Jeffrey W. Runge, M.D., Assistant Chair, Emergency Medicine,
Director Carolinas Center for Injury Control, Carolinas Medical Center;
Stephen Hargarten, MD, MPH, Professor and Chair,
Department of Emergency Medicine, Medical College of Wisconsin;
Valerie A. Gompf, Highway Safety Specialist, Impaired Driving Division,
National Highway Traffic Safety Administration
Alcohol-related crash injury is a national epidemic in the US, claiming about 16,000 lives annually and injuring 870,000. There have been reductions in alcohol-related deaths seen over the last two decades due to the advent of more stringent laws to curb impaired driving, more vigilant public education, and a societal shift toward the condemnation of DWI as socially undesirable. Patients with alcohol use problems (AUPs) 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.
In 1995, recognizing that the effects of changes in law and public attitude were limited and that the reduction in death rate would plateau, the National Highway Traffic Safety Administration (NHTSA) undertook to identify new partners and constituencies in the effort to curb impaired driving with an initiative called "Partners in Progress." This initiative recognized physicians, nurses and paramedics as key partners in overcoming this plateau due to their intimate involvement with the results of alcohol-related crash injury and their frequent interaction with the population known to be high-risk for impaired driving. In the years since the beginning of the initiative, these partners have been mobilized through programs, research, and intellectual input to contribute to the solution of impaired driving in the United States.
Reductions in impaired driving are realized by tackling the problem from many angles. Patients with AUPs are more likely to drive after drinking. Treating the AUP 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 paramedics 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.
In 1998 emergency physicians and nurses with a special interest in injury control worked with NHTSA to attempt to bring the current state of knowledge about alcohol impairment and treatment of patients with AUPs to the broad audience of trauma surgeons, practicing 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 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.
In response to the need to bring this state of knowledge to practitioners in the emergency medical community, NHTSA partnered with the Emergency Nurses Association (ENA) and the American College of Emergency Physicians (ACEP) to co-sponsor a conference to develop and publish recommended best practices for emergency medical providers based on current evidence. In June 2000, in Washington, DC, leaders in the field gathered to develop this statement, a list of whom appears in the Appendix B.
During the conference, professionals in the fields of medicine, nursing, and emergency medical 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 itís 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.