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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

Mostly it’s the getting by thing…

2,117 comments

We all joke in ways our families, friends and patients don’t understand. See around the 3:20 mark of this video:

Godspeed, friends!

Repeating myself….

2,130 comments

Only because I think I said it right the first time.

<strong>WE’VE ALL BEEN THERE….

Sad as it may be, many medics spend a great deal of time trying to get out of doing their jobs. We’ve all been there: annoyed, over tired, and over worked. We don’t get paid any more to transport, so sometimes we seem to think that maybe the patient doesn’t really need an ambulance….

I can see how it plaid out in my head. I really can… and that is what scares me the most. In 2008, 39 year old Edward Givens died shortly after EMS saw him at his home. The medic that day told Mr Givens he was just having acid reflux and recommended Pepto Bismol. Two hours later Mr Givens was dead.

You can see it now, can’t you? Maybe the patient is being overly dramatic, or maybe it is the family. You’ve been working for 20 hours and this is your 30th call. You’re 8 charts deep and know that another refusal or no ambulance needed is less work than the transport…

But here is the problem…. it is our job to transport people to the hospital. It isn’t our job to determine whether they need an ambulance or not. If someone wants to go, we take them. Regardless of whether you think they are sick or not. We don’t diagnose. We don’t cure. We are in the business of transporting patients.

I don’t know what really happened that day in 2008, but I do know that we’ve all been there before. We’ve all spent a considerable amount of energy on not transporting someone. Maybe you’ve even had a close call. A stroke you thought was a diabetic… or an AMI that you thought had reflux… But until now you’ve skated by.

Well stop. Stop expending so much energy trying to get out of doing your job. If you’re no longer interested in transporting patients, find a new line of work. When it comes down to it, is it worth risking someones life, your job, and your family’s livelihood on it? The medics in question here were not found to have violated any policies or procedures by their employer…. but do YOU want to live with that on your shoulders?

What do you think about it now?

We’ve all been there….

2,231 comments

Sad as it may be, many medics spend a great deal of time trying to get out of doing their jobs. We’ve all been there: annoyed, over tired, and over worked. We don’t get paid any more to transport, so sometimes we seem to think that maybe the patient doesn’t really need an ambulance….

I can see how it plaid out in my head. I really can… and that is what scares me the most. In 2008, 39 year old Edward Givens died shortly after EMS saw him at his home. The medic that day told Mr Givens he was just having acid reflux and recommended Pepto Bismol. Two hours later Mr Givens was dead.

You can see it now, can’t you? Maybe the patient is being overly dramatic, or maybe it is the family. You’ve been working for 20 hours and this is your 30th call. You’re 8 charts deep and know that another refusal or no ambulance needed is less work than the transport…

But here is the problem…. it is our job to transport people to the hospital. It isn’t our job to determine whether they need an ambulance or not. If someone wants to go, we take them. Regardless of whether you think they are sick or not. We don’t diagnose. We don’t cure. We are in the business of transporting patients.

I don’t know what really happened that day in 2008, but I do know that we’ve all been there before. We’ve all spent a considerable amount of energy on not transporting someone. Maybe you’ve even had a close call. A stroke you thought was a diabetic…  or an AMI that you thought had reflux… But until now you’ve skated by.

Well stop. Stop expending so much energy trying to get out of doing your job. If you’re no longer interested in transporting patients, find a new line of work. When it comes down to it, is it worth risking someones life, your job, and your family’s livelihood on it? The medics in question here were not found to have violated any policies or procedures by their employer…. but do YOU want to live with that on your shoulders?

Government Efficiency…

63 comments

The Pentagon’s 26 page Brownie and Oatmeal cookie recipe has gotten plenty of press lately….  If you haven’t seen it, please read some of it and understand why the budget is not balanced, the war on terror is failing, and the sky is now falling.

Somewhere in the middle of all of this crap it says this…

3.3.2 Brownie preparation. (NOTE: The contractor is not required to follow the exact procedure shown below provided that the brownies conform to all finished product requirements in 3.4.)

If that is the case… wtf is is this entire thing about?

Also, any Military document that says “fluffy” is a giant waste of my time…

a. Whip eggs in large bowl on high speed until light and fluffy.

Now quit wasting my tax dollars and get back to work…