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Jail or ER: An easy choice for drunks

What is the motivation behind the police asking alcohol intoxicated people to choose jail or the emergency department?

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The goal of SOBER is to reduce the number of times that so-called “super-users” of the 911 system require visits to the emergency room.

Photo/SCPR

Does this happen in your EMS system, too? Share your thoughts in the member comments section below.

I think it is fairly safe to say that all of us who work in the prehospital arena have fairly thick skin. What other profession can take care of a bloody motor-vehicle collision and then happily eat spaghetti for dinner without a second thought?

In the same vein (no pun intended), many of the things that occur in the ER really don’t bother me much; it’s just our chosen profession.

There is one thing, however, that drives me insane, and I feel helpless to do anything about it. My hope is that in writing this, I can find out if I am the only person in the EMS world to whom this happens. If I am not alone, maybe one of you reading this can figure out if there is there anything we can do about it.

The inciting event is actually fairly simple. In my city, often times, EMS will transport a gentleman (or lady) who is under the influence of alcohol. Over and over again, the medics bring them in, and usually with the same report: “The patient was found to be drunk, asleep somewhere.”

The police call EMS, then give the patient a choice: jail or the ER. Hmmm, let me think. Of course, the “gentleman” (many are urban outdoorsmen) chooses the emergency department and EMS is committed to transport to my ER.

As an aside, if the patient told the police that ‘No, I’d rather go to jail’, the medics should bring him to the ER anyway, since he must be loony! But I digress…

Now, for the next several hours, we will be watching as the “gentleman” slowly become less drunk. Depending on his personality, we will get to see a wide range of behaviors, sometimes tearful, often times loud and many times violent. Eventually, he will end up urinating in the bed, ask for some food and head out of my ER.

However, for the hours they are here, these patients certainly represent a time-consuming and frustrating endeavor. For most of my nurses, they feel that their own time and talents could be better spent taking care of other patients. Nevertheless, I am always impressed with what a good job my nurses do with such challenges.

Also frustrating for the police

For the life of me, I have been trying to guess the motivation of the police. The only one that I can think of, and I may be wrong, is that it is less hassle for the officer. They don’t have to transport someone in the squad car who smells bad and will probably vomit. They don’t have the hassle of paperwork to get him booked, especially when they know he may be back out on the street tomorrow.

That has to be terribly frustrating to the police. The sooner the officer can get him taken care of, like off to the ER, the sooner the officer can get back to more meaningful service for the community.

Now don’t get me wrong. I have the utmost respect for our police force. They are good people who are in the trenches like us. I hold them in high regard, as I do our military. These are men and women who daily put their lives on the line for the rest of us, dealing with some rather unpleasant elements of human existence. They deserve our gratitude and respect.

At worst, they have to end up in a position where people are pulling guns on them; at best they tolerate boring hours filling out paperwork as we do. As such, I’ve been giving them the benefit of the doubt for a long time, and I am willing to hear their side of the story. Maybe then it won’t drive me as crazy as it does.

So, to my police officer friends reading this, let me say: I am not talking about those patients who are so drunk or altered, that they can’t walk, or the ones you are really worried may have something else going on that is causing their altered state. Please bring those to me, so we can sort it out. That’s not your job. It’s mine! But if you are willing to do that, in the spirit of fair play, when I am able to medically clear the patient, then let me call you and make it your problem.

How do you handle drunk patients that need something other than an ER?

If this happens to you in your EMS system, please tell me about it. If you have a solution, then please let me know in the member comments section. Finally, if you can explain things so I can at last understand this and let it quit bothering me, please, I beg you, write!

I look forward to hearing from you.

Robert Donovan, M.D., FACEP, is an emergency physician with a broad background in both pre-hospital and hospital medicine.