alcohol, marijuana and dui

Monday, July 17, 2017

Things that I think I know but are probably just my opinion, and there are lots of numbers.

The NFL and Minnesota Vikings suspended Michael Floyd for the first 4 games of the 2017 season after he was convicted of extreme DUI in Arizona. In December, Mr. Floyd was found asleep at the wheel of his SUV with a blood alcohol level was measured at 0.217. His NFL suspension is in addition to the court’s punishment of 24 days in jail and 96 days of house arrest. It took just a little while for the NFL to react.

Drunk drivers are not beloved in the ER. It has to do with the sad knowledge that more than 10,000 people die each year associated with a DUI, either as the driver or the victim of their crime.

There is difficulty in decision making. Is the patient being belligerent or very quiet because of the effect of alcohol? or is there an associated head injury? In a larger hospital, the decision point is easy…the trauma patient with altered mental status, regardless of whether alcohol is involved gets a CT scan to look for bleeding. In a rural setting, where there isn’t a CT scanner on every corner, the decision is grayer whether the patient should be transferred by ambulance for an emergent scan. In foul weather (think blizzard or monsoon) that transfer decision may put other people, like EMTs and paramedics at risk. Watchful observation may be appropriate but there is little backup if things go south and that puts the patient at risk. And should the transferring ambulance leave the area for a prolonged transfer, those people in the vicinity may be left without any emergency transportation.

Those who drink and drive are not in the minority and there are a whole lot of people who make poor choices. According to the Centers for Disease Control and Prevention, 1.1 million people were arrested for driving under the influence. However, based on national surveys, there were more than 111 million self-reported instances of impaired driving in 2015. It seems that as a nation, we are very fortunate that “only” 10,000 people died.

Alcohol remains the drug of choice by people who drive while impaired, but marijuana use is increasing, with more than 1 in 8 weekend and nighttime drivers having the drug in their system. Having that marijuana in your system increases the risk of a crash by 25%.

Just a reminder:there is no legal limit of alcohol intoxication. The legality has to do with the activity being performed:

  • It’s de facto illegal to drive a car with an alcohol level greater than 0.08 BUT one can be found to be impaired at lower levels depending upon function
  • The legal limit to drive a commercial vehicle with a CDL (commercial drivers license) is 0.04
  • 0.04 is the same limit that the FAA imposes to fly an airplane
  • There is no limit for a surgeon to operate, but most of us would hope that level is absolute zeroThere is no legal limit to walk on the stree
  • The legal limit for a minor is zero

As for marijuana, whether the drug is prescribed for a medical situation or used recreationally, there are legal limits. Quoting from the Colorado Department of Transportation: Colorado law specifies that drivers with five nanograms of active tetrahydrocannabinol (THC) in their whole blood can be prosecuted for driving under the influence (DUI). However, no matter the level of THC, law enforcement officers base arrests on observed impairment”

 Widespread legal marijuana use is a new phenomenon and it will be interesting to see the effect on the frequency of impaired drivers on the road and the numbers of their vicitims in the ER.

When it comes to alcohol, emergency department doctors, nurses and techs care for a lot of drunk people, whether it is due to intoxication, withdrawal or trauma. Mr. Floyd is just one of the more than 3.8 million intoxicated patients who need care every year. And he is not the only celebrity, sports star who has made a significant error in judgement. He’s fortunate , however, that he fell asleep at the wheel while his car was stopped. Perhaps it was his potential victims who were thankful that he didn’t fall asleep driving 70 mph on the interstate and crashing into their school bus.

And those are just some of the things that I think I know…at least that’s my opinion.




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small favors

Monday, November 25, 2013

A crisis was brewing in room 12. Instead of the Green Bay-Vikings game, there was nothing but fuzz on the local Fox channel. The patient and family mentioned it in passing but clearly they were distraught. All were wearing Aaron Rodger jerseys and there was no doubt that it took a true emergency to bring them to the hospital, instead of being at home watching their beloved Packers play on TV.

There is nothing funny about being a patient in the ER. First, there is the illness or injury that prompted the visit. Second, there is the uncertainty of what the future might bring. Third, there is the unknown wait time, realizing that your care could be delayed because you are deemed less sick or hurt than the person being wheeled in on the next ambulance. And of course you have no real say in who is providing your care. Loss of control is a frightening thing.

But circumstance do arise that remind us of the humanity of the situation and in Wisconsin, football Sunday can bring the world to a stop. The Packers were playing and nothing much else matters to the bulk of state’s population. Our ER sits on the banks of Mississippi and across the river the green and gold is replaced by the purple of Minnesota and it is an easy way to break the tension when walking into the room to mention the colors that the patient is wearing. I’m certain the same situation happens on Saturdays in Alabama and Oklahoma but in Wisconsin, the fans own the team and having an undying allegiance.

The department was busy yesterday, even though the game was on at noon. Often we sometimes joke that patients try to rush in to be seen before the game starts or wait until after the final whistle to seek care, but in truth, the number of patients who register isn’t really affected by when the game is being played. Patients tend not to plan their emergencies, but it seems a little more festive hen the game is on. Normally, the television are turned to a variety of channels from CNN to HGTV (the Property Brothers seem to be a favorite), but on football Sunday, it’s wall to wall Packers. There are occasional cheers that are not because the lab test came back normal and that groan might be from a penalty or missed tackle instead of a spasm of pain.

I saw four plays all game. I watched with a family dressed in Viking home jerseys as Scott Tolzien rushed for his first touchdown as a Packer. They were not happy. They were less happy to know that abdominal CT scan that I had just ordered would take a couple of hours to complete. Never mind that all tests on House or Grey’s Anatomy can be done within the hour including commercials, but real world technology moves a little slower. I watched two plays with an older gentleman who remembered Bud Grant and Joe Kapp from Vikings history. I told him that I remembered those two from the Canadian Football League. He smiled. Play four was a Jordy Nelson catch, or I think it was but I couldn’t be certain in the fuzz of room 12.

There are small things that make the ER tolerable for patients. We have volunteers who provide coffee to families or help watch children. Our social workers try to find ways to keep elderly patients independent in their homes. There are nurses who stay late to comfort the family of a patient who is doing poorly. The art of medicine seems to be on display at the same time the science is being tended to.

And sometimes all it takes is the Packers and Vikings on the screen in the corner of the room to make even the most frightened patient smile just a little. I guess we’re readyfor some football.

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