Impact of a Community Based Paramedic Program on the Care of Intoxicated Individuals
In a context of widespread emergency department (ED) overcrowding, sobering centres have been used as an alternative destination for publicly intoxicated individuals who would otherwise be transported to hospital. The impact of sobering centres on patient volume and safety remains uncertain. In our setting, community paramedics (CPs) provide full-time medical screening and observation at the local sobering centre.
To evaluate the impact a sobering centre with CP medical assessment in terms of volume (number assessed) and safety (later transported to hospital).
Data were extracted for all consecutive adult patients assessed for intake at the sobering centre by CPs from January 2016 through February 2020. The patient group was described in terms of unique individuals and visits. Associations among presenting characteristics and transport to hospital (as compared to discharged from the centre) were analyzed with binomial logistic regression and reported as odds ratios (ORs).
During the study period, there were 42,481 assessments of 13,789 unique individuals. Of these, 4948 (36%) were female. The median age was 32 (interquartile range, 25 – 44). The majority (8,495, 62%) of patients had one visit; 4,676 (34%) had between 2 and 9; 599 (4.3%) had between 10 and 99; and 19 patients had over 100 visits. The majority of patients (41,346, 97%) were admitted and subsequently discharged. Only 418 (0.98%) were deemed ineligible for admission, while 600 (1.41%) were admitted and later transported to hospital. Among those patients transported to hospital, 15 (2.5% of 600 transported, or 0.04% of all admissions) were transported as Canadian Triage and Acuity Scale (CTAS) 1 and 358 (60% of transports, or 0.86% of admissions) as CTAS 2. Factors noted on intake with significant associations with transport to hospital (as compared to discharge) include: combative demeanor (OR: 1.6, 95%CI: 1.1 to 2.2); intoxication with potable alcohol (OR: 0.4, 95%CI: 0.3 to 0.5); illicit substances (OR: 5.1, 95%CI: 4.1 to 6.3); prescription medications (OR: 6.4, 95%CI: 4.5 to 8.8); and unknown substances (OR: 3.7, 95%CI: 2.7 to 5.0).
This model of care appears to be a safe alternative to ED transport for publicly intoxicated individuals.
Dr. Janelle Quintana is a PGY-4 Emergency Medicine resident physician at the University of Manitoba who has an interest in Trauma and Pre-hospital Medicine. Throughout residency, she has been working very closely with the Winnipeg Fire Paramedic Service.