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• W4236070926 abstract "On behalf of my coauthors, I would like to thank Drs. Connors, Shawn, and Hoffman for their interest in our recent article.1Ross D.W. Schullek J.R. Homan M.B. EMS triage and transport of intoxicated individuals to a detoxification facility instead of an emergency department.Ann Emerg Med. 2013; 61: 175-184Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar We agree with them that there is an oversight in the units presented with the ethanol concentration data. The units should have read “grams per deciliter, or g/dL” instead of “milligrams per deciliter, or mg/dL.” Because mg/dL was used, 0.40 mg/dL should have actually read 400 mg/dL. We regret the transposition error. Connors et al ask whether emergency medical services (EMS) personnel had a standard script describing the detoxification center to patients potentially eligible for transport there from the field to make the destination perhaps more palatable to them. The answer is that EMS did not have such a script. It is our supposition that many of these patients had some acceptance of the reality of their alcoholism and were already very familiar with the center because most had been patients there in the past. Refusals were most likely individually motivated and related to presumed previous negative experience with the sobering center. With respect to the medical services available to patients at the detoxification center, space limitations with respect to the article prevented us from more fully describing what was available. Oral benzodiazepines could be used for patients experiencing withdrawal symptoms “short of hallucinations.” Some other oral medications were available. Intramuscular promethazine was occasionally provided for nausea. To our knowledge, nothing else was parenterally administered. A psychiatrist was available during business hours to conduct some evaluation of mental health and substance abuse issues, and a physician's assistant dealt with minor medical problems. Both could be reached after hours for consultation. We agree that patients with near-normal sensorium and mean alcohol concentrations of 258 mg/dL are at risk for withdrawal. However, we did not observe any transfers from the detoxification center to an emergency department (ED) because of acute withdrawal symptomatology. Moreover, there were few reported significant withdrawal episodes in the ED cohort. We do not have data about the specific incidence of withdrawal symptoms requiring oral treatment and management at the detoxification center but not requiring patient transfer to an ED. It seems reasonable to suggest that the availability and early use of benzodiazepines at a sobering center might reduce the development of more significant withdrawal symptoms subsequently requiring an ED evaluation. Indeed, the capability of a detoxification center is a significant factor in the success of an inebriate diversion program. We also agree that the numbers of patients transported directly to the detoxification center were small, and trials with larger numbers of patients are needed to confirm the overall safety of such a program. According to what we learned during the time frame of our report, and with our continuing experience with significantly increased alcohol diversion patient numbers, we believe that our practice is safe. But this remains to be validated. Once again, we appreciate the insight and comment of Connors et al. In Response to “EMS Triage and Transport of Intoxicated Individuals to a Detoxification Facility Instead of an Emergency Department”Annals of Emergency MedicineVol. 62Issue 1PreviewWe read with interest the recent article1 concerning emergency medical services (EMS) transport of intoxicated patients directly to a detoxification center rather than the emergency department (ED) according to predetermined eligibility criteria. Although preventing unnecessary ED visits is clearly beneficial, there are issues with this report that make interpretation of the results difficult. Full-Text PDF" @default.
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• W4236070926 date "2013-07-01" @default.
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• W4236070926 doi "https://doi.org/10.1016/j.annemergmed.2013.02.017" @default.
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