Editor’s Note: This originally appeared as the Ask Doc in the Jan/Feb 2008 Journal.
Rawlin Sowell of the Woodland Park Police Department (Colo.) asks:
Why isn’t there a specific determinant code for an overdose of alcohol? After all, it is a frequent call and there are determinants for many other types of drugs that are ingested.
Rawlin:
This is actually an age-old question that has trickled in for almost 30 years and involves two issues.
Alcohol as an overdose is not necessarily uncommon but may not come in reported as such. There are not really any special considerations or treatments so it is lumped into the generic group and not given its own determinant code. Level of consciousness (LOC) is the key concern for assessment. Once the patient becomes not alert or unconscious, any information from the patient may be difficult to obtain, such as other medications taken or concurrent medical problems, etc. These patients, when the cause of their condition is initially unknown, will generally be coded into either Protocol 26 or 31 depending on their condition. Again, the LOC will drive the level of coding in these cases.
We have specifically avoided having any “alcohol” pigeonholes in the MPDS® since these would be heavily abused by calltakers when dealing with patients reported to be “drunk.” While true drunks are the bane of public safety, the ability to sort out who is only drunk vs. drunk with medical problems, drunk with diabetes, drunk with internal injuries, drunk with subdural hematomas, drunk with hemophilia (actual local case—and botched release at scene death—in the ‘70s) is difficult for field responders and even ER personnel, much less dispatch. Without Dr. Whatshisname’s Tricorder diagnostic tool on Star Trek, we must basically “eat” these patients and let the ER sort them out—as much as they hate doing it. Not our call. Sometimes in the ER, the traditional well observed “sleeping it off” treatment is the only diagnostic that works—and it takes hours.
In addition to Dr. Clawson’s comments, Brett Patterson, the Academies’ Council of Research chair, has also provided some input at the Doc’s request:
I would only add that there is no "diagnosis" more eagerly sought by callers, EMDs, and field personnel than "s/he's drunk." Pure alcohol overdoses do occur and are confirmed by a physician with the help of a lab. However, the MPDS is symptomatically designed to determine pre-arrival and response need. In this case, to be safe, my bet is on the ER physician.
