Substance Abuse Among Emergency Medical Service Patients: A Pilot Study on the Clinical Impact of an On-site Oral Fluid Screening Test

Abstract Diagnosing illicit substance and drug intoxications in prehospital setting may be difficult. Invasive treatment procedures might be avoided with substance specific antidote treatment. An oral fluid (OF) screening device may aid differential diagnostics in the care of a patient suffering from an unknown intoxication or unconsciousness. The aim of this study was to evaluate whether on-site OF screening improves the diagnosis and treatment of emergency medical service (EMS) patients with lowered level of consciousness due to suspected intoxication or an unknown cause. A retrospective analysis was conducted on patients who were treated by a mobile intensive care unit due to a lowered level of consciousness and tested with an OF screening device. Patient characteristics, the cause of EMS activation, and screening test results were recorded from EMS run sheets, hospital medical records, and laboratory data. Prehospital treatment was evaluated in regard to the OF screening result. A total of 57 patients were tested during the study period. Of these, 8 were excluded owing to missing screening results. Of the final 49 patients (35 males, 14 females), 16 patients (33%) tested positive for one or more substances. In 6 (38%) of the 16 patients, treatment was modified based on the screening results, and in 4 of these cases, there was a clinically relevant prehospital response. Oral fluid screening for illicit substances can be a valuable diagnostic tool in addition to the usual diagnostic methods in EMS patients with unconsciousness due to an unknown cause or intoxication.