Impact of the San Diego Serial Inebriate Program on Use of Emergency Medical Resources

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1 EMERGENCY MEDICAL SERVICES/ORIGINAL RESEARCH Ipa of h Sa Digo Sial Ibia oga o Us of Egy Mdial Rsous Jas V. Dufod, MD Edwad M. Casillo, hd, MH Thodo C. Cha, MD Gay M. Vilk, MD Jso, MD Suza. Lidsay, hd, MSW, MH Fo h Dpa of Egy Mdii, Uivsiy of Califoia, Sa Digo Mdial C, Sa Digo, CA (Dufod, Cha, Vilk); h Isiu fo ubli Halh, Gadua Shool of ubli Halh, Sa Digo Sa Uivsiy, Sa Digo, CA (Casillo, Lidsay); ad h Log Bah Moial Faily Mdii Rsid oga, Log Bah, CA (Jso). Sudy objiv: W di h ipa of a a sagy alld h Sa Digo Sial Ibia oga o h us of gy dial svis (EMS) ad gy dpa (ED) ad ipai svis by idividuals padly asd fo publi ioxiaio. Mhods: This was a ospiv viw of halh a uilizaio ods (EMS, ED, ad ipai) of 529 idividuals fo o 3. Judgs offd idividuals a 6-oh oupai a poga i liu of usody (Sial Ibia oga). Dogaphis ad halh a uilizaio a pod ovall ad by a apa. Rsuls: Fo o 3, 38 of 529 (58%) idividuals w aspod by EMS 2,335 is; 9 of 529 (77%) idividuals aassd 3,318 ED visis, ad 217 of 529 (41%) idividuals quid 652 adissios, sulig i 3,361 ipai days. Halh a hags oald $17.7 illio (EMS, $1.3 illio; ED, $2.5 illio; ad ipai, $13.9 illio). Ta was offd o 268 idividuals, ad 156 (58%) apd. Us of EMS, ED, ad ipai svis dlid by 5% fo lis who hos a, sulig i a siad das i oal ohly avag hags of $5,662 (EMS), $12,6 (ED), ad $55,684 (ipai). Th was o hag i us of svis fo idividuals who fusd a. Th was a sigifia iasig d i apa aog idividuals wih log jail ss (.1). Ta apa was % aog hos wih ss of o 3 days ad ahd 63% fo hos wih ss log ha 15 days. Opaioal oss ad ala a a liis ad opaiipaig hospials w o aalyzd. Colusio: This ouiy-suppod a sagy dud h us of EMS, ED, ad ipai sous by idividuals padly ioxiad i publi. [A Eg Md. 6;47: ] /$-s fo a Copyigh 6 by h Aia Collg of Egy hysiias. doi:1.116/j.agd INTRODUCTION Holss idividuals padly ioxiad i publi dispopoioaly osu sous hough ous wih poli, fi dpa, gy dial svis (EMS), ad gy dpa (ED) psol Tadiioal hial dpdy as hav b iffiv fo his idivis populaio. Is as aag has show bfi i so 2,5,1 bu o all 11 sudis, ad h is o ffiv sagy o addss hi odiio. Moivaio is ssial fo ovy, ad lgal pssu has b apabl of oivaig bfiial hag i bhavio fo aduls wih alohol ad oh dug pobls. 14 I Jauay, h Sa Digo oli Dpa iiiad a pilo Sial Ibia oga o assis a goup of holss idividuals suk i a volvig doo bw jail, EDs, ad h dowow Volus of Aia ibia pio (sobig). Ealy suss allowd his poga o volv houghou h gio as a paship likig law fo, fi dpas, EMS, hospials, h publi dfd, h iy aoy, h supio ou, Volus of Aia, busiss, a povids, ad loal gov. Th goal of h Sial Ibia oga is o povid pais who hav xhausd adiioal hapui opios wih a sob livig 328 Aals of Egy Mdii Volu 47, NO. 4 : Apil 6

2 Dufod al Sa Digo Sial Ibia oga ad Egy Mdial Rsous Edio s Capsul Suay Wha is alady kow o his opi Choi alohol abuss, spially hos who ak a publi uisa of hslvs, ay xis i a ppual yl of as, iaaio, ad halh a visis fo ald al saus o alohol wihdawal. This yl buds halh ad law fo syss wihou ipovig h wlfa of h subj o soiy. Wha qusio his sudy addssd This sudy xaid whh a sys i whih hoi aloholis ould op fo halfway hous a isad of jail i dud halh a uilizaio ad os. Wha his sudy adds o ou kowldg Th pais who hos o avoid jail by ollig i h poga uilizd usd fw dial sous gy dial svis, gy dpa, ad ipai, asud i dollas i h sho opad wih hos who opd fo jail. How his igh hag liial pai This sudy dos o hlp h gy physiia who is paiig i a ouiy wh o suh sys xiss bu povids a odl fo hag ha would psv valuabl sous fo oh ouiy halh ds. alaiv whil duig hi advs ouiy ipa. Th Sial Ibia oga aligs h judiial sys wih a o a iiv fo idividuals paiipaio i a oupai ovy poga ailod o hi ds. Law fo is sposibl fo povidig idividuals did o b publily ioxiad wih a saf sobig vio. Idividuals who lak oh as of saf shl a aspod o h ibia pio, wh hy iv supvisio ad oioig by a saff uil sob. Suh idividuals iv ouslig ad a ouagd o h Volus of Aia ovy poga, bu ay dli his off ad poply su dikig. Califoia dos osid publi ioxiaio disodly odu, ad ud ai iusas his isdao a sul i iaaio fo up o 18 days. Th Califoia 4h Disi Cou of Appals did ha h sa ay iaa ioxiad idividuals baus i has a lgiia d o ool publi dukss wh suh bhavio as a safy hazad. 15 Th ou oludd ha sa law dos o puish h odiio of big a holss, hoi aloholi bu ah h assoiad odu ha poss a publi safy isk. Califoia law also povids judgs h opio of offig suh idividuals a oppouiy o opl a aloholis a poga i liu of usody. Bfo h iplaio of Sial Ibia oga, loal a pogas w uwillig o ap hs lis baus of hi idivis bhavio, ad jails aly housd h log ha 72 hous. I 1999, h Sa Digo oli Dpa uid a a povid o ollaboa i h dvlop of a ovl pilo poga ailod o his populaio. Th Sa Digo oli Dpa also sud h suppo of h iy aoy o dvlop w bookig ad sig podus. Ipoaly, h publi dfd l is iial suppo o poga dvlop af oludig lis would b affodd valuabl w suppo ad a. Volus of Aia saff w askd o dfi h iia ha should osiu a hoi ibia (ad hfo Sial Ibia oga li), ad h supio ou dosd a ial poga. I Jauay, h ou bga offig ligibl idividuals h opio of a 6-oh oupai a poga i liu of usody (Sial Ibia oga). Sial Ibia oga poli offis assud sposibiliy fo oioig li pogss whil foig laws govig violaios of pobaio. This sudy was dsigd o valua h ipa of h Sial Ibia oga o h us of EMS, ED, ad ipai sous duig is fis 4 yas of opaio. MATERIALS AND METHODS Th iy of Sa Digo is h aio s svh lags, wih a populaio of 1.3 illio sids. Th iy opasss 73 squa ils ad is ho o 12 au a hospials. Th iy is svd by 1 paadi povid (h Sa Digo Mdial Svis Epis), a publi/piva paship bw h Sa Digo Fi-Rsu Dpa ad h Rual/Mo Abula Copay. Idividuals did o b publily ioxiad ad fo who h a o oh as of suig safy a aspod by poli o h ibia pio. Th ibia pio is o saffd wih uss o physiias, ad lis us b dially sabl ad abulaoy wihou assisa. ublily ioxiad idividuals judgd by paadis o law fo o b oabulaoy a aspod by paadis o aa hospials. Two iay a dial s sv h dowow gio ad bah ouiis wh h ajoiy of suh alohol-lad alls ais. Boh hospials povid sig, bif ivio, ad fal subsa abus svis o all ED pais. Figu 1 illusas h Sial Ibia oga poss. Idividuals auulaig 5 aspos o h ibia pio wihi 3 days a osidd hoi by ibia pio saff ad jd. oli aspo hs psos o jail, wh hy bo sob, iv dial a, ad ai uil aaig ad ial. Judgs issu pogssiv ss basd o pvious oviios i a ypial squ: fis oviio, i svd, pobaio gad ; sod oviio, iaaio fo 3 days; hid oviio, 6 days; fouh oviio, 9 days; fifh oviio, 1 days; sixh oviio, 15 days; svh oviio, 18 days. Wih ah s, judgs xis h opio of offig a is 6- oh, oupai liial ivio poga i liu of usody (Sial Ibia oga). Volu 47, NO. 4 : Apil 6 Aals of Egy Mdii 329

3 Sa Digo Sial Ibia oga ad Egy Mdial Rsous Dufod al 5 h aspo o IRC wihi 3 days, asd fo Duk i ubli. ogssiv ss a issud basd o pio hisoy Ta Offd I Cou Ta No Offd I Cou Ap Dos No Ap Evaluad by Ta ovid Apd No Apd Bgis Ta Copls oga (6-ohs) Copls 3 Days Coiuu of Ca Ahivd Doppd Ou I < 3 Days Svs S Figu 1. Sial Ibia oga poss fo h i of as o poga oplio o jail, Sa Digo, CA, Jauay 1,, o Db 31, 3. sos xpssig is i h Sial Ibia oga a alaiv a valuad by ouslos whil i usody. Thos wih hisois of viol i, aso, o hild abus a xludd baus of h liiaios of goup livig. Idividuals apd fo a a lasd fo jail dily o h usody of a Sial Ibia oga poli offi who povids aspoaio o a paiipaig goup sidial a si. Sussful oplio of h 6-oh a poga fulfills a odiio of pobaio, ad hs Sial Ibia oga gaduas a subsquly fd fo addiioal suppo svis ad assisa. Howv, hos lis who su dikig o ohwis fail o opl a a ud o usody ad a quid o opl h bala of hi pviously iposd s. This sudy was did o h iia of h US Dpa of Halh ad Hua Svis Cod of Fdal Rgulaios allowig fo waiv of ifod os 16 ad was appovd by h Hua Rsah oio ogas a h Uivsiy of Califoia, Sa Digo ad h Sipps My Hospial. This sudy usd a hisoial oho dsig o valua h ffivss of h Sial Ibia oga i duig h us of EMS, ED, ad ipai svis ad h ospodig halh a oss. Fo law fo ods, 1 Sial Ibia oga offi absad a lis of dogaphi ifoaio, as ad aaig ifoaio, ou s, a (offd ad whh apd), poga pla, ad ouo (as waa issud o a opld) fo h dfid populaio. A spadsh oaiig as, soial suiy ubs, ad das of bih of hs idividuals was subid o h ifoaio syss dpas of h iy EMS abula povid ad h 2 gioal hospials paiipaig i his sudy. O ifoaio syss aalys a ah si pfod a sigl loi sah of hi agy o isiuio s billig ods o idify das of svi, billig ods, ad h au of ous fo hs idividuals bw Jauay ad Db 3. Ths 3 aalyss w uawa of h pupos of h quy. Th iiial pos w viwd fo auay by 2 auhos (EC, JD), ad duplia is ad billig igulaiis w fd fo laifiaio. Fial pos w gd ad ad aoyous by dlig all pod halh ifoaio. EMS povid daa iludd das of abula aspos, as wll as billig ad pay ifoaio; oh oaspo paadi oas w xludd. Hospial daa iludd ED ad ipai das of visis, billig, ad pay ifoaio ad piay diagoss. Ipai daa also iludd adissio ad dishag das. ED ad ipai daa fo oh gioal hospials o whih hs idividuals ay hav also ivd a w o availabl. iay Daa Aalysis Fquis ad pags fo dogaphi ifoaio ad halh a uilizaio a pod. Idividuals w agoizd io a apos ad oapos. - ad pospiods w alulad fo ah pso basd o h da of apig a i ou fo h fis i (fo hos who apd a) ad h da of fis as fo hos who did o ap a. Avag ohly EMS aspos ad ED o ipai adissios ad assoiad hags w alulad fo p ad pospiods fo a apos ad oapos ad dias, ad assoiad iquail ags a pod. To assss h ff of iasd ss o h apa of a duig aaig, h ub of ovall apas was opad o h duaio of ss iposd usig a s fo lia d. Daa w aalyzd usig SSS vsio 11.5 (SSS, I., Chiago, IL). RESULTS Fo Jauay o Db 3, 529 idividuals w jd by ibia pio saff ad agoizd hoi af big aspod o hi failiy 5 is wihi 3 days fo publi ioxiaio. Th ajoiy of h idividuals w (92%), whi (75%), ad 35 o 5 yas of ag 33 Aals of Egy Mdii Volu 47, NO. 4 : Apil 6

4 Dufod al Sa Digo Sial Ibia oga ad Egy Mdial Rsous Tabl 1. Typ of halh a sous usd by 529* Sial Ibia oga lis, Sa Digo, CA, Jauay 1,, o Db 31, 3. Rsous Toal Rag Mdia (Iquail Rag) EMS aspos ( 38) 2, (2.,9.) ED visis ( 9) 3, (2.,1.) Ipai adissios ( 217) (1.,3.) Lgh of say (days) (652 visis) 3, (2.,5.) *Svy-i sial ibiad idividuals had o od of us of halh a sous. Dfid as visiig h ibia pio 5 o o is wihi 3 days. Tabl 2. ay ifoaio by yp of a fo 529* Sial Ibia oga lis who usd halh a svis, Sa Digo, CA, Jauay 1,, o Db 31, 3. Typ of Ca Rag ($) Toal ($) aid, % EMS aspos ( 38) Chags 237 3,789 1,276, ays 9, ,725 ED visis ( 9) Chags 18 59,567 2,53, ays 12, 389,286 Ipai adissios ( 217) Chags 2,824 1,31,76 13,939, ays 142,51 2,742,85 Toal ( 45) Chags 18 1,68,59 17,747, ays 147,68 3,38,862 *Svy-i sial ibiad idividuals had o od of us of halh a sous. Dfid as visiig h ibia pio 5 o o is wihi 3 days. (69%). Tabl 1 dosas h us of ED, EMS, ad ipai svis by his populaio a h 2 hospials ad h iy s sol paadi aspo agy. Of h 529 idividuals, 79 (15%) idividuals had o od of usig ay halh a svi duig h sudy piod. O hudd hi (21%) idividuals usd 1 svi, 19 (36%) idividuals usd 2 svis, ad 147 (28%) idividuals usd all 3 svis. Th ED was h os oo svi usd by hs 529 idividuals, wih 9 (77%) lis auulaig a oal of 3,318 oal ED visis. Th x os ooly usd svi was EMS wih 38 (58%) lis auulaig 2,335 aspos. Two hudd sv (41%) lis quid 652 adissios o hospial ad aud a oal of 3,361 ipai days. Tabl 2 iluds hag ad pay ifoaio fo h sudy populaio. Th oal hags aud by hs psos fo halh a svis w $17.7 illio. Th svis wih h 8% 6% % % % -3 (=95) 31-6 (=123) 61-9 (=8) 91-1 (=93) Days (=37) 151+ (=174) Ovall (=62) Figu 2. apa of a* by duaio of iposd ou s, Sa Digo, CA, Jauay 1,, o Db 31, 3. *Gaph iluds offs i whih idividual ih apd o fusd a ( 62); all oh iids xludd (did, faild, o offig ukow/o sad). os hags w ipai adissios ($13.9 illio), followd by ED visis ($2.5 illio) ad EMS aspos ($1.3 illio). Aog h 3 svis, ibus as w ipai (19.7%), ED (15.4%), ad EMS (13.8%). Ovall, pays w ivd fo 18.6% of hags. Idividuals ould b offd oll i a a poga af ay oviio fo publi ioxiaio. Baus duaio of h iposd s was lad o h ub of pvious oviios, lis usually apd a oly af pad oviios. Figu 2 illusas a apa by lgh of s. Judgs issud a oal of 62 Sial Ibia oga offs o 268 (51%) idividuals bw ad 3. Th was a sigifia iasig d i apa aog idividuals wih log jail ss (.1), fo % aog hos wih ss of 3 days o fw o 63% aog hos wih ss of 15 days o o. Th os oo aso fo o big offd a was a fis oviio whi h ou ypially gas pobaio ah ha usody. Oh asos fo a o big offd iludd oxisig iial hags ad idividuals wih hisois of viol bhavio iopaibl wih goup livig aags. A oal of 156 (58%) idividuals apd h a alaiv a so poi. Copaisos of dogaphi haaisis bw hos who apd a ad hos who did o ap (o w o offd) a psd i Tabl 3. Th was o ipoa diff i ag o sx fo hos who apd a opad wih hos who did o. Whis w o likly o ap a opad wih oh a o hi goups. Fo h ppiod, h avag ub of ohs fo followup was (13.67) fo hos who did o ap a ad (13.28) fo hos who apd a. Fo h pospiod, h avag ub of ohs fo follow-up was (13.67) ad (13.28), spivly. Figu 3 Volu 47, NO. 4 : Apil 6 Aals of Egy Mdii 331

5 Sa Digo Sial Ibia oga ad Egy Mdial Rsous Dufod al Tabl 3. Dogaphi haaisis fo 529 Sial Ibia oga lis* by a apa, Sa Digo, CA, Jauay 1,, o Db 31, 3. Chaaisi Ta No Offd o Apd Ta Apd Nub (%) Nub (%) Valu Ag goup y y y Sx.199 Mal Fal Ra/hiiy.36 Whi Blak Hispai Oh *Dfid as visiig h ibia pio 5 o o is wihi 3 days. illusas h disibuio of halh a uilizaio ad assoiad hags fo h sudy populaio by a apa. Th disibuio of halh a uilizaio aog hos who did o ap a aid laivly uhagd fo h p- o pospiod. Howv, h disibuio fo hos who apd a shifd o h lf fo h p- o pospiods, whih idias h us of fw svis. Addiioally, h Sial Ibia oga affd h high-d uss of hospial ad abula sous. Th dia avag ohly EMS ad ED visis p pso fo hos who apd a w aly 2 is o ha fo hos who did o ap a. Mo ipoa, h dia p pso us of EMS, ED, ad ipai sous dlid by a las 5% fo h p- o pospiods fo idividuals who apd a (.13 o.5,.16 o.5, ad.5 o.2, spivly), whas h was o hag o a ias i h dia us of hs svis aog psos who fusd a ad hos o ai i usody (.6 o.7,.6 o.6, ad.2 o.4, spivly). Th sulig ovall das i halh a oas aog h goup who apd a was osidabl. Th oal ohly avag uilizaio dasd by a siad 15 EMS aspos aog h 198 EMS uss, 29 ED visis aog h 277 ED uss, ad 4 adissios aog h 136 idividuals who usd ipai svis. Fo hos who did o ap h Sial Ibia oga, h siad oal ohly avag ED oas dasd by 1 aog h 132 ED uss, whas h oal ohly avag EMS aspos iasd by 6 aog h 11 EMS uss, ad ipai adissios iasd by 3 aog h 81 idividuals who usd ipai svis. As xpd, h disibuio fo hags assoiad wih halh a uilizaio followd siila pas as oas (Figu 3); h disibuio aid laivly uhagd fo hos who did o ap a fo h p- o pospiods, whas h disibuio fo hos who apd a shifd owad low hags. Fo hos who apd a, h dia avag ohly p pso hag dasd fo all yps of a fo h p- o pospiods ($65.7 o $29.8 fo EMS, $95.31 o $35.73 fo ED, ad $65.87 o $ fo ipai). Fo hos who fusd h off of a, hs hags aid uhagd o iasd ($29.49 o $36.99 fo EMS, $.89 o $34.3 fo ED, ad $ o $ fo ipai). Th sulig oal ovall das i hags aog h goup ha apd a was also subsaial. Fo hos who apd a, h oal ohly avag hags dasd by a siad $5,662 fo EMS aspos, $12,6 fo ED visis, ad $55,684 fo ipai adissios. Fo hos who did o ap a, h oal ohly avag ED hags dasd by a siad $434, whas hags fo EMS ad ipai svis iasd by $6,521 ad $5,56, spivly. LIMITATIONS This sudy has sval liiaios. Mdial hags w usd o fl h xps of a, bu hags ad oss a o quival. Sod, hospial hags a likly udsiad baus oly 2 of h iy s doz hospials paiipad i h sudy. Howv, hs 2 hospials a h piay ivig failiis fo ighbohoods wih h gas ubs of poli alls lad o aloholis. Thid, his sudy did o addss h di o idi oss of opaig h Sial Ibia oga. Th oss iud by law fo, h iy aoy, h ouy jail, ad hos assoiad wih a ad housig w o aalyzd. Howv, i 199 h Sa Digo oli Dpa siad ha h aual os of asig, aspoig, jailig, ad fillig ou papwok fo a siila goup of 9 dowow idividuals was $3,. 17 Tha aalysis did o fl h os o iy gov fo publi dfds, posuos, ad ou i, o h soial oss o fiaial ipa of hs idividuals o h piva so. This sudy opad idividuals who apd a vsus all ohs ad assus h la populaio shas a siila us pa gadlss of whh hy jd o w o offd a. Fuho, his sudy did o asu h suss of h Sial Ibia oga i ahivig log sobiy o duig holssss o h us of dial a a oh loaios. Sial Ibia oga lis a fd o oupai dial failiis fo ogoig a, bu h x of hi us of suh svis was o availabl fo aalysis. I is hfo possibl ha h duio i hags dosad by his sudy ovsiad h aual das i us of halh a sous. Howv, piva aspoaio o liis is ypially pfabl o pad EMS aspo o EDs. Follow-up was o pfod o assss h possibiliy ha so idividuals igh hav did o load. Aiio ous i fqu ED uss, 1,7,11 ad so auhos hav suggsd 332 Aals of Egy Mdii Volu 47, NO. 4 : Apil 6

6 Dufod al Sa Digo Sial Ibia oga ad Egy Mdial Rsous Avag Mohly Egy Mdial Svis Taspos Avag Mohly Egy Dpa Visis Avag Mohly Ipai Adis d p o A ( ) N b u N a T s o 6 6 Mdia= Mdia= Mdia= Mdia= Mdia= Mdia=.4 p d ) Mdia=.13 6 Mdia=.16 Mdia=.5 A b ( u N s T a o Mdia= Mdia= Mdia=.2 Avag Mohly Egy Mdial Svis Chags Avag Mohly Egy Dpa Chags Avag Mohly Ipai Chags d p A ) ( o N b N o s a T d Mdia=29.49 Mdia=.89 Mdia= u Mdia=36.99 Mdia=34.3 Mdia= Mdia= Mdia=95.31 Mdia=65.87 p ) 25 A b ( u N s T a o Mdia= Mdia= Mdia= Figu 3. Th disibuio of halh a uilizaio ad assoiad hags fo 529* Sial Ibia oga lis by a apa saus, Sa Digo, CA, Jauay 1,, o Db 31, 3. *Svy-i sial ibiad idividuals had o od of us of halh a sous. Dfid as visios o h ibia pio 5 o o is wihi 3 days. Oulyig ohly avags o h igh of h gaph w xludd fo h gaph o fous o h bulk of ods bu w iludd i diig h di a. Volu 47, NO. 4 : Apil 6 Aals of Egy Mdii 333

7 Sa Digo Sial Ibia oga ad Egy Mdial Rsous Dufod al ha ivios should b agd oly owad pais who ai fqu ED uss fo a las 2 yas. 1 Howv, h Sial Ibia oga is idd o off a idpdly of h fquy of ED visis, ogizig ha hospials will bfi if h poga is sussful. Fially, his sudy ould o di halh a uilizaio as a fuio of aual ohs i a o iaaio. Th u duaio of a o iaaio vais aog idividuals basd o oxisig lgal issus. Baus pis a ad iaaio piods w uavailabl, a sipl p- o posfoa usig h i follow-up piod was usd. DISCUSSION This sudy dous h xaodiay osupio of EMS, ED, ad ipai sous by o iy s populaio of holss hoi aloholis. Assuig a avag obsvaio piod of 4.5 hous (Dufod, upublishd daa) hs pais osud aly 15, hous of ED saff i a 2 of Sa Digo s ajo gioal hospials, whih quas o a 34% ha ha a Sial Ibia oga li was oupyig a ED bd a o of hs failiis a ay o duig h 4- ya sudy. Ths daa povid vid ha a laivly sall ub of idividuals a hav a lag ipa o a ouiy s safy. This sudy also dosas ha a ouiy-suppod alohol a sagy ha iopoas lgal osqu a du h osupio of gy halh a sous. Th was a 5% dli i h us of ED, ipai, ad EMS sous fo h 156 idividuals who apd a 6-oh oupai a poga i liu of usody. Covsly, h was o hag i sou osupio by h 112 idividuals who ld o o a. Th Sial Ibia oga s suss divd piaily fo is ipa o h os idivis idividuals. Thos apig a w ypially old who had b aspod by EMS ad ad i ED wi as of as oapos. Th a ay qusios aisd by his sudy. I is ula whih faos di h d fo dial a i his populaio. Cuiously, duig 4 yas h is o vid ha 79 (15%) of h 529 Sial Ibia oga lis w v aspod by paadis o ivd hospial a. Fuho, i is ukow whih asp of h Sial Ibia oga oivad hag. Aloholis sah suggss ha oivaio is ssial o ovy. 18 A sis of sags (poplaio, oplaio, ppaaio, aio, ad aia) dsibs h poss a idividual xpis wh udgoig bhavioal hag. I has b suggsd ha lgal pssu ay hav paiula poial o oiva hag i dug ad alohol bhavio baus i a b o osisly applid ha oh soial pssus. 14 Aodig o a povids failia wih his populaio, i is akabl ha ay, l alo 156, of h ouiy s os faoy idividuals apd a. I ay b ha idividuals wih hoi aloholis o o viw hslvs diffly ha ias iaad fo oh is (Dufod, oal ouiaio, 5). Giv h pogssiv sig suu of h Sial Ibia oga, so idividuals hav xplaid hi paiipaio i a as h lss of 2 vils. If i ould b subsaiad ha o log iiial s was as likly o sul i a as h u spwis poss, o apid iiiaio of hapy ad sigifia os savigs igh b ahivd. T p of h aio s holss a osidd hoially holss (o ha 1 ya wihou pa shl), 19 ad i Sa Digo ha figu ay b as high as 19%. Th US Iagy Couil o Holssss sias ha 1% of h aio s holss osu 5% of publi sous, iludig EMS, doxifiaio, shl, law fo, ad psyhiai ad oioal a. 21 Th ff of publily ibiad idividuals o EMS ad ED has b pviously dsibd. udi al 6 pod ha 14 of 16 ED pais wih o ha 1 visi p oh fo 6 ohs a h Dv Gal Hospial w ioxiad. Two hudd wy-h (84%) of hi 267 ED visis ivolvd 911 paadi aspo. Bios 4 pod ha h Hpi Couy ED ad siila idividuals a oal of 1,858 is i 1 ya. I 2, 5.6% of all ED visis o ha failiy w lad o alohol ioxiaio. 2 A h Sa Faiso Gal ED, fqu us of h ED olad wih alohol-lad pobls, iludig ioxiaio (laiv isk, 2.4), sizus (laiv isk, 3.), ad dpd (laiv isk, 3.4). 1 Th hav b ffos o du h us of gy svis by his populaio. 2,5,13,14 Hpi Couy dvlopd a housig ad s as aag poga fo idividuals who had faild doxifiaio a, fals, al halh holds, ad ivoluay ois. 2 Alhough h poga dud h ub of visis o doxifiaio s ad EDs fo 96 idividuals, ovall visis fo dial illss did o dli, ad h poga did o ap o ahiv pai sobiy. Oki al 5 dosad ha is as aag a du h iodia us of ED sous. Fify-h pais ad i h Sa Faiso Gal ED 5 o o is wihi 12 ohs w voluaily assigd o a psyhiai soial wok. Th dia ub of ED visis dlid fo 15 o 9 (.1), dia ED oss dlid fo $4,124 o $2,195 (.1), dia ipai oss dlid fo $8,33 o $2,786 (.1), ad alohol us was dud by 25% (.5). Th auhos oludd ha ah dolla ivsd yildd a $1.44 savigs. No all sas osid publi ioxiaio as a publi offs. Fo xapl, h Nvada lgislau has dlad ha h hadlig of alohol abuss wihi h iial jusi sys is iffiv ad iappopia, whas aig alohol abus as a halh pobl allows pvio ad a whil livig law fo agis of a bud. 22 Nvada asfd h hadlig of publi ioxiaio fo saus povidig iial saios (iludig loiig ad vagay) o saus povidig fo ivil poiv usody. A pso foud i a publi pla i Nvada ud h iflu of alohol, i suh a odiio ha h 334 Aals of Egy Mdii Volu 47, NO. 4 : Apil 6

8 Dufod al Sa Digo Sial Ibia oga ad Egy Mdial Rsous is uabl o xis a fo his halh o safy o h halh o safy of oh psos, us b plad ud ivil poiv usody by a pa offi. If a lisd failiy fo h a of psos who abus alohol xiss i h ouiy wh h pso is foud, h us b dlivd o h failiy fo obsvaio ad a. If o suh failiy xiss, h pso so foud ay b plad i a ouy o iy jail o dio failiy fo shl o supvisio fo his halh ad safy uil h is o log ud h iflu of alohol. Sa Digo viws publi ioxiaio fudaally as a halh pobl also. Th goal of h Sial Ibia oga is o ipov h halh of is lis ad h ouiy. Th Sial Ibia oga is dsigd o ouag idividuals o osid h bfis of a whil addssig h publi safy osqus of hi dial odiio. Rpad ffos a ad o lik hoially ioxiad psos wih ophsiv a. Oly af suh ffos pov fuil (i h ys of a povids hslvs) dos h Sial Ibia oga bo availabl as a hapui opio fo judgs. This sudy dosas ha iaaio alo is o bfiial i duig h d fo pisodi gy a. Clis who hos o sv i i usody ah ha h Sial Ibia oga a haaisially sud high as of EMS, ED, ad ipai osupio af uig o h s. Howv, hos who hos h a pahway subsquly joyd a dud d fo abulas, EDs, ad hospializaios. Th oppouiy fo suh suss af yas of failu was a ky fao i suig ad aiig h suppo ad us of h Offi of h ubli Dfd fo his poga. To build paships suh as h Sial Ibia oga ha addss ulifaoial publi halh issus, EMS dial dios a play valuabl ols as hapios hough hi affiliaios wih publi safy, hospial, ad publi halh sous. Couiis should ba ovl appoahs suh as h Sial Ibia oga o ipov h a of adiioally diffiul-o-sv populaios. Th auhos akowldg h spial assisa of Chif Willia Lasdow, Sga Rihad Shll, ad Offi Joh Liig (Sa Digo oli Dpa), Di MLaga (Mal Halh Syss, I.), Chals Sios, MD (Sipps My Hospial), Dpuy Chif y ak (Sa Digo Fi-Rsu Dpa), hilip Fogio (Sa Digo Mdial Svis Epis), h Hooabl Rob C. Coas (Sa Digo Supio Cou) ad Maga MCahill, MD (S. Vi d aul Mdial Clii). I addiio, h followig ogaizaios a ogizd fo hi ssial ols i h Sa Digo Sial Ibia oga: Sa Digo Supio Cou, Offi of h Ciy of Sa Digo Aoy, Offi of h ubli Dfd of Sa Digo Couy, Sa Digo Dowow aship, Sa Digo Couy Dug ad Alohol Svis, Sa Digo Shiff s Dpa, Mal Halh Syss, I., S. Vi d aul Villag, ad h Sa Digo Volus of Aia Dox/Ibia Rpio C. Supvisig dio: Doald M. Yaly, MD Auho oibuios: JVD oivd h sudy, supvisd is iplaio, ad ld h wiig. EMC assisd wih h sudy ad opld h saisial aalyss. SL assisd wih h aalyss. J assisd i h daa ollio. TCC ad GMV assisd wih wiig. JVD aks sposibiliy fo h pap as a whol. Fudig ad suppo: Th auhos po his sudy did o iv ay ousid fudig o suppo. ubliaio das: Rivd fo publiaio Ju 2, 5. Rvisios ivd Augus 1, 5; Spb 9, 5; ad Novb 4, 5. Apd fo publiaio Novb 8, 5. Availabl oli Jauay 19, 6. sd as a odad pos a h Naioal Assoiaio of EMS hysiias, Jauay 5, Napls, FL. Rpis o availabl fo h auhos. Addss fo ospod: Jas V. Dufod, MD, Uivsiy of Califoia, Sa Digo Mdial C, Ws Abo Div, # 8676, Sa Digo, CA 9213; , fax ; E-ail jdufod@usd.du REFERENCES 1. Madlbg JAS, Kuh RE, Koh MA. Epidiologi aalysis of uba publi gy dpa s fqu flis. Aad Eg Md. ;7: Thoquis L, Bios M, Olad R, al. Halh a uilizaio of hoi ibias. Aad Eg Md. 2;9: Bak DW, Svs CD, Book RH. Rgula sou of abulaoy a ad dial a uilizaio by pais psig o a publi gy dpa. JAMA. 1994;271: Bios MH. Th fquy of ususpd io illss o ijuy i ioxiad pais. Aad Eg Md. 1996;3: Oki RL, Bollai A, Azoa F, al. Th ffs of liial as aag o hospial svi us aog ED fqu uss. A J Eg Md. ;18: udi FRJ, Hoiga B, Ros. Th hoi gy dpa pai. A Eg Md. 1981;1: K T, Youg R, Spilla L. Fqu ED uss: pas of us ov i. A J Eg Md. 1998;16: Bokaw J, Olso L, Fullo L, al. Rpad abula us by pais wih au alohol ioxiaio, sizu disod, ad spiaoy illss. A J Eg Md. 1998;16: Bow E, Sidla J. Th g pobl of abula isus. A Eg Md. 1993;22: op D, Fads CM, Bouhill F, al. Fqu uss of h gy dpa: a poga o ipov a ad du visis. CMAJ. ;162: Spilla LL, Lub EW, Cobaugh DJ, al. Fqu uss of h gy dpa: a w iv? Aad Eg Md. 1997;4: Kushl MB, y S, Bagsbg D, al. Egy dpa us aog h holss ad agially housd: suls fo a ouiy-basd sudy. A J ubli Halh. 2;92: Lil GF, Waso D. Th holss i h gy dpa: a pai pofil. J Aid Eg Md. 1996;13: Ggoi TK, Buk AC. Th laioship of lgal oio o adiss o hag aog aduls wih alohol ad oh dug pobls. J Subs Abus Ta. 4:26: opl v Thoas Kllogg (4) 119 Cal. App. 4h 593, 14 Cal. Rp. 3d, 57. (iio fo viw did, Spb 22, 4). Volu 47, NO. 4 : Apil 6 Aals of Egy Mdii 335

9 Sa Digo Sial Ibia oga ad Egy Mdial Rsous Dufod al 16. Uid Sas Dpa of Halh ad Hua Svis. Gal quis fo ifod os: pa (d): poio of hua subjs [Uid Sas Dpa of Halh ad Hua Svis Wb si]. Availabl a: hp:// h# Assd July 13, Coas RC. A S Is No a Ho: Solvig Aia s Holss Dila. Buffalo, NY: ohus Books; DiCl CC, Bllio LE, Navis TM. Moivaio fo hag ad aloholis a. Alohol Rs Halh. 1999;23: Thopso TG. Edig hoi holssss: sagis fo aio [Uid Sas Dpa of Halh ad Hua Svis Wb si]. Availabl a: hp://asp.hhs.gov/hsp/holssss/sagis3. Assd May 3, 5.. Thl J, Basi K. Rgioal Holss ofil. Sa Digo, CA: Rgioal Task Fo o h Holss; 4: Uid Sas Iagy Couil o Holssss. Th ya pla o d holssss i you ouiy [Uid Sas Iagy Couil o Holssss Wb si]. Availabl a: hp:// Assd May 2, Nvada Sa Lgislau. Nvada visd saus: hap 458: abus of alohol ad dugs [Nvada Sa Lgislau Wb si]. Availabl a: hp:// 458.hl#NRS458S25. Assd Oob 7, 5. Volu fo a Coi ad Ld You Expi ad Expis ACE ad Egy Mdii Nd You Assisa Th poss o sl bs o sv o ACE ois is bgiig, ad all ACE bs a ouagd o apply. EMRA sid bs who a isd i svig as ha ogaizaio s psaiv o a ACE oi should also apply. Th poss is h sa fo sid ad aiv bs, ad you a xpdi h poss by usig h oli appliaio. You us subi a u CV o volu fo a oi ad you a ih aah h fil o h oli fo o ail i o ACE hadquas. You ay also wa o subi a l of suppo fo you hap. Mbs who do o kow how o oa hi sa haps should all Gloia Thopso, Chap Svis Maag, a , x. 3227, o sd a -ail o ghopso@ap.og. Th podu o subi boh fos is iludd wih h oli appliaio: hp:// www2.ap.og/1,32336,.h Th ajoiy of oi wok is aoplishd hough -ail, ospod, ad of alls. Howv, oi bs a xpd o ad h ogaizaioal igs a h Siifi Assbly i Nw Olas, Oob 15-18, 6. You us subi you oi is fos by May 15, 6. This is a oh ali ha pvious yas. If you hav ay qusios, plas oa Rohll Ross a , x. 3145, o oss@ap.og. Bia Kao, MD, FACE, ACE s sid-el, will fializ oi appois i Ju. Rb, you paiipaio will ak a diff. las osid voluig. ACE ad gy dii d you xpi ad xpis. 336 Aals of Egy Mdii Volu 47, NO. 4 : Apil 6