Management of intoxicated patients with trauma

Summary

The request sought policies for managing intoxicated trauma patients in the Ambulance Service and Emergency Department, specifically regarding pain relief and intoxication assessment. The response disclosed that paramedics follow JRCALC guidelines advising caution with opioids due to alcohol interaction, while the Emergency Department relies on clinical indications rather than specific intoxication protocols.

Key Facts

• Paramedics use JRCALC guidelines for pain management and altered consciousness.
• Opioids are administered with extreme caution to patients who have consumed excessive alcohol due to potentiation of CNS depressant effects.
• Entonox and Paracetamol are not contraindicated for suspected alcohol intoxication.
• Paramedics assess intoxication by observing the scene (e.g., bottles) and clinical presentation (e.g., alcohol on breath).
• The Emergency Department has no specific guidelines for intoxicated patients, managing pain based on clinical indications like reported pain levels and vital signs.

Data Disclosed

• 2019-08-27
• 2019-09-20
• 938446
• 3
• 1

Original Request

All policies, procedures and protocols that the Ambulance service/paramedics and Emergency Department have relating to the management of patients who have experienced trauma who they believe to be intoxicated. Specifically, details of what measures and tests are used to assess levels of intoxication if pain relief if required after trauma.

Data Tables (1)

Full Response Text

Interim Chief Executive: Angela Murray Freedom of Information Team DHSC Crookall House Demesne Road Douglas IM1 3QA

(01624) 642621 dhsc@foi.gov.im Website: www.gov.im/dhsc

Our ref: 938446 18th September 2019

Dear ###

We write further to your request which was received on the 27th August 2019 and states:

"All policies, procedures and protocols that the Ambulance service/paramedics and Emergency Department have relating to the management of patients who have experienced trauma who they believe to be intoxicated. Specifically, details of what measures and tests are used to assess levels of intoxication if pain relief if required after trauma."

Our response to your request is as follows: Within the Ambulance Service, Paramedics use the guidelines published by the Joint Royal College Ambulance Liaison Committee (JRCALC) on management of pain using morphine and other analgesics and treatment of patients with altered levels of consciousness. In particular paramedics are advised to exercise extreme caution when administering opioids to patients who have consumed excessive alcohol as such drugs potentiate the central nervous system depressant effect of alcohol. No other analgesic drugs that can be administered by Paramedics (namely Entonox and Paracetamol) are contraindicated when a patient is suspected of alcohol intoxication. In scenarios where a patient is presenting with an altered level of consciousness, Paramedics are advised to pay attention to the scene of the incident and the patient’s clinical presentation to ascertain whether alcohol has been involved (i.e. presence of bottles on scene or alcohol on the breath). The guidelines confirm that alcohol intoxication is a cause of decreased level of consciousness however management of transient loss of consciousness is the same regardless of cause (such as carbon monoxide poisoning, inadequate ventilation etc.).

Within ED we have no specific guidelines as management of pain is based on clinical indications i.e. the level of pain reported by the patient or pain that is clinically evident (such as through facial expressions, grimacing, and other clinical signs such as raised heart rate, change in respiratory rate and pattern etc.).
Please quote the reference number 938446 in any future communications.

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I will now close your request as of this date.

Yours sincerely