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Booze in the Nose.

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of “alcohol on her breath”. I’ve started a lot of charts like this. Seen PD run reports that said the same. I’ve seen it testified to in court….  And it is pretty interesting, in part because you can’t smell alcohol. Sure, you can smell booze–the other crap in the alcoholic beverage. But nope, you can’t smell “alcohol” on someones breath.

 

Smell of alcohol on the breath. There is a very poor correlation between the strength of the smell of alcohol on the breath and the BAC. Pure alcohol has very little smell. It is the metabolism of other substances in alcoholic beverages that produces most of the smell. This explains why a person who drinks large amounts of high-proof vodka (a more pure form of alcohol) may have only a faint smell of alcohol on the breath. On the other hand, a person who drinks a modest amount of beer may have a strong smell of alcohol on the breath.

 

This is hammered on by DUI lawyers, with mixed results:

“I Smelled a Strong Odor of Alcohol on the Suspect’s Breath”

Posted by Lawrence Taylor on June 23rd, 2006

You will never see a DUI case where the officer does not report an odor of alcohol on the suspect’s breath. Never. The officer expects to smell it and it is a psychological fact that we see, hear and smell what we expect to see, hear and smell. In fact, most police DUI reports are formatted for the usual symptoms: there will be a box for “odor of alcohol”, which the officer checks off. There are often three boxes, labelled “strong”, “moderate” and “weak”; there is no box for “none”, so that is not an option for the officer.  The ”strong” box is almost always checked.  Presumably, the stronger the odor of alcohol, the more intoxicated the person arrested.

There is only one problem with this:  alcohol in a beverage has no odor.

Assuming the officer actually does smell an odor on the breath, what he is smelling is not ethyl alcohol but the flavoring in the beverage. And the flavoring can be deceptive as to the strength or amount consumed. Beer and wine, for example, are the least intoxicating drinks but will cause the strongest odor. A much stronger drink, such as scotch, will have a weaker odor. And vodka leaves virtually no odor at all.

Consider a simple experiment. Have a friend drink a can of “near beer” — the stuff that looks, smells and tastes like beer but has no alcohol in it. Then smell his breath. You will smell an “odor of alcohol” — and maybe a strong one.

And, of course, there can be any number of causes of an “odor of alcohol” on a person’s breath: mouth wash, throat spray, cough syrup. Illness, indigestion or simple bad breath has been the cause of more than one officer’s trigger-quick conclusion that the suspect has an “odor of alcohol on his breath”.

The point of all this is that the odor of alcohol has very little relevence in a drunk driving case. It may or may not indicate that the person has consumed alcohol. It has absolutely no evidentiary value on the much more important question of how much the person has consumed — orwhat he had to drink, or when. Depending upon circumstances, a person with a single drink can have a “strong odor of alcohol on his breath”, and an extremely inebriated person can have a “weak” odor. And an experienced and honest DUI officer will readily admit this….if he is ever asked.

Unfortunately, evidence of the odor of alcohol on a person�s breath can have a significant impact on a DUI case. This is because most officers who pull a driver over for some driving irregularity at night are looking for further signs of drunk driving. When the officer approaches the driver’s window and smells alcohol, that confirms his suspicions. Since few can pass the “field sobriety tests”, particularly under the conditons in which they are given, an arrest is likely.

Are there any scientific studies to back up my claim that breath alcohol odor is largely irrelevant yet disproportionately weighted as “evidence” of intoxication?

In 1999, the same scientists whose federally-contracted studies became the basis of the so-called “standardized” battery of field sobriety tests conducted another study on the effectiveness of alcohol odor in detecting intoxication. These researchers used 20 experienced officers working with 14 subjects who were tested at blood-alcohol concentrations (BACs) ranging from zero to .13 percent. Over a four-hour period, the officers smelled the subject’s breath odor under optimal conditions, with the subjects hidden from view.

The conclusions of the study: Odor strength estimates were unrelated to BAC levels. In fact, estimates of BAC levels failed to rise above random guesses. Further, officers were unable to recognize whether the alcohol beverage was beer, wine, bourbon or vodka. According to the scientists, these results demonstrate that even under the best of conditions, breath odor detection is unreliable. Moscowittz, Burns & Furgeson, “Police Officers’ Detection of Breath Odors from Alcohol Ingestion”, 31(3) Accident Analysis and Prevention 175 (May 1999).

 

So the moral of the story is that we need to examine how we chart suspected intoxicated patients. Being highly suspicious of all medical conditions that could cause these symptoms is important too:

http://www.monkeydoit.com/medical-act-drunk.php

DIABETES
Symptoms of diabetes may make a person appear drunk or intoxicated.
A person with diabetes may exhibit abnormal behavior as a result of the many different signs or symptoms associated with the disease. The signs and symptoms listed here only relate to symptoms that mimic drunk or intoxicated behavior. Generally, these are warning signs that a person needs immediate medical attention and should be treated as a medical emergency. Police dealing with suspects often times mistake diabetes for drug or alcohol use during field sobriety exercises. 

Signs & Symptoms of Diabetes
-- The smell of acetone on the person's breath
-- A distinctive fruity odor on the breath (Police Officers often mistake the smell as alcohol during a field sobriety tests)
-- Dizzy, has trouble keeping balance
-- Altered states of consciousness
-- Arousal such as hostility or mania
-- Apprehensive with no obvious reason
-- Unusual nervousness
-- Disoriented in place or time
-- Confused when asked simple questions or confused in general about circumstances
-- Sweaty with clammy perspiration
-- Inability to concentrate on what you are telling them or on the tasks at hand
-- Sudden mood changes
EPILEPSY
Epileptic seizures generally happen without warning for most people. A seizure is a brain disorder of abnormal electrical activity in the brain. Seizures may be either partial or generalized and will present signs and symptoms that very among individuals. 
Signs & Symptoms of Epilepsy
-- May appear detached from reality
-- The person might be in a dreamy state 
-- Dizzy, unable to maintain balance
-- Falls down
-- Staring spells
-- Unresponsive
-- Walks away during a conversation
-- The person may have pupillary dilation
-- Sweating
-- Problems speaking
-- They may display an inability to answer questions
-- Contorted posture / limbs appear twisted
-- Flushing
-- Memory and time distortion (they may not remember what just happened)
-- May appear unrealistically fearful
-- May exhibit emotional signs of heightened pleasure
-- May exhibit emotional signs of displeasure
-- May appear aggressive or angry
-- Complete loss of consciousness
BRAIN INJURY
Brain injures will generally have signs and symptoms that relate directly to what part of the brain was injured. Here are just a few symptoms that someone could easily mistake as the person being drunk or intoxicated. These will vary among individuals and to what extent the brain was injured.

Signs & Symptoms of Brain Injury
-- The person may exhibit tremors
-- Dizzy, unable to maintain balance
-- Unable to make simple movements of various body parts
-- Inability to perform a sequence of complex movements
-- Unable to focus on tasks
-- Sudden mood changes
-- Inability to focus attention visually
-- Difficulties with hand and eye coordination
-- The person may suffer from hallucinations or visual illusions
-- They may have difficulty in understanding spoken words
-- They may show signs of aggressive behavior
-- The person may slur their speech 
Brain Picture -EpilepsyALZHEIMER'S
Alzheimer's or dementia is unique for every individual. Alzheimer’s is a progressive and fatal brain disease and the most common form of dementia. The signs and symptoms like the other medical conditions listed here may mimic impairment or drunkenness.

Signs & Symptoms of Alzheimer's
-- The person may show signs of paranoia
-- There may be drastic changes in mood
-- Confusion is quite common with people suffering from Alzheimers or dementia
-- They may have problems speaking
-- The person may exhibit aggressive behavior
-- It's common that there will be problems with remembering things

Why it Hurts

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Like a page from a book, dispatch sends us code 3 for a finger amputation. Grumbling as I roll out of bed while dispatch updates us–a 27 year old female at one of the local state-run group homes who intentionally put her hand in a garbage disposal. The grumbling increases. The staff at these facilities leave something to be desired and the patients usually are fine. This has to be an overreaction, doesn’t it?

As we round the corner inside the door, the scene is as expected–practically empty.  One staff member sits with our wheelchair bound patient, everyone else seems to be missing, despite it being meal time. A quick once over leads me to believe there is no amputation, the annoyance sets in.

So I ask my patient “whats going on tonight? How come you did this?” I am completely unprepared for the answers that follow. My patient–a 27 year old paraplegic female who suffers from Bipolar disorder, severe depression, and a gamut of other psychological issues–literally just came from our Behavioral Hospital. The very behavioral hospital she has requested to be transported to several times over the last few weeks due to depression and serious thoughts of suicide.

The story goes like this… as a child she was sexually abused by her father, her brothers, and her uncles. Her father pushed her down a set of stairs leading to a mild Traumatic Brain Injury and complete paralysis from the belly button down.

The state put her back in this home where these ingrates continued to sexually assault, mentally abuse, and psychologically destroy her for the next 9 years.  Finally the father is arrested for assaulting a neighbor’s daughter–when the story comes out again and the state takes her into their custody–only to be bounced from group home to group home, from one mental facility to another and back to the group homes. She has literally begged to be given inpatient treatment and the physicians say she just needs long term counseling. She is unable to do anything for herself–she cannot function without someone pushing her along. Not because she is physically weak, but because she is mentally broken.

She hurts because she has to actually hurt herself to get anyone to listen. I tell her we’ll get her help but she knows what that means. I will take her to yet another hospital where yet another doctor will push her back into the care of undereducated and overworked group home staff. All she wants is to feel safe. She wants to know that she can’t get out and THEY can’t get in–but no one will give this to her.

By the time we arrive at the hospital I know her story. I know enough to know that she needs this help. She knows what she needs, but doesn’t have the resources to do it herself.  As I transfer care I take the doc aside and give him the story. I tell him how I think she is a genuine threat to herself and that her mental anguish is real–not like so many of the calls we go on–the ones that made me grumble as I rolled out of bed. This is the real deal.

– — –

Two months later the tones startle me awake. Code 4, Any unit in position, Cardiac Arrest to an address I am all too familiar with. Dispatch updates with a 28 year old female, unconscious, not breathing, her throat is cut.

My foot reaches the floor. My knuckles are white on the wheel. My partner looks at me and asks me if I’m O.K.  I just drive faster. I walk in, the same deserted scene. The same deafening silence. I look down and know we’re too late. I let out a sigh, turn around and make the call.

I hurt because we failed.


Code 4

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Little Ambulance, Code 4, Cardiac Arrest, 200 W House you’ve been 3 times in 40 days.

One of the hardest things about small town EMS is that inevitably you run on someone you know, or like today, you run on a “frequent flyer” for the last time.

She wasn’t the bad kind of frequent flyer though. She was the best patient I’ve ever had. Today was my third and last time giving her a ride.

Her husband will probably follow soon. Stage 4 Lung cancer, prostrate cancer, CHF. Like his wife, it will be too late before we even get there. They have no family close, so when he goes hopefully he isn’t all alone.

I   checked him out and tried to make sure he knew we were there for him before I left. I don’t think he heard a word we said.

May God Have Mercy On Your Soul. god have mercy.