Creating, Implementing, and Evolving an Alcohol Refusal Policy for Intoxicated Patients
- 1 minVirtually all collegiate EMS providers encounter a college-aged patient intoxicated from the classic “two beers.” While these patients may require evaluation by prehospital providers, hospitalization for some may be unnecessary and these patients may be allowed to refuse further care and transport. Yet, in the age of liability where collegiate agencies face scrutiny from college or university administrators in addition to medical directors, facilitating a patient refusal is often difficult and inherently risky.
At the 2019 annual conference of the National Collegiate EMS Foundation, I presented a lecture which examined the development, implementation, assessment, and evolution of an alcohol intoxication refusal protocol for a collegiate EMS agency. This presentation explored the multi-year evolution of Carnegie Mellon University’s agency-specific alcohol refusal protocol from an initial, unofficial set of criteria to a comprehensive, research-based policy developed and iterated between multiple agencies and departments. We reviewed the medical and legal essentials for evaluating intoxicated patients, offered guidance and criteria useful to determining patient outcomes, and provided agencies with the necessary elements to think critically about their own processes for allowing intoxicated patients to refuse transport.
Learning objectives for audience members included exposure to the progression and development of a new medical protocol. Audiences were introduced to the processes of managing complaints from patients and partner agencies, developing evidence-based protocols, integrating new procedures into an existing operational frameworks, training providers to new standards, re-evaluating protocols after implementation, and updating protocols to address problems identified during re-evaluation. Specifically, this presentation provided audience members with the understanding of how joint collaboration and the willingness to iterate and modify existing protocol can improve clinical outcomes while allowing collegiate EMS providers to retain control of patient care. Additionally, we covered aspects of patient care for intoxicated collegiate students, and briefly detailed the medical foundation of the policy.
Header image source: Carnegie Mellon University Alcohol Intoxication Refusal Policy and Checklist.
Tom Goode
Data Scientist & EMS Researcher