Most often, when rescuers are faced with an intoxicated victim, they are not responding to an emergency directly related to the alcohol, such as alcohol poisoning. Instead, rescuers are responding to victims of typical illnesses and injuries - complicated by alcohol or drugs. An acutely intoxicated victim requires a diligent assessment.
Alcohol may mask certain medical conditions and alcohol intoxication appears similar to many life-threatening conditions. Chronic alcohol consumption causes damage to the body that leaves alcohol abusers more susceptible to certain medical conditions. Regardless whether a victim is simply intoxicated for a single incident or is a chronic alcohol abuser, certain adjustments for assessment and treatment will have to be made.
Consent and Alcohol or Drug Intoxication
Intoxication affects the way consent works in first aid and emergency medical situations. In all cases (intoxicated or not), victims of a medical emergency must give permission for a rescuer to help. It's required for the victim to understand the necessity of medical treatment before agreeing to any help, as well as understanding the consequences of refusing treatment. Victims must also know the possible side effects of any treatment they receive.That's a lot of information. It's particularly difficult for a victim impaired by alcohol or other substances. Because of the complexity of thought required, it is often assumed for intoxicated victims (the more intoxicated, the more it applies) that if they were sober and reasonable, they would accept help in their condition. We call this form of permission implied consent.
Alcohol and the ABC's
The ABC's of first aid do not change simply because a victim is intoxicated. In fact, the ABC's become much more important for an impaired victim. Alcohol is a central nervous system depressant and can depress the gag reflex, causing an airway emergency. Alcohol also causes vertigo in some people, which leads to nausea and vomiting. Vomiting and a depressed gag or cough reflex will lead to aspiration of emesis (vomit) into the airway.Deep alcohol intoxication may lead to depressed respiratory effort, causing the victim to breath slowly and shallowly. Besides alcohol, there are several other substances which cause even deeper respiratory depression. Opiates, such as heroin, commonly cause complete respiratory arrest (cessation of breathing). Benzodiazepines, such as valium, also cause respiratory depression and become more potent when combined with alcohol.
Alcohol causes dilation of the blood vessels, which decreases blood pressure and blocks the body's ability to compensate for bleeding and shock. Vessel dilation (vasodilation) lets blood rush to the skin and flood the surface of the body, where it is cooled - potentially leading to hypothermia.
