EMS transferring patients to a detox facility rather than the ER

January 12th, 2015

Every ED experiences an influx of inebriated patients each year who drain the hospital and ED of necessary time and resources.

Trying to find a solution to this population, and with the knowledge that certain inebriated patients may be safely transported by emergency medical service (EMS) ambulance crews to a detox facility rather than the ER, with minimal adverse events, a study was conducted to evaluate this theory.

The study, run by providers in Colorado and published online, evaluated inebriated patients using a 29-item checklist to determine whether patients could safely be transported to a detoxification center instead of the emergency department by paramedics. The checklist was developed by EMS officials, emergency physicians, emergency nurses and detoxification center personnel. The criteria that most commonly excluded patients from being taken to the detoxification center were inability to walk and unwillingness to cooperate with a physical exam.

The detoxification center was equipped with a 24-hour nurse and technicians, and consultation was available by phone with a physician's assistant and a psychiatrist.

"Widespread use of this type of protocol has the potential to provide significant financial savings for the U.S. health care system," said lead study author David Ross, DO FACEP, an emergency physician with Penrose-St.Francis Health Services and medical director of American Medical Response in Colorado Springs, Colo. "This population is very frequently transported to the ER by EMS or police, consuming a disproportionate share of resources and contributing to ER overcrowding. A detoxification center is a good alternative to the ER for certain intoxicated patients who just need an appropriately staffed facility to 'dry out.' Our research suggests that EMS personnel can identify patients who are safe for this alternative destination."

The study, which was conducted between 2003 and 2005, included 718 inebriated patients. Of those patients, 138 were transported to the detox center, while 580 were transported to the emergency department. Of the 580 patients who were taken to the ER, 339 were determined to require emergency care.

"We believe our data suggests that paramedics with specific training and protocols can safely identify patients who are appropriate for direct transport to a detox facility," said Dr. Ross. "Since the period described in our paper, we have been able to refine our protocol further and have substantially increased the number of patients taken from the field to detox instead of the ER, without any adverse consequences."