Engine Company EMS, Fire EMS

Engine Company EMS: Responding to the Impaired Patient

Photo found on Wikimedia Commons courtesy of SBHarris.

 

By Michael Morse

Responding to an emergency involving an intoxicated person or persons is routine for an emergency medical services (EMS) engine company. The emergency may or may not be related to intoxication; in fact, being intoxicated does not make an individual immune to very real emergencies. As experience has taught us, intoxication actually increases the chances of an emergency happening to a person.

Most people who have had too much to drink are reticent to acknowledge this fact. Very few people who call 911 willingly offer their level of intoxication to the dispatcher. People calling on behalf of a friend or family member who is intoxicated, fighting mad, and out of control may conveniently leave those facts out of their conversation with the 911 operator hoping to avoid police involvement. Accordingly, EMS is dispatched without police, and the EMS engine is first on scene with a potentially volatile patient or crowd.

Impaired patients, family members, and strangers make a difficult job even harder. Deciphering a barely understandable monologue of an emotional, intoxicated person is difficult at best. Getting to the root of the problem and condensing it into a concise radio message is equally challenging. Finding out exactly what is wrong so you and your crew can begin triage and treatment is the most important task, secondary to scene safety.

 

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Assessing an impaired patient is a challenge. Often, another (less impaired) person initiated the call for help, and the patient you have been sent to assist has no idea why. An impaired person loses the ability to reason. Explaining to an intoxicated person that you need to stop bleeding, splint an extremity, or immobilize his spine is not as simple as it seems. Fighting with an impaired person seldom ends well, especially in crowds. Simply walking away from the problem until more help arrives may be considered abandonment if the patient crashes and suffers permanent damage.

So, what to do? I have found the following strategies to be effective:

  • Call for backup. All of the reasoning in the world will not control some people. The police are far better at controlling uncontrollable crowds than we are.
  • Avoid confrontation. Standing to the side of an impaired person rather than in front of him helps create the illusion of camaraderie rather than authority.
  • Be genuinely concerned for the patient’s emotional state, injuries, or problems. By showing concern, you build trust. Confrontational behavior triggers animosity, which leads to escalating confrontation.
  • Touch. If you must touch a patient, do so in a concerned, gentle manner so there is no chance of your touch being misinterpreted as aggression. A slight touch of the elbow while talking works well.
  • Talk. Asking good questions pertaining to the situation at hand will establish you as an outsider rather than a potential cause of the problem that prompted your involvement. Dialogue keeps the impaired patient focused on the existing problem rather than starting new problems (with the responders).
  • Be vigilant. Impaired people are apt to change in an instant. Just when you think things are under control, everything can change.

As annoying as they can be, intoxicated and impaired people are still people. Sometimes we have to get physical. Try to remember that whatever precipitated the encounter, it is not personal. The patient is not attacking you; he is lashing out at a shape, a voice, or a presence he perceives as a threat. Always avoid one-on-one confrontations. It takes many hands to safely restrain a person intent on not being restrained.

Impaired consciousness is a legitimate medical emergency. Try not to become jaded. Cynicism breeds contempt, which leads to poor patient care. A person’s mental state may have been compromised, likely by his own hand, but beneath intoxication lies the person that will reappear when the substance that caused the impairment wears off. The patient may or may not remember his encounter with you, but that is irrelevant. How you respond to the patient is what matters most. Treating everybody who comes into your care with dignity and respect reflects on you, your crew, and your department.

 

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Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.