256 Safety and Efficacy of a Sobriety Emergency Response Unit in an Urban Emergency Medical Services System

Abstract

Approximately 1% of all emergency department (ED) visits in the United States involve uncomplicated alcohol-related complaints, and these patients may undergo unnecessary testing while occupying limited ED resources. Most of these patients arrive by emergency medical services (EMS) ambulance. This is a preliminary evaluation of the safety and efficacy of a new Sobriety Emergency Response (SOBER) Unit, which is a unique EMS resource staffed with a firefighter/paramedic, a nurse practitioner and caseworker, whose mission is to medically clear publicly inebriated patients and transport them to a sobering center, where they can be connected to appropriate mental health and social services, instead of transport to an ED. The study was conducted in the City of Los Angeles, which has a population of approximately 4.1 million covering 471 square miles. Los Angeles Fire Department (LAFD) provides all 911 EMS responses via a tiered, fire-based basic life support (BLS) and advanced life support (ALS) system. Data were collected prospectively for the first 6 months of implementation of the SOBER Unit, from November 2017 to May 2018. Inclusion criteria included age between 18-65 years old, suspected alcohol intoxication, no evidence of head injury and non-combative patients. Exclusion criteria included any loss of consciousness, Glasgow Coma Scale < 14, any anticoagulant use, pulse rate > 120 or < 50 beats per minute, blood glucose > 250 or < 60 mg/dL, or any evidence of trauma above the clavicles. Descriptive statistics were captured. The SOBER Unit was operational Tuesday through Friday from 1000-2000 hours around the Skid Row area of downtown Los Angeles. The unit was activated via request by on-scene LAFD units or responding to calls at their discretion. All secondary transports from the sobering center to an ED were captured. There were 419 patients evaluated by the SOBER Unit, of whom 374 (89.3%) were transported. Of the 374 transports, 363 (97%) were taken directly to the sobering center in lieu of transport to an ED. The mean age was 46.6 years (IQR 17, median 48) and 337 (85%) were male. Additionally, 6 (2%) were medically cleared and directly transported to a mental health urgent care center. Of those treated, common comorbidities were substance abuse (51%), hypertension (14%) and psychiatric illness (10%). There were 393 total transports for 298 unique patients. Six patients had 5 or more transports, of which 1 was placed in long term substance abuse housing through the sobering center and had no further 911 or SOBER Unit contacts. There were 10 secondary transports from the sobering center to an ED: 8 were transported via non-emergency van and 2 were transported via 911 ambulance (1 for seizure activity and the other because his wheelchair could not be accommodated in the non-emergency van). In the study period, all patients who required secondary transport were either treated and released from the ED or discharged home within 72 hours, with no significant adverse effects. Preliminary data suggests that a mobile SOBER unit is a safe and efficacious means of medically clearing public inebriates and transporting them to a supportive, non-ED setting. Further research is needed to determine its long-term impact on recidivism and cost-effectiveness.