Amy Eisenhauer Developed for Pulse Check 2016
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1 Amy Eisenhauer Developed for Pulse Check 2016
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3 Understand alcoholism, co-morbid diseases, and treatment options Possible emergent presentations Discuss societal and EMS perceptions of alcohol related illness
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5 Mayo Clinic: Pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking.
6 National Institute on Alcohol Abuse and Alcoholism: A pattern of drinking that brings blood alcohol concentration levels to 0.08 g/dl. Typically occurs after 4 drinks for women and 5 drinks for men. The Substance Abuse and Mental Health Services Administration: drinking 5 or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days.
7 Image from Mayo Clinic
8 Choice/Addiction Mental/ Physical Most commonly used addictive substance in USA; 1 in 12 adults More than half of all adults have family history of alcohol or problem drinking 4 rd preventable cause of death (88,000 a year) Alcohol impaired driving fatalities 9,967 (31% of all driving fatalities Nat l Institute on Alcohol Abuse and Alcoholism
9 CVA, dementia, neuropathy Cardiac: HTN, MI, Afib, cardiomyopathy Psychiatric Illnesses Unintentional injuries Increased risk for CA Liver diseases: fatty liver, cirrhosis, hepatitis GI problems And more Nat l Council on Alcoholism & Drug Dependence
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11 Caused by abrupt cessation of alcohol Mild: anxiety, diaphoresis, tachycardia, sleep disturbances Moderate into Severe: fever, confusion, hallucinations, seizures Most severe complication: delirium tremens, can lead to cardiovascular & respiratory collapse, arrhythmias, dehydration, multiorgan dysfunction (2 to 5 days after last drink) Critical Care Nurse Feb 2016
12 Binge drinking at high intensity Exceeds body s capacity to process alcohol Signs & Symptoms progressive: Slurred speech, reduced muscle coordination, vomiting, reduced level of consciousness, unresponsiveness 6 deaths per day related to alcohol poisoning Suicide attempt? Centers for Disease Control & Prevention
13 Not only from binge drinking Drinking other substances for alcohol content Nausea, vomiting, diarrhea Gastrointestinal problems Blindness Organ failure & death
14 Driving Under the Influence/ MVC (40%) Pedestrian Struck (40%) Falls Assaults Trauma Center patients (50% male, 40% female) American College of Surgeons
15 Maybe using alcohol or other substances for self medication (depression, bipolar disorder, PTSD) Increases risk for suicidal ideations and attempts (22% intoxicated at time of suicide) Journal of Injury Prevention
16 Medications Cognitive Behavioral Therapy (CBT) Support programs May require inpatient rehab including all the above Not a quick fix Tools without effort doesn t work
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18 Rape Murder Assault Domestic Abuse (offender) Homelessness Factor in 40% of all violent crimes Present in half of murders and assaults where victim, offender, or both have been drinking Nat l Council on Alcoholism and Drug Dependence
19 What s our automatic reaction when we hear that address or name? How do we speak with these patients? How does our demeanor change when we learn alcohol was involved in the incident? Do we take these patients seriously when they complain of non-alcohol related complaints?
20 Johns Hopkins Bloomberg School of PH, BCFD, Behavioral Health System Baltimore- Linkage to Addiction Recovery through Emergency Response (Ladder) 2014 Train BCFD EMS on addiction, enable them to better treat patient and refer them for further care Recruit 300 individuals for program with counseling and assistance addressing barriers entering addiction treatment Staff follows up 30 days later
21 San Francisco Sobering Center est Nurse managed program for those actively intoxicated on alcohol Pre-hospital diversion, accepting adult clients from EMS and PD Link to detox and rehab services Provide other services for homeless population ,000 encounters
22 Touches every socioeconomic group There but for the grace of God, go I. Difficult interpersonal relationships
23 Crossing the line Medical or Intoxicants Social experience Legal Ramifications SOP/ SOG Training (EV4EMS) Notes in CAD/ Dispatch All scenes are ever evolving
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26 Amy Eisenhauer Instagram: The EMS Siren Facebook: The EMS Siren LinkedIn: Amy Eisenhauer
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