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Developing Best Practices Of Emergency Care For The Alcohol Impaired

Patient

Number 255 September 2001

U.S. Department of Transportation

National Highway Traffic Safety Administration

400 Seventh Street, S.W., Washington, DC 20590

Developing Best Practices Of Emergency Care

For The Alcohol Impaired Patient

The National Highway Traffic Safety Administration (NHTSA), the American College of Emergency

Physicians (ACEP) and the Emergency Nurses Association (ENA) sponsored a national conference

on June 2, 2000 in Washington, DC. The conference brought health care professionals together to

develop best practices of emergency medical care for the alcohol-impaired patient. The

conference was a part of an ongoing Partners in Progress initiative to increase health care

professionals involvement in transportation issues and to contribute to the national goal of

reducing alcohol-related traffic deaths to no more than 11,000 by the year 2005.

The conference followed up the recommendations of the Partners in Progress: An Impaired

Driving Guide for Action report (See Traffic Tech 163, 1997). Partners in Progress recognizes

physicians, nurses, and paramedics as key partners in reducing impaired driving consequences

because of their intimate in-volvement with the results of alcohol-related crashes and their

frequent interaction with the population known to be high risk for impaired driving.

Patients with alcohol use problems (AUP) are more likely to drive after drinking and have both

higher rates of illness and motor vehicle crash injury than the general population. Health

promotion and prevention mandates a structured approach to these individuals. Patients with AUP

frequently come into contact with the emergency medical services system, from pre-hospital

through the trauma center, as a result of their high risk behaviors. Treating this disorder leads to

reductions in impaired driving episodes, which in turn leads to fewer alcohol-related crash

injuries. Emergency physicians, nurses in the emergency department and trauma center, and prehospital providers in the field have a unique role to play in the identification of the disease,

patient education and intervention, and referral for formal evaluation and treatment.

Screening for the disease and appropriate intervention and referral are not widely practiced in

emergency medicine and trauma, thus missing a prime opportunity for prevention of an epidemic

disease. Moreover, many of these patients may interface with the medical system only through

emergency medicine or trauma care, particularly at early stages of their disease when they can

benefit most from intervention and treatment.

During the conference, a best practice strawman for physicians, nurses, and prehospital

professionals was presented and participants provided input about the strawman and ultimately

into the development of best practices for each area.

The following Best Practices are intended to serve as the basis for changing how patients with

AUP are treated in the ambulance, the emergency department, and the trauma center. The full

report contains notes about the recommendations.

Recommended Best Practices for Pre-Hospital Professionals

1. Assess the patient and document signs and symptoms of alcohol use problems; assess the

environment for alcohol-related risk factors.

2. Report alcohol use problems (AUPs) to hospital personnel.

3. Assist with on scene information and referrals for AUP patients.

4. Provide care for alcohol-impaired patients in a professional and non-judgmental manner.

5. Advocate in the community for public education, prevention programs, public policy, and

treatment programs for AUP patients.

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Traffic Tech Publications | National Highway Traffic Safety Administration(NHTSA) | U.S. Department of Transportation

http://www.nhtsa.dot.gov/...mID=0ba1cd8c4e7bff00VgnVCM1000002c567798RCRD&orderTrafficTechSelect=3D&trafficTechYearSelect=2001&overrideViewName=Report[5/28/2009 3:59:26 PM]

6. Participate in collaborative research, education, and data gathering to improve the care of

patients with AUPs.

7. Integrate alcohol screening and alcohol education into curricula, continuing education, and

standards for emergency health care professionals.

Recommended Best Practices for Nurses

1. Listen to prehospital professionals' reports and elicit patient information indicative of

alcohol use problems (AUP).

2. Identify alcohol-related events in initial assessment of the patient.

3. Perform an assessment using appropriate tools, such as history, physical examination, and

screening tools.

4. Document objective findings of assessment, interventions, and plan of care for AUP

patients.

5. Collaborate with health care team to implement interventions, such as brief interventions,

discharge planning, and referrals.

6. Communicate plan of care to appropriate services, such as physicians, substance abuse

counselors, referral agencies, and inpatient caregivers.

7. Provide care for alcohol-impaired patients in a professional and non-judgmental manner.

8. Advocate in the community for public education, prevention programs, public policy, and

treatment programs for AUP patients.

9. Participate in collaborative research, education, and data gathering to improve the care of

patients with AUPs.

10. Integrate alcohol screening and alcohol education into curricula, continuing education, and

standards for emergency health care professionals.

Recommended Best Practices for Physicians

1. Physicians should incorporate screening for alcohol use problems (AUPs) into routine care

of injured patients.

2. Physicians should document history and physical findings consistent with AUPs.

3. Physicians should provide a brief intervention for patients who screen positive for alcohol

use problems.

4. Physicians should be aware of state laws and consider reporting alcohol use problems in

accordance with these laws (for those who cannot operate a motor vehicle safely).

5. Provide care for alcohol-impaired patients in a professional and non-judgmental manner.

6. Advocate in the community for public education, prevention programs, public policy, and

treatment programs for AUPs.

7. Participate in collaborative research, education, and data gathering to improve the care of

AUP patients.

8. Integrate alcohol screening and alcohol education into curricula, continuing education, and

standards for emergency health care professionals and trauma surgeons.

HOW TO ORDER

For a copy of Developing Best Practices of Emergency Care for the Alcohol Impaired

Patient: Recommendations from the National Conference, (53 pages) write to Media and

Marketing, NHTSA, NTS-21, 400 Seventh Street, S.W., Washington, DC 20590, fax (202) 366-

2062, or download from www.nhtsa.dot.gov

U.S. Department

of Transportation

National Highway

Traffic Safety

Administration

400 Seventh Street, S.W. NTS-31

Washington, DC 20590

Traffic Tech is a publication to disseminate information about traffic safety programs, including

evaluations, innovative programs, and new publications. Feel free to copy it as you wish.

If you would like to receive a copy contact:

Linda Cosgrove, Ph.D., Editor, Evaluation Staff

Traffic Safety Programs

(202) 366-2759, fax (202) 366-7096

E-MAIL: lcosgrove@nhtsa.dot.gov
Traffic Tech Publications | National Highway Traffic Safety Administration(NHTSA) | U.S. Department of Transportation

http://www.nhtsa.dot.gov/...mID=0ba1cd8c4e7bff00VgnVCM1000002c567798RCRD&orderTrafficTechSelect=3D&trafficTechYearSelect=2001&overrideViewName=Report[5/28/2009 3:59:26 PM]

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