[traumanurses] Re: ETOH interventions

["Leiding, Lisa" <Lisa.Leiding@stvin.org>]

John,

I am not sure that if you are providing an intervention that you could sequester the blood alcohol result. When we do domestic violence and sexual assault interventions we make them a "forensic" record and that is stored in medical records in a separate file cabinet by alphabetical order. These charts then have to be subpeoned to be released.

Our state does not allow insurance companies to deny claims based on alcohol. Other states do allow alcohol to be a reason for denying payment. Many of our MD's have come from some of these states and therefore won't even draw an alcohol level.

In fact in our court system in our state - they will not use the medical blood alcohol result for court anyway because it is not spun down enough. The State Drug Lab has set standards to ensure that all blood that comes from the DUI kits is spun to the same specification so that results are equal regardless of where they come from.

The other interesting thing - and I saw an article a couple days of ago on the topic - but when the blood alcohols are done depends on the symptoms. I will try and find that reference - although we are two weeks away from re-designation - so it is a bit crazy. In our very rural state the medical bloods are always higher and bloods are always higher. Here is why - the law enforcement officers have to watch the patient for 20 minutes to ensure that the person does not burp, vomit - they have to look in their mouths to make sure there is no blood in the mouth. Then if after 20 minutes they can do the breath test. Well 20 minutes after a beer starts the absorption phase into the blood. So by the time the field sobriety test is done and they arrive at the ED to have the blood drawn - it is peaking absorption. If the patient comes directly from a crash chances are that at least 30 minutes to an hour has gone by before LE shows up after being on the scene - again the bloods are high.

If however the patient truly did have "2 beers" earlier in the evening and they are on the down side of absorption curve then they have may have no presenting ETOH symptoms that would clue in a provider to think that the medical blood alcohol was necessary. Even though the downside of absorption could be still above the legal limit. Now in your chronics - as you know - they can start withdrawing at 360 if they aren't use to having "blood in their beer."

Hope this is helpful.

Lisa McLaughlin, RN
Trauma Nurse Coordinator
ST. Vincent Hospital
Santa Fe, NM 87505
505-820-5708

-----Original Message-----
From: John Bleicher [mailto:BLEICHER@saintpatrick.org]
Sent: Friday, June 13, 2003 12:39 PM
To: TraumaNurses@TraumaNurseSoc.org
Subject: [traumanurses] ETOH interventions

Hi - We're establishing a program to provide brief interventions for alcohol abuse for our trauma patients.  One of the many screening options is to draw a BA on all of our patients and, if not drawn for reasons of medical necessity, sequester that information outside the medical record as a means of keeping it non-discoverable.  I'm wondering if anyone doing this could contact me on or off-list with specifics about how this is accomplished in their facility.  Thanks, and happy weekend to all!  John Bleicher

John Bleicher, RN
Trauma Coordinator
St. Patrick Hospital and Health Sciences Center
500 West Broadway
Missoula, MT 59802
ph: 406-329-5603
fax: 406-329-5875
bleicher@saintpatrick.org

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