ED nurses can save lives by reporting drunk drivers
ED nurses can save lives by reporting drunk drivers
By Carol Bonnono, RN, CEN
Emergency nurse
Oregon Health Sciences University Hospital
Portland, OR
ED nursing exposes us to many difficult situations. One of the most frustrating and heartbreaking situations is caring for drunk drivers and their victims. These patients are hard to care for not only because of their intoxication, but also because of the emotional conflict we as caregivers face. Often, the victims of drunk drivers are critical-or dead-in the next room or died at the scene. The frustration comes when attempting to get these troubled individuals into the established system that intervenes, treats, and prevents future fatalities.
Due to current confidentiality laws in many states, nurses are not allowed to report the blood alcohol levels of drivers suspected of involvement in motor vehicle crashes. Patients are most often released and do not receive the benefit of intervention for their alcohol abuse.
In Oregon, we've had a blood alcohol reporting law in effect for two years, and initial reports show it is making a difference. Last year, alcohol-related fatalities increased nationally by 4%, but in Oregon, they were down by almost 1%. I believe the reduction in fatalities is related to the new law permitting ED personnel to report blood alcohol levels to law enforcement. Drunk driving crashes are predictable and can be prevented!
Many hospitals are sanctuaries for drunk drivers. A three-year study beginning in January 1987 at Emanuel Hospital in Oregon found that once a patient enters the hospital after a drunk driving collision, they are rarely issued a drunk driving citation. This problem is not unique to Oregon. Another published study found that not one of 56 alcohol-impaired drivers, injured seriously enough to warrant hospital admission, was convicted for driving under the influence. The likely outcome for an untreated alcoholic driver is another crash.
Driving is a privilege, not a right. By allowing drunk drivers to avoid the legal consequences of their actions and intervention into their alcohol abuse, we become enablers of their disease. We must take advantage of these times when intervention will be the most effective. The hallmark of alcoholism is denial; crises are the most common events that allow persons with alcohol problems to break through their denial. Many alcoholics enter the health care system only through the door of EDs and trauma centers. Research has demonstrated that the attendance rate of persons required to attend outpatient alcohol treatment as a condition of probation is much superior to that of voluntary patients.
As nurses, our duty lies not only in caring for the injured patient, but also in the prevention of injuries and fatalities. More and more, attention is focused on society's right to safety and protection.Medical personnel are required to report a wide variety of confidential patient situations such as suspected child and elder abuse, various communicable diseases, and assaults with weapons. The car is a lethal weapon. We know that drinking drivers kill and injure more people than all the violent criminals put together.Hospital blood alcohol reporting will allow health care professionals to be socially responsible and help stop drunk driving fatalities.
Blood alcohol reporting of suspected drivers involved in crashes does not make police officers out of nurses. It will enable us to save lives and get the patient mandatory alcohol evaluation and treatment before there is a fatality. After a drunk driver kills someone, then there is a public outcry to throw them in jail--but by then it's too late. The time to get involved is before a death occurs.
References
1. Bachulis BL. The injured drunk driver: A study of driving under the influence of intoxicant charges and the criminal profiles of these drivers. Emanuel Hospital and Health Center, 2801 N. Gatenbein Ave., Portland, OR 97227.
2. Maull KI, Kinning LS, Hickman JK. Culpability and accountability of hospitalized injured alcohol-impaired drivers: A prospective study. JAMA 1984;252:1880-1883.
3. Gentilello LM, Duggan P, Drummond D, et al. Major injury as a unique opportunity to initiate treatment in the alcoholic. Am J Surg, 1988:156:558-561.
4. Ibid
5. Soderstrom CA, Cowley RA. A national alcohol and trauma center survey. Arch Surg. 1987;122:1067-1071.
6. Reyyna TM, Hollis HW, Hulsebuss RC. Alcohol related trauma: the surgeon's responsibility. Ann Surg 1985;201:194-197.
7. Rosenberg CN, Liftik J. Use of coercion in the outpatient treatment of alcoholism. J Stud Alcohol 1992:21:284-290.
8. Jonsen A, Siegler M and Winslade W. Clinical Ethics. New York: McGraw-Hill, Inc.; 1992.
9. Oregons' Tough DUI Law, Be Ready-Report Every Drunk Driver Immediately. (brochure) Oregon Traffic Safety Commission, State Library Building, Salem, OR 97310.
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