How to keep intoxicated out of emergency rooms
When you call 911 for a family member or friend, you expect the paramedics will have the option to transport the patient to the best available care. Yet, emergency responders have no options.
The law requires transport directly to a hospital emergency room. Many of these people have “uncomplicated alcohol intoxication,” needing only time and basic monitoring to sober safely. These visits cost millions and contribute to emergency department overcrowding, reducing resources for those who have medical emergency needs.
California lawmakers have an opportunity to ensure patients receive the right care, at the right time and at the right place. Assembly Bill 1795, introduced by Assemblyman Mike Gipson, D-Carson, would give counties authority to allow specially trained paramedics to transport intoxicated adults directly to sobering centers when it’s determined they do not have an underlying medical issue.
Sobering centers offer a safe and effective alternative. California has sobering centers in operation from San Francisco to Santa Cruz and Los Angeles, Alameda County to Santa Clara County, San Diego to San Mateo.
At these centers, intoxicated adults are provided frequent monitoring and care, and most programs offer direct access to drug and alcohol treatment facilities, shelter and social services, and case management. Their staff are specialists in drug and alcohol-use disorders. These facilities are accessible to intoxicated persons, referred by clinics, police, emergency rooms and street outreach teams.
In the more than 10 years I have spent working in sobering facilities, through conversations and in surveys, clients frequently state they find the centers to be safe, accepting spaces where they can be cared for without judgment and stigma. Breaking down the walls of mistrust and overcoming the effects of trauma is paramount to increasing both patient safety and improving health and social outcomes.
The connection to stabilizing and treatment services is paramount. Many emergency departments and clinics do refer individuals with alcohol-use disorders to treatment. But sobering
center staff offer a level of dedicated engagement not available in standard health care environments.
First and foremost, AB 1795 is safe. Research shows a paramedic can evaluate an individual to see if a person is only intoxicated or if they may have other acute medical conditions. In three studies published in the Annals of Emergency Medicine, American Journal of
Emergency Medicine and Emergency Medicine Journal, results indicate paramedics and emergency medical technicians could make transport decisions safely using a triage checklist, assigning intoxicated individuals with no other medical need appropriately to a sobering facility.
A review of sobering programs in California also demonstrates a track record of safe and appropriate care. Since 2003 one California sobering center pilot program has cared for more than 15,000 intoxicated individuals referred by ambulance. Another survey found that in nine sobering centers over 90 percent of clients sobered safely without emergency-level medical or psychiatric care.
Transferring intoxicated clients to sobering centers opens beds in the emergency room and decreases overall wait time for care. Emergency nurses and physicians should be able to focus on patients with complex, critical and often-fatal conditions.
AB 1795 gives paramedics choices to help ensure the best care option for those intoxicated, and for those who require emergency-level care for often-critical conditions.