Ambulance Driver

Urban paramedics see a lot of drunks and I’m not talking about people who are merely alcoholics. Those who are able to hold down a job and navigate through life in a half-way decent fashion are not the subject here.

I want to talk about the Hall of Famers, the chronic inebriates, those who have not seen a sober moment in years and attempt, if they have found themselves sober, to do everything they can to remedy the situation.

Two patients in recent weeks stand out in the annals of drunkedness and merit some discussion. The first will be dealt with in this posting

This was a fellow that was found unconscious lying on a sidewalk.  He reeked of alcohol. His best response to hard pain stimulus was to raise his head and grunt. Despite this, his blood pressure, pulse, ventilations and oxygen saturation were normal. He had no sign of trauma and the blood sugar was normal. Given that my partner and I have over 70 years experience, we were able to quickly diagnose the patient’s problem.

He was drunk.

Now I know what you’re thinking – “Those medics are sharp as tacks.”

Well, its not quite that simple. Yes, he was drunk, but this is where a little discernment is required. This patient is not one of those who can just be taken to a facility where he can sleep it off. His level of consciousness was so decreased that he was in a potentially dangerous situation. It is also possible that my partner and I had completely missed something obvious – although we try not to let that happen, as a rule.  At any rate this patient needed to be taken to an emergency room where he would be monitored closely.

And I’m not talking about just any emergency room. Patients such as these need a place where the personnel are used to dealing with those deeply intoxicated and understand the need for close monitoring. Not all ER’s can be trusted with this in my opinion.

A lot of things can happen as they detoxify. They could vomit and aspirate at any time. They are in danger of hypoventilation, where they are so neurologically depressed that their breathing becomes so inadequate that they stop altogether. They can awake in a 2-3 hours and not fully appreciate why they are lying on a hospital bed and start throwing things around – like nurses.

So what we did was to initiate our protocols for an unconscious patient of unknown origin and transported to an appropriate ER. Once there we were asked if the patient could go to the area where the less intoxicated go to sleep it off.

Our answer was “no”, not until he is evaluated by a physician. The Doctor soon appeared and agreed that the patient was too “down” and needed admission to the main ER.

Up to this point, all of this is fairly routine. It’s what we found out next that makes this a little more interesting.

I don’t know how many of you have seen how a breathalyzer works but here is what they look like:

What you need to do in order to get an accurate reading is to blow HARD into that little plastic tube until the operator tells you to stop.

Well, for this patient, having him to blow hard was not going to happen, so they merely stuck the tube in his mouth and obtained a “passive BAC.”

Which resulted in a measurement of 0.419%.  This is the mark of a true professional.

But that’s not the end of it. A nurse walked in and shook her head stating, “He was in here 2 days ago with a blood-drawn BAC of 0.80%.”

Now over the years I’ve found that 0.50 isn’t all that rare. I’ve had several patients over 0.60 and even one who measured 0.65 who was standing erect, swinging his arms around and loudly telling everyone he was going to kick my ass.

I’ve heard of 0.75% at my hospital – but I’ve never heard of 0.80% BAC.

Think of it. First of all this guy had to drink enough to get to 0.80, which is quite an accomplishment in and of itself, but then he had to live through it. In addition to that, he had to sober up in the hospital, (and I’m sure that was an all-day thing)  gather his wits, get discharged from the hospital, get outside and say, ” Ya know, that was fun. I think I’ll do it again.”

Now, my readers not in the medical profession may chuckle and shake their heads. My colleagues may shrug their shoulders. What we all need to think about, however, is the impact of folks like this on our health care system and the costs incurred in taking care of this patient over a course of years.

It ain’t a pretty scenario. It is also something that no one wants to talk about.

My next posting will drive this point home.