What happens when EMS forced to bring drunks to ER

[Hawaiian]

Great article about how EMS rules in some cities are jeopardizing patient care.

http://nycrn.blogspot.com/2010/06/cant-get-cab-hail-ambulance.html

[canoehead, BSN, RN]

They get vitaled, and diapered, and IV fluid. They usually are physically and verbally abusive to everyone around them. They are a fall risk but refuse to lie down and stay put. They wake up with a minimal hangover, get a good breakfast and are sent on their way. Better service than a 5 star hotel.

[classicdame, MSN, EdD]

HOWEVER, they are not driving a car that could kill innocent people

[casi, ASN, RN]

HOWEVER, they do bring in minimal reimbursement for the bed they occupied. They are also wasting a bed for someone who potentially needs the bed a lot more.

[Freedom42]

In many cases, they're also receiving treatment for a chronic illness. The "article" cited by the OP is not an article. It's a screed by a frustrated nurse who passes judgment. It says as much about the nurse as it does about the drunks.

[Julia87]

most patients like this are a drain on resources and a drain on people. The are not productive citizens and simply abuse the system because they continue to get away with it. It's patients like this that makes you wonder if debter's prisons did serve some small value to society. Perhaps the police could take this guy to the drunk tank for the night.

[FlyingScot, RN]

In many cases, they're also receiving treatment for a chronic illness. The "article" cited by the OP is not an article. It's a screed by a frustrated nurse who passes judgment. It says as much about the nurse as it does about the drunks.

Really? Seems to me the blogger is passing judgement on our current healthcare system not on the patient and I agree with him. There is something very wrong with a system that forces people with chronic illnesses or who just need something to eat to tie up EMS and a critically needed hospital bed just to get their needs met.

[JBudd, MSN]

We had one FF come in because it was raining, worked up 3 times in 24 hours, kept insisting he would have seizure in his tent if we made him leave again. We had IV loaded him with anti seizures AND given him a supply of his pills. He would get escorted off the property, walk as far as a phone, call 911 and show back up. Our doc that night said "Look, you cannot live here", and his reply was "but why not?" , and was sincere about his question!

She gave EMS permission that night to refuse to transport him again for the night (unless of course he was actually in distress)

[blondy2061h, MSN, RN]

In school I felt like all I ever saw in my ER clinical days were drunks some days. Got to give a lot of IM thiamine.

[colton_waite]

I am also an EMT it makes me so mad that drunks a ride to the hospital. We had a pt that broke there leg and we took them to the hospital and had to transfer them to a bigger facilaty because of the way the break was but boy was that person so annoying. It makes me mad that we have spend time care for idiotsike these when we could be taking care of some one more seriously hurt. Am I wrong or what

[EricJRN, MSN, RN]

On the issue of intoxicated patients being transported to the ER, EMS is really just stuck between a rock and a hard place - knowing that the ER doesn't want them, but working under policies that dictate something else.

This patient is drunk. Heck, the patient admits to being drunk. He doesn't want to go to the hospital, we don't want to haul him in, and the ER surely doesn't want him. But TPTB have decided that because he's under the influence, he can't refuse. Even if there's not really another single thing wrong with him, most systems say that a drunk patient must either go with the police or be transported to the ER. If PD won't take him, guess who gets him.

I understand it, in part. In more than a few instances, providers have made grave assessment errors. Their patients weren't drunk at all, but instead in DKA or stroking out. So this is where we are now. Easier just to take 'em all in.

The scene played out over and over again in my EMS days.

Triage nurse: "He's drunk."

Me: "You said it, not me."

Triage nurse: "So why'd you bring him to the ER?"

Me: "Our medical director made me."

Over and over again...

[medicrn13]

Like Eric, I too have some experience in the EMS field.

It was always impressed upon me that these patients could be experiencing other medical problems, vis a vis DKA/Stroke/hypoglycemia...etc etc....

The situation gets muddled even further when the patient has been involved in a fight and has a head injury...had that happen numerous times.

However, I as an EMS provider have had multiple occasions where I've called the doc and said something to the extent of:

"Pt does not want to go to the hospital...we have a sober party here who says they will take responsibility for the patient....can we sign them off?"

Nine times out of ten the doctor has said yes when all vitals are stable and the assessment was benign.