Managing Intoxicated Patients in the Field: An EMR Guide

As an Emergency Medical Responder (EMR), you’re trained to provide care in unpredictable situations. One of the more challenging scenarios is responding to patients under the influence of alcohol or drugs. Intoxicated patients can present with unpredictable behavior, altered physiology, and a higher risk of injury—making careful assessment and management critical.

At Delta Emergency Support Training, we emphasize both safety and effective patient care. Here’s a detailed guide for EMRs on safely responding to intoxicated patients, aligned with Alberta Health Services (AHS) guidelines.

Understanding Intoxication

Intoxication can result from alcohol, prescription medications, or illicit drugs. Common effects include:

• Altered level of consciousness

• Slurred speech or impaired coordination

• Agitation, aggression, or unpredictable behavior

• Nausea, vomiting, or respiratory depression

• Increased risk of trauma from falls, fights, or accidents

• Masked pain: Alcohol can dull pain perception, making trauma patients unreliable reporters of injury severity

• Mimics: Hyperglycemia or hypoglycemia can appear similar to intoxication, making blood glucose assessment crucial

Recognizing the signs early helps EMRs anticipate complications and prioritize patient and responder safety.

Safety First: Protecting Yourself and Others

Intoxicated patients can be unpredictable. Before providing care, ensure:

• Scene safety: Survey for weapons, hazards, or bystanders that may interfere.

• Backup: If the patient is aggressive, call law enforcement or additional responders.

• Personal protective equipment (PPE): Gloves, eye protection, and masks may be necessary.

• Distance and positioning: Maintain a safe stance and keep an exit route clear.

Never compromise your safety—intoxicated patients may act impulsively, and an aggressive patient can escalate quickly.

Patient Assessment

Assessment of an intoxicated patient may be complicated by their altered state. EMRs should focus on:

1. Responsiveness: Determine if the patient is fully conscious, verbally responsive, physically responsive, or unresponsive.

2. Airway, Breathing, Circulation (ABCs): Alcohol and drugs can depress breathing and circulation.

   • Be prepared to clear the airway using suction if the patient vomits.

   • Airway adjuncts (oropharyngeal or nasopharyngeal airway) may be required if the patient’s airway is compromised but spontaneous breathing is present.

3. Vital signs: Monitor heart rate, blood pressure, respiratory rate, oxygen saturation, and blood glucose.

   • Hyperglycemia or hypoglycemia can mimic intoxication and significantly affect patient management.

4. Secondary survey: Look for trauma, especially since alcohol can mask pain. A patient may not report broken bones, internal injuries, or head trauma. Monitor carefully for subtle signs.

Common Challenges and How to Manage Them

• Aggression or agitation: Stay calm, use a non-confrontational tone, and avoid physical confrontation unless absolutely necessary.

• Vomiting or aspiration risk: Use suction immediately if needed, and position the patient in the recovery positionif unconscious but breathing.

• Altered decision-making: Intoxicated patients may refuse care. Document refusals and use implied consent in life-threatening situations.

• Polysubstance use: Patients may have multiple substances in their system, complicating presentation. Monitor closely for unexpected symptoms.

• Trauma considerations: Be extra vigilant for head injuries, internal bleeding, or fractures. Pain may be unreliable, so rely on vital signs, visual assessment, and mechanism of injury.

• Glucose considerations: Rapidly check blood glucose in any altered patient; treating hypoglycemia or hyperglycemia may resolve the presentation entirely.

Communication Tips

• Use simple, clear language.

• Speak slowly and calmly to reduce confusion.

• Avoid judgmental language—patients respond better when treated respectfully.

• Keep bystanders informed, but focus on patient care.

Transport Considerations

• Monitor continuously: Intoxicated patients can deteriorate rapidly.

• Secure safely: If aggressive, use restraints only per local protocols and monitor the patient closely.

• Communicate with receiving facility: Provide details on level of intoxication, suspected substances, vital signs, airway interventions (suction or adjuncts used), trauma concerns, and any interventions performed.

Red Flags: When to Call for Immediate Backup

• Unresponsiveness or decreased level of consciousness

• Difficulty breathing or abnormal airway sounds

• Vomiting with risk of aspiration

• Seizures or convulsions

• Severe trauma, especially head or internal injuries

• Aggressive or violent behavior that cannot be safely managed

• Hypoglycemia or hyperglycemia causing altered mental status

Final Thoughts

Responding to intoxicated patients requires a balance of emergency care skills, safety awareness, and empathy. Alcohol or drug use can mask pain and complicate assessment, and abnormal blood glucose levels can mimic intoxication. With proper airway management, suction, airway adjuncts, and glucose monitoring, EMRs can provide effective care safely.

At Delta Emergency Support Training, our courses prepare responders to handle complex patient scenarios, including intoxicated and trauma patients so you can provide care with confidence, skill, and safety.

Opioid Overdose: Recognizing the Signs

Welcome to our two-part blog series on opioid overdose awareness and intervention. In this first blog post, we will delve into the nature of opioid addiction, the signs and symptoms of overdose, and how this epidemic can impact anyone, regardless of background. Stay tuned for the second blog, where we will focus on naloxone, an opioid antagonist, and provide comprehensive training on its usage.

Opioid Overdose, What is it?

An opioid overdose occurs when an individual takes an excessive amount of opioids, which are a class of drugs that include prescription painkillers like oxycodone, hydrocodone, and fentanyl, as well as illegal substances like heroin. Opioids bind to opioid receptors in the brain and spinal cord, reducing pain sensations and producing feelings of relaxation and euphoria.

However, when too many opioids are consumed, the respiratory system becomes depressed, leading to slowed or shallow breathing. This can result in a dangerous lack of oxygen, causing severe hypoxia, brain damage and death.

Signs and Symptoms

Recognizing the signs and symptoms of an opioid overdose is crucial for timely intervention, as it can mean the difference between life and death. Here are some expanded details on the signs and symptoms to watch for:

1. Slow or Shallow Breathing:

   One of the hallmark signs of an opioid overdose is slow or shallow breathing. The individual may take abnormally long pauses between breaths or have difficulty taking a full breath. Their breathing may become erratic, weak, or barely noticeable.

2. Unresponsiveness:

   Opioid overdose can cause loss of consciousness. The person may be unresponsive to stimuli, and have difficulty staying awake. They may appear excessively drowsy, as if in a deep sleep, and have difficulty speaking or interacting.

3. Pinpoint Pupils:

   A clear indication of an opioid overdose is constricted or pinpoint pupils (pupils that appear very small). This occurs due to the effect opioids have on the muscles controlling the size of the pupils. In normal lighting conditions, the pupils of someone experiencing an overdose will not dilate or respond to changes in light.

4. Pallor:

   During an opioid overdose, the individual's skin may appear pale, cool, and clammy to the touch. This is due to decreased blood circulation and oxygenation resulting from the suppressed respiratory system.

5. Cyanosis:

   In severe cases of opioid overdose, the person's lips, nails, or fingertips may turn bluish or purplish. This condition, called cyanosis, indicates a lack of oxygen in the bloodstream, signaling a medical emergency.

6. Slow or Weak Pulse:

   Opioids can slow down the heart rate, resulting in a slow or weak pulse. The person's pulse may feel faint or difficult to detect.

Understanding and Addressing the Crisis

Opioid addiction is a pervasive issue that knows no boundaries. It can affect individuals from all walks of life, irrespective of age, gender, or social status.

Understanding the underlying risk factors associated with opioid addiction is essential. Chronic pain, often treated with prescription opioids, can increase the likelihood of developing an addiction. Additionally, individuals with a history of substance abuse or mental health disorders may be more susceptible to opioid misuse. Lack of access to healthcare, social isolation, and environmental factors can also contribute to the risk.

Addressing the opioid crisis requires an approach that focuses on prevention, education, and support. It is essential to educate individuals, healthcare professionals, and communities about the risks associated with opioids and alternative pain management strategies. Building strong support systems and promoting access to evidence-based addiction treatment and counseling services is vital. Encouraging open dialogue and reducing the stigma surrounding addiction can help individuals feel comfortable seeking help.