A Brewing Problem

Excessive alcohol use is responsible for approximately 88,000 deaths per year, and is known to be a contributing factor in motor vehicle accidents, homicides, suicides, sexual assault, domestic violence, and unintentional injury. Because of this, it is frequently the case that EMS professionals are called to a scene in which alcohol has been involved.

It is important for EMS personnel to understand what constitutes excessive drinking, which groups are at highest risk, and the health consequences of consuming excessive alcohol. They should also be able to recognize the signs and symptoms of acute alcohol intoxication and what treatment to implement.

Alcohol Consumption

Many people consume alcohol in a responsible manner, but some individuals run in to trouble when they drink too much. Guidelines put out by the Centers of Disease Control Prevention can help determine if someone is consuming an excessive amount of alcohol. Moderate or acceptable alcohol use for adults means up to one drink per day for women of all ages, and for men who are older than 65 years of age. For men younger than 65-years-old, they can consume up to two drinks per day.

Remember that even consuming alcohol in moderation is not risk free. Examples of what constitutes a single drink for different types of alcohol are as follows:

  • Beer: 12 fluid ounces
  • Wine: 5 fluid ounces
  • Distilled liquor (80 proof): 1.5 fluid ounces

Most of the major problems with alcohol occur when individuals abuse alcohol by excessive drinking. Excessive drinking includes both binge drinking and heavy drinking. Binge drinking is the most commonly seen form of excessive drinking and is defined as follows:

  • Female: 4 or more single drinks in a single occasion
  • Male: 5 or more single drinks in a single occasion

In 2015, a national survey conducted across the United States found that 7% of people ages 18 and older reported that they had engaged in heavy alcohol drinking within the past month. Heavy drinking is defined in the following way:

  • Female: 8 or more single drinks per week
  • Male: 15 or more single drinks per week

At-Risk Groups

There are several groups that have an increased risk of abusing alcohol by consuming excessive amounts. These include individuals who are:

  • Genetically predisposed to alcoholism or have a parent who abuses alcohol
  • Involved in high stress activities on a regular basis
  • Suffering from a mental health problem like depression or schizophrenia
  • Feeling a high level of anxiety or low self-esteem
  • Experiencing conflicts within relationships or have poor social skills

It is important to never assume that every high school/college student or homeless individual you encounter has a predisposition for alcohol intoxication. It is also important to remember that anyone can abuse alcohol. Do not become blinded by a person’s respected position in the community, elevated financial status, or high level of education and miss the important signs of alcohol abuse.

Health Consequences

The potential health consequences of excessive alcohol consumption are numerous and can be categorized into both short-term and long-term health risks. The short-term health risks are often the result of binge drinking and include the following:

  • Injuries: these include motor vehicle accidents, falls, burns, and drownings.
  • Violence: this include homicide, sexual assault, suicide, and spousal or partner abuse.
  • Alcohol poisoning: a serious medical emergency that is caused by very elevated blood alcohol levels.
  • Risky sexual behavior: this would include engaging in unprotected sex and having sex with, multiple partners. All of this increases an individual’s risk of contracting a sexually transmitted disease or having an unintended pregnancy.
  • Pregnancy issues: this would be things like miscarriage, stillbirth, and fetal alcohol spectrum disorder.

Over time, consuming excessive amounts of alcohol can lead to the development of several chronic disease states, health conditions, and behavior problems. These can include the following:

  • Cardiovascular disease: hypertension, heart disease, and stroke.
  • Gastrointestinal disease: cirrhosis, digestive problems, and esophageal varices.
  • Cancer: breast, mouth, throat, esophagus, liver, and colon.
  • Learning and memory problems: dementia and poor school performance.
  • Mental health issues: depression and anxiety.
  • Social problems: decreased productivity, relationship problems, and unemployment.

Assessment

In assessing a patient of whom you suspect is experiencing alcohol intoxication, look for the following signs and symptoms.

Signs:
  • The smell of alcohol on breath or clothing
  • A confused or dazed appearance
  • Poor coordination
  • Seizures or generalized tremors
  • Sweating
  • Reddened facial features
  • Agitation
  • Evidence of frequent and unexplained accidents
  • Evidence of poor nutrition or hygiene
  • Elevated body temperature
  • Hypertension
Symptoms:
  • Nausea and vomiting
  • Hallucinations
  • Abdominal pain and diarrhea
  • Loss of appetite
  • Numbness or tingling throughout the body
  • Depression

Due to the fact that many individuals who chronically consume alcohol can become tolerant to its effects or learn to mask their symptoms, assessing these patients can sometimes be challenging and will require extra vigilance on the part of the EMS professional. Because the alcohol can have a delayed effect on the body, it is frequently recommended to transport any patient who presents with even a mild level of intoxication. It is important to know and follow your local protocols regarding this issue.

Treatment

As there is no antidote to alcohol intoxication, the treatment is supportive in nature with rapid transport to an appropriate medical facility. Even in severe acute blood alcohol poisoning, the administration of activated charcoal is not indicated as alcohol is rapidly absorbed into the bloodstream through the gastrointestinal tract. Activated charcoal is used only if the individual has also ingested another absorbable toxic substance.

Like all patients, always begin by checking to make sure that their airway, breathing, and circulation are intact. Their vital signs and mental status should be routinely checked in order to monitor for any adverse changes in their condition. It is not uncommon for someone who has consumed large amounts of alcohol to vomit and, in their intoxicated state, there is a risk that they might aspirate. For any of these patients who are in a semiconscious or unconscious state, it is recommended to have a suction unit nearby in order to clear their airway quickly if they should vomit.

In addition, the patient can be placed in the recovery position to help clear their airway and keep it cleared. Alcohol has a suppressive effect on the respiratory centers of the brain so it may be that you will need to provide bag-valve-mask ventilation if the patient is not breathing adequately on their own.

Alcohol intoxication can cause some individuals to become violent and combative so it is important to be prepared for this when treating these patients. Aggressive actions or behaviors that jeopardize the safety of you or members of your crew should not be tolerated. If the situation cannot be resolved through verbal methods, it is advised that member of law enforcement be contacted to deal with the problem.

In situations where the patient becomes combative while being transported, if it can safely be done, pulling the ambulance over is often the best method to eliminate the risk of the patient causing a motor vehicle accident. Remember, regardless of the medical situation, your safety and the safety of those you work with is always a top priority.

Sources & More Information

EMS, “Acute Alcohol Poisoning” https://www.emsworld.com/article/11305965/acute-alcohol-poisoning

EMS World, “Prehospital Care of the Intoxicated Individual” https://www.emsworld.com/article/10324347/prehospital-care-intoxicated-individual

Centers for Disease Control and Prevention, “Fact Sheets – Alcohol Use and Your Health” https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

Mayo Clinic, “Alcohol: If you drink, keep it moderate” https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/alcohol/art-20044551
By Jeremiah Johnson, MD

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