Tuesday, October 27, 2009

Public Inebriates

What in the world is a "public inebriate"?

A person drunk in public. Immobile drunk. Not staggering out of a bar with friends, but passed out cold on the ground in public. Not someone who is a social person out having fun, but a hard core alcoholic, whose goal in life is to get drunk. Someone who will start having nasty with drawl symptoms if they got below the legal limit to drive.

It's a problem in Anchorage, AK. The New York Times did an article and a video piece on the topic. Basically, Anchorage is going to do short and long term "insanity" commitments on some of those they pick up drunk off the street. Anchorage is not the only city with this problem; Kansas City has it too. Anchorage's is highlighted by their extreme winter weather, which will kill those passed out outside. An additional factor for Anchorage is their native North American population. Inuits, like Indians in the lower 48, seem especially vulnerable to the ravages of Demon Rum. Don't worry though, Kansas City has chronic public inebriates too. They're coming to an Emergency Room near you.

Here's the sequence of events: there's a guy (it's usually a guy; there are a few women, but more often, it's a guy.) lying on the ground where he can be seen. Usually it's a public place, like a park or the street. A citizen spots this guy lying there. Maybe, if the citizen is really brave, they might go over and try to wake the guy up, get him moving. Most times though, the citizen calls up 911 and reports the guy lying in the street. This then proceeds through the dispatch system. Police will typically be dispatched to "check the need for an ambulance". The ambulance will be dispatched for "unconscious person"; this call nature will trigger an automatic dispatch of a fire crew as well. There are other types of 911 calls that will bring the EMS system and the police in contact with a drunk person, but this type of call is pretty typical.

Now, if the person wakes up, and can walk, and is oriented to person, place, time and situation, and doesn't wish to go to the hospital, and clears the criminal check by PD, he can go. He'll be encouraged to go "home", wherever that is, and sleep it off in private. If he is oriented as above, but has legal issues, he'll go to jail. However, if the person is not ambulatory, not oriented and cannot protect himself, he will go to the hospital. Even with legal issues. Yes, to the hospital. Kansas City does not have a place for public inebriates to "sleep it off". People this drunk are not accepted at the jail, due to fear of them coming to harm and then suing the city.

According to my informants, Truman Hospital Hill has a special room for the supervision of drunks while they sleep it off. They still have some medical interventions, typically an intravenous line is started and they are given vitamin, folic acid and thiamine laced IV solution, but generally, it's just a safe place for them to be while their liver metabolizes the alcohol and their BAC returns to a safer level. (BACs on these folks can typically run in the 300-450 range--and higher. To put it in the familiar terms drivers know, they would be at 0.3 to 0.45--the legal limit is 0.08.) Generally, once a chronic drinker drops into the 150-200 range, he looks and acts pretty normal. At that point, they can leave the ER. If Truman is on ambulance diversion, the drunk will end up at the next closest open ER. Another place that ends up with chronic drunks is the Kansas City VA Medical Center. They may not be able to walk, but they can produce that VA card.

This may happen several times a week. And this is where it's gets relevant to the health care system, because it costs money. They take an ER bed. They require staff supervision. Sometimes, even though they can't walk, they will resist any intervention physically, requiring restraint. They're messy, they puke, poop and piss all over the place. Rarely, unless they are old enough for Medicare, do they have insurance. (Single people, especially men, rarely, if ever qualify legitimately for Medicaid.) So the cost of care given to them is rarely reimbursed. If they are on a government program (Medicare, Medicare, VA), it's your tax dollars at work, sobering them up, so they can go out and do it again. So they cost money, time, effort and compassion.

Anchorage authorities are hoping to rehab a few of these folks and get them out of the cycle, thus saving money and other resources better used elsewhere. I hope it works. I know we need something different in Kansas City. I can't tell you how many times I've had an ambulance bring me a drunk guy I just saw last week--also drunk. It has got to be getting expensive handling these drunks through the Emergency Department. I hope Kansas City is watching what is happening in Alaska. It might be a helpful model for us.

In the meantime, if you see a drunk person passed out, and he's breathing and obviously alive, and he's relatively safe (not in traffic, not flat on his back, the weather's temperate), don't call 911.

I joke. Call 911 if you're not sure about things. But give it some thought before you call.

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