Should ED nurses report blood alcohol levels of drunk drivers?
Should ED nurses report blood alcohol levels of drunk drivers?
As state legislatures pass laws permitting clinicians to report blood alcohol levels, opinions of ED nurses are sharply divided.
Any emergency nurse would agree that drunk drivers and their victims are too common a sight in the ED, but opinions vary as to how to combat this problem. Until recently, nurses were barred from reporting blood alcohol levels to police. Since 1995, five states have passed laws that permit reporting: Oregon, Illinois, New Hampshire, Indiana, and Hawaii (mandatory). Several other states may pass similar laws in the coming year, and legislation is being considered on the federal level.
The laws have affected the clinical practice of ED nurses, who are sharply divided on the issue. Some insist nurses have an obligation to society to report impaired drivers, while others argue it's a breach of patient confidentiality. (For arguments on both sides of the issue, see Point-Counterpoint on page 74.) The Emergency Nurses Association has taken no formal position on the issue, because its members were unable to come to an agreement.
Those who oppose the laws insist the nurse's primary obligation is to the patient. "By reporting drunk drivers, we may force them to face their problem with alcohol or drugs, but we also have a relationship with the patient that involves trusting that we'll keep what we find confidential," says Christine Dimitrakopolous, MS, RN, MICN, current president of the California Emergency Nurses Association and an ethics consultant for the Emergency Nurses Association, based in Park Ridge, IL. "We are not policeman, we are nurses, and our job is to care for that patient."
Police should report, not nurses
Instead of reporting impaired drivers, nurses should help to ensure that police do so, argues Dimitrakopolous. "Police routinely don't cite drunk drivers, especially if their injury is minor and no one else got hurt," she says. "If a drunk driver ran into a concrete barrier instead of a busful of children, they say, 'He'll be hurting tomorrow-why give him a ticket, he's been hurt enough.'"
ED nurses should urge police officers to have legal blood alcohol levels drawn and entered into evidence, Dimitrakopolous recommends. "You can encourage the officer to have a legal blood alcohol done without violating patient confidentially," she says. "Sometimes it's necessary to be pretty adamant, and say something like, 'Did you give him a ticket? He's out there killing your kids and mine?' Ask the police officer, 'Why aren't you citing him?' or, 'You cited him, why aren't you drawing blood?'"
Nurses should also reach out to impaired drivers, she advises. "You have an obligation to at least let them know there is help available and give solid referrals," says Dimitrakopolous. "It doesn't have to be confrontational, you can hand them a pamphlet and say, 'You may not want this now, but keep it.' You can't give them enough resources."
A 1992 national survey indicated that 78% of emergency room physicians favored mandatory reporting of blood alcohol levels with appropriate legal safeguards.1 However, this year the American College of Emergency Physicians took a position against reporting laws. "Laws that exist on the books should be enforced to their full extent before any new effort is taken," says Susan Nedza, MD, FACEP, president of ACEP's Illinois chapter, chair of the state legislation section, and a clinical faculty member at Christ Hospital in Elmhurst, IL
ED clinicians should make it easier for police officers to do their jobs. "We are very anxious to work with law enforcement officers to break down the barriers of obtaining legal levels," says Nedza. "Instead of saying, 'We're so busy with this trauma patient, we can't do the test.' We need to find ways to facilitate the efforts of law enforcement."
A high blood alcohol level on a patient's medical records can cause problems with health insurance and at the patient's workplace, Nedza notes. "The ED should be a safe haven of refuge for patients from all walks of life," she says. "If we start reporting, patients in need might be fearful and not come in for treatment," she says.
Reporting laws that aren't mandatory might also invite bias, argues Nedza. "Patients in certain socioeconomic circles might be reported more often than others," she says. "Permissive laws allow health care providers to select who you report on, which diminishes the effectiveness of the law."
Reference
1. Chang G, et al. Reporting alcohol-impaired drivers: Results from a national survey of emergency physicians. Ann Emerg Med 1992;21:284-290.
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