Give a Drunk a Brake

The costs of alcohol abuse are staggering, probably exceeding $250 billion dollars annually in the United States 1, 2. Nearly half of these expenses fall on the alcohol abuser and his family. Sidestepping financial consequences is a gigantic motivator to avoid being convicted of an alcohol-related offense. A good lawyer can help a client charged with an alcohol-related crime steer clear of the significant consequences a conviction would bring. One way to do this is by showing that prehospital records contain nothing suggesting intoxication. Fire/EMS providers can unwittingly provide exactly what the defense needs to help an alcohol abuser skate away from responsibility and treatment.

Pertinent findings – you’ve heard of the term, right? Pertinent Findings include significant things we document on the patient care report (PCR), usually so the next person treating the patient can address the problem. A crushed pelvis, tension pneumothorax, rigid abdomen, or dysconjugate gaze are all pertinent findings. They are also out of the ordinary, so we note them. Findings like slurred speech, staggering gait, gross odor of alcohol on the patient’s breath (AOB), depressed level of consciousness, glassy appearing eyes, and confusion are all out of the ordinary, too – really. You may have heard the statistic that alcohol is involved in just less than half of all fatal motor vehicle crashes 2, 3. I think that statistic is wrong. In my 25 years on the street, I’ve come to expect the odor of alcohol just about every time I intubate a motorcyclist in the back of my bus at 3 AM. Chest decompressions just wouldn’t be the same without the smell of booze in the air. Call me a cynic, but I’ll bet alcohol is involved in far more than half of all traumatic injuries. That’s a public health problem – one that deserves to be noted for treatment later on down the line.

It never occurred to me that my omitting the all too common signs of intoxication from a patient care report would come in handy for a defense attorney. However, it became apparent to me as a chief that some patients were requesting copies of their PCRs to avoid the consequences of their alcohol abuse. Armed with our records, the patient and attorney marched into court to demonstrate that the fire/EMS providers noted none of the usual findings of intoxication. When you, the recognized medical expert, fail to make mention of findings that suggest intoxication, your record can imply that the non-medical expert law enforcement folks on the scene were simply wrong in their evaluation. Medical evidence, which in many jurisdictions holds greater weight than assessment by non-medical law enforcement, becomes the means by which a conviction is dropped or charges lessened.

Alcohol abuse is a major public health problem and contributes significantly to trauma 1-3. Exam findings that corroborate allegations of intoxication must be recorded for your patient to get treatment for the drinking problem that landed him in your care. When those findings exist but don’t make it onto your report, everyone can lose. Don’t let it happen – give a drunk a brake.


References

1 Babor TF, Aguirre-Molina M, Marlatt GA, Clayton R. Managing alcohol problems and risky drinking. American Journal of Health Promotion. 1999 Nov-Dec;14(2):98-103.

2 Tenth Special Report to the United States Congress on Alcohol and Health. Economic analysis aids alcohol research. Alcohol Research and Health. 2000;24(1):62-71.

3 Centers for Disease Control. Alcohol Involvement in fatal motor vehicle crashes. Morbidity and Mortality Weekly Report. 1994 Dec 02; 43(47):878-879.


Mike McEvoy, PhD, REMT-P, RN, CCRN is the EMS coordinator for Saratoga County, NY; chief medical officer for the West Crescent Fire Department; and EMS director for the New York State Association of Fire Chiefs. He is a clinical coordinator and instructor in cardiothoracic surgery at Albany Medical College in New York and a member of the editorial advisory boards for Fire Engineering and fireEMS. Contact Mike at mcevoymike@aol.com.

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