't want to go to the hospital. Whose side do they stand on??

    Well, there are a few instances where ambulance crews cannot accept a refusal from a patient: if they are minors, if there are psychiatric issues, and if there is impairment (alcohol or drugs). Pretty much if they are unfit to make decisions for themselves, you treat and transport under 'implied consent'. You assume that any reasonable person under similar situations would want medical care and treatment.

    but you do know what assume does, yes? i think the family was being twits. if he could answer the crews questions, that should have been the end of it. family needs to deal.

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    We try to keep them til they are sober. We would never force them into a locked room in seclusion. We will call security if they try to leave.

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    We administer a tryptophan bolus and then let them sleep it off in the hallway.

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    but you do know what assume does, yes? i think the family was being twits. if he could answer the crews questions, that should have been the end of it. family needs to deal.

    It does not matter if the intoxicated person can answer questions- they are impaired, they cannot refuse. They stay in the ED until sober, if they get out of control they are typically put in seclusion- we try to avoid giving haldol/Ativan but if necessary, we will. The only way an intoxicated person can leave us with a responsible party. We are 100% liable if something happens to them if we allow them to leave alone. Or, they can go to jail- typically, they choose us.

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    The police are called and they are put in protective custody in a jail cell for the evening. Or they stay with us and have a nice IV and a banana bag. And some wicked cool Zofran and some Ativan....all to help ensure that their hangover is non-existent.

    Impaired people can't refuse transport. Huge liability. But equally as liable is a secluded room with no windows and a cement slab for a bed and a door that locks. Who observes this? Is there a camera I hope?

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    Once they hit ".08 or can get a sober ride they can go

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    If the ED has to keep the drunk patient, what's to prevent every cop in town from bringing the drunks to the hospital, instead of to jail?

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