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EXECUTIVE SUMMARY

Developing Best Practices of Emergency Care for the Alcohol
Impaired Patient: Recommendations from the National Conference


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 Developing Best Practice Standards of Emergency Medical Care for the Alcohol Impaired Patient. This one-day conference was held June 2, 2000 at the Grand Hyatt Washington Center in Washington, DC. The conference brought together health care professionals to develop best practices of emergency medical care for the alcohol-impaired patient. It addressed treating the harmful and hazardous drinking behaviors (e.g., drinking and driving) of patients that present to the emergency department. The conference was part of an ongoing Partners in Progress initiative to increase the involvement of health care professionals 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.

Patients with alcohol use problems (AUPs) are more likely to drive after drinking and have higher rates of illness and motor vehicle crash injury than the general population. Health promotion and prevention of injury and other disease mandates a structured approach to these patients. Patients with AUPs come into contact with all phases of the emergency medical services system, from pre-hospital through the trauma center, frequently as a result of their high-risk behavior. Treating this disorder leads to reductions in impaired driving episodes, which in turn leads to fewer alcohol-related crash injuries. Emergency nurses, emergency physicians, and pre-hospital providers have a unique role to play in the identification of the disease, patient education and intervention, and referral for formal evaluation and treatment.

NHTSA, ACEP and ENA partnered to bring the current state of knowledge about alcohol impairment and treatment of patients with AUPs to a broad audience of trauma surgeons, emergency physicians, emergency nurses, and paramedics. The need for this arises from the general attitude held by many practitioners that treating the underlying AUPs in patients who are sick or injured due to alcohol abuse is futile, in spite of emerging research to the contrary. Therefore, screening for the disease and appropriate intervention and referral are not widely practiced in the emergency setting, thus missing a prime opportunity for prevention of an epidemic disease. Moreover, many of these patients may interface with the medical system only through the emergency department, particularly at early stages of their disease when they can benefit most from intervention and treatment.

In response to this need, NHTSA, ACEP and ENA co-sponsored the National Conference: Developing Best Practice Standards of Emergency Care for the Alcohol Impaired Patient to develop and publish recommended best practices for emergency medical providers based on current evidence.

During the conference, professionals in the fields of emergency medicine, emergency nursing, and pre-hospital emergency services presented the current research in the area of AUPs and the impact of alcohol related injuries on our society. The following papers were presented:

Additionally, a best practice "strawman" for physicians, nurses, and pre-hospital professionals was presented and discussed in the breakout sessions. Participants were given the opportunity to provide input regarding the "strawman" and ultimately, into the development of the best practices for each area.

The full impact of the conference may not be known at this time. By the end of the conference, participants had a greater understanding of AUPs and their impact on society. The development of the best practices is a start to addressing the problem. However, the best practices need to be implemented by physicians, nurses, and pre-hospital professionals in order to be successful. Follow-up will be needed to determine how the best practices are being used and whether the number of alcohol related injuries have been reduced due to the use of the best practice.

A major outcome of the conference was the consensus to change the Best Practice Standards to Best Practices. The attendees felt strongly that this group was not yet prepared to recommend standards based on the current research, and that Best Practices was the more appropriate term. The following Best Practices are intended to serve as the basis for changing how patients with AUPs are treated in the ambulance, the emergency department, and the trauma center.

Recommended Best Practices for 
Pre-Hospital Professionals

  1. Assess the patient(s) and document for signs and symptoms of alcohol use problems and assess the environment for alcohol-related risk factors.
  2. Report information on alcohol use problems (AUPs) to hospital personnel.
  3. Assist with on-scene information and referrals for AUP patients.
  4. Provide care for the alcohol-impaired patient(s) in a professional and non-judgmental manner.
  5. Advocate in the community for public education, prevention programs, public policy, and treatment programs for AUPs.
  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 pre-hospital professionalsí report and elicit patient information indicative of 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 patient with AUP.
  5. Collaborate with health care team to implement interventions, such as brief interventions, discharge planning, and referral.
  6. Communicate plan of care to appropriate services, such as physicians, substance abuse counselors, referral agencies, and inpatient caregivers.
  7. Provide care for the alcohol-impaired patient(s) in a professional and non-judgmental manner.
  8. Advocate in the community for public education, prevention programs, public policy, and treatment programs for AUPs.
  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 for a brief intervention for patients who screen positive for alcohol use problems.
  4. Physicians should be aware of state laws and consider the reporting of alcohol use problems in accordance with these laws.1
  5. Provide care for alcohol-impaired patient(s) 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. Participant in collaborative research, education, and data gathering to improve the care of patients with AUPs.
  8. Integrate alcohol screening and alcohol education into curricula, continuing education, and standards for emergency health care professionals.2

  1. For those patients who cannot operate a motor vehicle safely. 
  2. For example, trauma surgeons.