EMS Transport vs PD Incarceration

[caption id="attachment_3579" align="alignleft" width="240" caption="Drunk Girl - Crossfirecw"][/caption]

When people call 911 for an intoxicated person, which amazes me to begin with, I have to wonder why the badges start to bump into each other.

"Code 3 for the PD request" is a call classification I hate hearing because it means the call taker has not completed a triage of the call.  There is a glitch (yes, I'll call it a glitch because if this is done purposely I need to fix it) that allows PD to bypass call triage and get an amulance immediately.

There is no reverse for this system.  When I request PD code 3 I get barraged with questions.  And when I'm fighting someone no less.  When I get on scene to the PD request, they are most often standing, looking at someone.  Not providing care (which they usually don't need to and are not trained to do), so why not take the time to classify their call too?

Who knows.

The reason this is fresh in my mind is because on a recent run with our boys in blue I was told "We're not arresting him, it's too much paper work and too expensive for the department to hold him until he sobers up."

I stood up and cocked my head aside.

I responded that our paperwork is just as burdensome and the cost was exponentially more to the same city for what he was requesting.

Drunk is not an emergency, nor is it necessarily an arrestable offense, so what do we do?  If a person is unable to refuse transport (meaning unable to sign, not that they don't need an ambulance, which they don't) we're trapped in a way.  We HAVE to take them and the ER HAS to accept them, meaning the actaul patient we bring in later has no room and has to be diverted.  This is not an argument to have on scene. When on a run THAT patient is your concern, not the next one.  Let me worry about the next one.

This is an opportunity for a third service to step in and handle intoxicated individuals.  We do have "sobering centers" although I'd reclassify them as ambulance drop-in and pick-up zones with a 2 hour waiting period.  We take people there in an ALS ambulance, then when they awake and vomit, the center calls us back code 3 for the "unconscious."

Public intoxication is more common in my area than sudden cardiac arrest, yet there is no tool in my kit or on my radio to help.  The van service for shelter and detox requires a person to be ambulatory and climb in the van unassisted.  Most folks that meet that metric wander away when they hear us coming.

So why not let them sleep it off in the holding cell at the local PD?  I'm sure there's a person there to monitor them and it is remarkably less expensive than an ALS transport and hospitalization.

But that's not where they belong.  That is not the right place for them.

But the hospital is the more inappropriate place for them.  Why not check them out in the field, clear them of life threats (which the triage nurse will do from 100 yards) and let them sleep it off somewhere less expensive than an ER?

Motorcop?  Trauma Pig?

Turfing them to me is easy for you, but not for us, nor for the citizen.

Fodder for a Crossover indeed!


P_G_S said…
Actually, we get that a lot.  Most often it's "Respond to the police station, holding area for a psych eval".  We arrive and find...a drunk.  Not a diabetic, not a medical, not a chest pain...a DUI drunk.  Sometimes they're not even drunk, they are just over the limit for driving.  In fact, we have been told by more than one "they gave me a choice, to go to the hospital or go to jail".  Yeah...then we transport and dump them on the hospital.  In the process we take an ALS resource off the road and tie up resources at the hospital. 

We've been trying like hell to get that PD policy changed and it's getting there but we still have a ways to go.
Hilinda said…
Had a situation recently that brought up a lot of the same questions. Patient did not want to go, was "alert" as far as answering questions- but was shaking, falling off the chair, and couldn't stand up. Then got pissed off, aggressive and belligerent, which did not please the cops. There was really no appropriate solution available and I'm pretty sure no one was happy with how it turned out.
Another part of this is that I , like you, find it amazing that people call 911 for an intoxicated person. Most of them, by far, don't need a hospital.  And the few who do?  Seems like people don't call for those.
It's a mess.
Paul said…
I haven't been in EMS for 10 years now.  Reading your blog makes me sad sometimes.  Like this one.  We had the same problems back when I was involved.  I don't know about now but then it was a combination of PD not wanting to deal with the drunk and CYA for the cities.  It all ended up in EMSs lap to deal with and I don't think anyone thought about the cost of it all.  The only LEOs that seemed to deal with it thoughtfully were the State Patrol guys. (Maybe the State realized that they would be footing the ER and ambulance bills in the long run.)
Too Old To Work said…
It's all about the liability. Well that and not wanting to deal with smelly drunks. Around these parts, the shelters will not take in intoxicated people, even if they can walk. How they make that determination, I don't know. The police have no good facility to handle these drunks, as you point out. It would make sense for the hospitals to do it, if they could bill for it, and if they could not have to staff and equip the unit, room, whatever, as a medical facility. Unfortunately, they probably can't bill for it, they do have to equip and staff it as a medical facility, and they probably would have a hard time finding people to work in it.

So, what happens? We get called. Unlike you, our bypass works both ways. The only question the cops are asked (by their dispatchers) is if the patient is conscious and breathing. Which is about all we expect and often more than we get from our own call takers.

Our only saving grace is that we send a much less expensive to operate BLS ambulance most of the time.
CombatDoc said…
I have a different thought on this Happy.  Why not sign them off If questions can be answered to determine an appropriate LOC.  Typically they are alcoholics and have no life threats and just want to sleep it off.  I call the ER and speak with the doc and then do a refusal on them.  PD does not "like" this but they will get over it, there is no reason to transport them to a hospital unless they want help for their alcohol problem or they have an immediate threat.  I was always taught that when transporting someone against their will it is because we are intervening on their behalf because they have an actual medical problem or life threatening injury and their decision making is altered due to intoxication or other reason.  If there is no immediate threat to life that a reasonable person would request us for, then there isn’t a need to transport against their will and accept their refusal.  After all we will accept a refusal from someone having a STEMI as long as they understand the risks.  PD made the contact with the patient and is just as liable for their safety as EMS is, I am sick of them being lazy and wanting to get back to Pizza Hut so they make it an EMS problem.  I am also sick of the "Liability" catch all, we are clinicians and usually we have enough knowledge and experience to make appropriate judgment calls in the field.
Burnedoutmedic said…
your area too with the non-traiges? i wonder why that is...

i miss "get out of my beat or i'll thump your skull."
Tobias Schmidt said…
In old gemany the correct process for drunks differs by regions.
Usually drunks are triaged by whomever arrives first in three categories:

1. walking and "alert": PD or cab to his flat
2. requires help walking: PD or Hospital, depending on how swamped is either, and how cooperative is the patient (and the medic or cop)
3. different levels of unconsciousness: Hospital

All drunks get a normal assessment so there won't be bad surprises. 
Fortunately we don't need a physician for treat and release, although in difficult cases the emergency physician or primary care physician will be called to the scene for further assessment(or to turf responsibility).
A physician is also called in cases that have court potential, because to claim doctors confidentiality a doctor has to have been on scene.

Formally PD runs through the same questionaire at dispatch as does EMS with the police. In favor of good relations this requirement is often relaxed an when a crew request police backup or a cop an ambulance with lights and sirens they usually get it.
the Happy Medic said…
Indeed, I consider most of these folks citizens, not patients, until they roll over and ask to be taken to the ER.  When they refuse and tell us to get lost, we usually do.  All they have to do is get up and walk away while I tell them the risks.  Then it's entirely their idea, not mine.  PD is not liable for their safety the second they call EMS, at that point the perceived liability of this person doing something transfers to me.  I want to be able to transfer it to someone better qualified who can actually solve the problem, then get my crews back in service.  This section of the population represents 10-20% of our calls, yet we have nothing for them.  If SCA was 20% we would be the location of landmark studies and drug trials.  Thanks for reading!
the Happy Medic said…
TOTW, why do you have to brag like that?  We had a BLS tier, but with the puncturing of skin for a BGL still not considered a BLS skill here (It actually hurt to type that) each and every person hard to awaken is having a diabetic emergency until proven otherwise. The old BLS tier failed for this reason, I'd like to see it back, mainly staffed by paramedic student EMT's who may not be able to treat ahead, but can think ahead.  California Dreaming...In New Mexico, one of the most advanced EMS states, it was easy, here it is a nightmare.
Hellow said…
I havent read the other comments, but I think San Mateo County has a "First Chance" program where they drop off DUIs and if I remember correctly, people who are drunk in public.
[…] has been a paradigm shift in this country.  Being drunk on a street corner, or sleeping on a park bench used to be society’s problem.  With the introduction of a cell […]