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.

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).

 

Do you ever feel like we’re playing a losing game?

The other day I went through my cardiac arrest statistics. Dispatched to 91 cardiac arrests since I became a medic. ~30/year. I have worked approximately 50% of those. I have EXACTLY 1 cardiac arrest save.

ONE!.

If this were baseball, I’d have a batting average of 0.01098901098901099.  OOOH! If we call all of the no start calls “sacrifices” I’d have an average of 0.021739130434782608. If we only say that the ~45ish times I’ve actually worked an arrest count as “at bats”, then I have an amazing 0.022222222222222223.

In baseball the record for lowest career batting average for a player with more than 2,500 at-bats belongs to Bill Bergen, a catcher who played from 1901 to 1911 and recorded a .170 average in 3,028 career at-bats. I’m well below the “Mendoza Line”

What is YOUR batting average?

Seriously. It did. I take ambien for sleep(12.5mg XR), as the chances of me sleeping on my own are not so good. But if I am awake past that first 40 minutes it makes me do crazy crap. Like post on my blog. Or clean out the fridge. OR trim, cut and cure 40 lbs of deer meat for Jerky slices. I’ve rearranged my 75 gallon aquarium and not remembered. I’ve don a LOT of things and not remembered.

It is mildly terrifying to know how much can happen with so little control. MY wife sure like the cleaning version of me though, so I doubt I’ll be changing over soon.

Do any of you have first hand experience of the crazy things meds made you do?  We hear stories all the time from patients and coworkers, but I’d like to hear your own stories.

ON a clinical note, what do we need to look for with these odd situations? Can a patient sedated with ambien be reliable?

Drop me a line!

Ambien Side Effects

• Constipation
• Difficulty with coordination
• Hallucinations
• Disorientation
• Anxiety
• Depression
• Binge eating
• Memory problems (see Ambien CR and Memory Problems)
• Spinning sensation (vertigo)
• Nausea
• Gastroesophageal reflux disease (GERD) – heartburn is the most common symptom
• Heart palpitations
• Fatigue
• Muscle pain.

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

Godspeed, friends!

doesn’t seem so bad now:

You could drop them from a moving ambulance.

One of the most common, and hardest patient encounters for me as a medic is that of someone who has lost their ability to do things. They still have all of their cognitive function…. they are just unable to do the things that you and I take for granted every day. Things like opening the milk, buttoning our pants, or driving the car. All gone, in what seems like a flash.

All of the sudden we are thrust into a moment where our patients are exposed for their weakness: they can no longer care for themselves. They KNOW they can do these things…. they just can’t actually complete the task. Our brain tells us we can do the things we’ve done countless times over our lives… but our bodies just don’t cooperate.

Today we had a patient at a local retail store. Found by staff in the bathroom. On the floor, covered in feces. He seemed alert, but was too weak to stand. To weak to grasp, to move. We arrived on scene found him sitting in a power chair, running into the wall… then the sink. Repeat.

It was obvious we were in one of these dreaded moments. Where it had to be explained to him that he needed help. Perhaps family has tried. Or maybe they haven’t. Maybe they’ve left this up to a stranger. To me.

As I explain to the man, who just knows he can take care of himself that I can’t let him drive. That I think we should take him in to get checked out–even though I don’t think he actually needs an emergency room–I see that look in his eyes. I see that he knows that he can’t do this anymore.

But he can’t let go. When he lets go of this he knows the rest is soon to come. That every piece of independence he loses is another piece of his dignity, all but forgotten.

While these patients can be frustrating, because it should seem like common sense that grandpa can’t drive, or grandma can’t climb the stairs anymore… families are in a hard place… taking the dignity from their elders. So take the time, the compassion to try to approach things delicately. Remember that some day, someone is going to have to tell you that you too are unable to do the things you’ve done all of your life. That you know you can do.

Despite being slower, weaker, and unable to complete seemingly simple tasks…. they are still in there. There is a soul in there still needing our compassion.

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?

“Mr Thompson…. Today when we arrived your wife was not breathing, her heart was not beating. We began CPR and hooked her up to our cardiac monitor. The monitor showed that your wife’s heart had stopped. It had no electrical activity.

At that time we continued CPR while administering heart-starting medications and inserting a breathing tube. After nearly 20 minutes, nothing has changed.  Her heart is still not beating. She is still not breathing.

I give you my most sincere condolences, but she is deceased and there is nothing more we can do. I’m very sorry sorry for your loss. ”

This is how it plays out in my head. Well put, accurate, somewhat concise…

But it never comes out as well and they never let you get that far. It is even harder in untimely deaths.

What do YOU tell people when their loved ones have died?

Are we “service” professionals? Do you view patients as “customers”?

I work for a corporate system and I am having a hard time wrapping my head around some of corporate nonsense they are using in employee publications as of late.

What do you think of calling “patients” “customers”?

My first impression…. I was under the impression “customers” “bought” things…. not took them for free?

• You are running around the house trying to gather your cellphone, charger, makeup, purse, keys, underwear, kitchen sink, and other miscellaneous ”essential”.
• You continue to cut me off, tell me I’m wrong, and insist that you must have some sort of cancer(unrelated to the 3 pack a day habit you have).
• Are mad I am not going to carry you to the ambulance after you have been running around the house(up and down stairs, too!).
• Are made that I will not give you morphine for this mysterious leg pain that just started when we got into the ambulance.

Reasons I don’t care:

• I only work one day this week.
• I haven’t listened to anything you’ve said.
• I’m dreaming of a nap.
• You smell something like a mix of cigarette smoke, old cheese, and pot roast.

Sincerly,

m3