Burden of inebriate cases on local emergency medical services (EMS)

Introduction: Inebriate cases are a significant burden on EMS and healthcare systems in Santa Clara County, a large and diverse county in Northern California. Determining the characteristics of inebriate cases may inform establishment of sobering centers and help redistribute limited resources. Objectives: To (1) determine the burden of inebriate cases on the county EMS system; (2) describe demographic characteristics; (3) establish points of origin and destinations; (4) identify “frequent users”. Methods: Data came from Service Bridge, a data management system for ambulance transports. An inebriate case was defined as a person with a chief complaint or paramedics' primary clinical impression coded as alcohol use. The analytic sample included 1453 unduplicated cases from July-December 2011. Results: Approximately 4% of all EMS transports were inebriate cases, with a cost of $1.7 million to the county EMS in six months. Seventy-five percent of cases were male and 51% were ages 40-59. Most (48%) transports occurred over the weekend and from 4pm to 2am (71%). Twenty frequent users accounted for 15% of transports. The point of origin for 65% of cases was a single low-income high-density geographic cluster with a higher density of alcohol retailers than countywide. Fifty-eight percent of cases were transported to 2 of 15 hospitals. Conclusion: The burden of inebriate cases on the EMS system supports the need for a sobering center. Geographic and temporal clustering of cases may help to prioritize the center location and hours. Programs targeting frequent users may help further reduce the economic impact on various systems.