Alcohol Withdrawal in the Field
Objective: Recognize withdrawal versus still-intoxicated, treat seizures as withdrawal seizures per protocol, and do not leave DTs on the sidewalk.
Why This Is Hard
They stopped drinking in jail yesterday and now they are seizing. Crews treat it like a first-time epileptic and miss the withdrawal clock. ASAM and NASEMSO: withdrawal seizures and DTs are medical emergencies.
- Ask last drink, usual amount, prior DTs/seizures.
- Glucose. Hypoglycemia mimics everything.
- Benzos are the treatment class for withdrawal seizures if protocol includes them — not phenytoin theater.
Field Rules (Education)
- Intoxicated is still drunk. Withdrawal starts hours after the last drink: tremor, sweat, HR, hypertension, anxiety, then seizures, then DTs (hallucinations, profound AMS, autonomic storm).
- Seizure in a known alcoholic is withdrawal until you disprove it — still check glucose and trauma.
- DTs die. Cooling, benzos per protocol, airway, destination. Not a psych hold in the hallway if they are hot and acidotic-looking.
- CIWA-Ar is not a truck clearance tool.
Field Pitfalls
- “Let them sleep it off” for DTs.
- Skipping glucose.
- Treating withdrawal seizure as a reason to refuse transport.
Practice
60-second drill
Partner: last drink 36 hours ago, now seizing, glucose 92. Drug class and destination.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ASAM Alcohol Withdrawal Management Guideline — benzodiazepines are first-line for withdrawal seizures/DTs — hospital scoring is not a field clearance
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.