Identification and Referral of Impaired Drivers through Emergency Department Protocols
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Summary
This study evaluated the efficacy of an emergency department (ED) protocol designed to identify and refer motor vehicle crash (MVC) patients at high risk for alcohol abuse or alcohol dependency (AA/AD) to substance abuse treatment. The research was motivated by the public health burden of alcohol-impaired driving, noting that 15–20% of MVC patients treated in EDs are at high risk for AA/AD and likely to drive while impaired again. Because these patients often escape law enforcement detection and are frequently discharged home, the authors sought to determine if a structured screening and brief intervention protocol could increase rates of definitive treatment enrollment. The researchers conducted a prospective, randomized, controlled trial at two EDs in North Carolina: Carolinas Medical Center in Charlotte and Pitt County Memorial Hospital in Greenville. Over a one-year period, consecutive patients aged 18 and older treated for MVC injuries between 10 AM and 10 PM were screened using the TWEAK instrument, a validated tool for detecting alcohol problems. Patients who screened positive (TWEAK score ≥2) or had a breath alcohol content ≥0.12 g/dl were randomized to either an intervention group or a control group. The intervention consisted of a brief, scripted counseling session (ED DIRECT) followed by a referral for formal evaluation. The control group received standard care without specific intervention. Patients were followed up via telephone at three and six months to assess treatment uptake and subsequent crashes. Of 5,602 patients identified with MVC injuries, 2,787 consented to screening. Approximately 13.9% (388 patients) screened positive for AA/AD and were randomized; 130 received the intervention and 157 served as controls. The primary finding was that the intervention significantly increased the likelihood of patients receiving a formal evaluation for alcohol problems. Specifically, 19.2% (25 of 130) of the intervention group received an evaluation, compared to only 4.5% (7 of 157) in the control group, yielding an odds ratio of 5.1 (95% CI: 2.128–12.235). Among those who agreed to an evaluation in the intervention group, 48.8% attended the appointment. Additionally, no patients who received the intervention and agreed to evaluation were involved in a subsequent crash during the follow-up period, whereas seven patients in the control or refusal groups experienced subsequent crashes. The study concludes that ED-based screening and brief intervention protocols effectively increase the rate at which high-risk MVC patients seek definitive treatment for alcohol abuse. The authors suggest that such protocols are feasible within the ED setting and provide a critical opportunity for intervention that is often missed by law enforcement. They recommend that EDs adopt standardized screening tools and referral mechanisms to address alcohol-impaired driving as a public health emergency. The findings support the integration of behavioral health interventions into trauma care to reduce recidivism in impaired driving and subsequent injury.
Key finding
Patients receiving the emergency department intervention were 5.1 times more likely to receive a formal evaluation for alcohol abuse or dependency than those in the control group.
Methodology
lab_experiment
Sample size: 287
Provenance
The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed. Discovered via bulk_ingest_rosap on 2026-05-23 (6 acquisition events logged).
| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | rosap | — | — | 2 | 2026-05-23 |
| archive | success | — | — | — | 1 | 2026-05-23 |
| extract | success | cached | — | — | 2 | 2026-06-10 |
| clean | success | — | — | — | 1 | 2026-06-01 |
| chunk | success | — | — | — | 1 | 2026-06-01 |
| embed | success | — | — | — | 1 | 2026-06-02 |
| enrich | success | — | — | — | 1 | 2026-05-23 |
| promote | success | — | — | — | 1 | 2026-05-23 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 3 | 2026-06-10 |
| tag | success | vector_similarity | — | — | 19 | 2026-06-11 |
| verify | success | — | — | — | 2 | 2026-06-10 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.
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- Applied Guidance: countermeasure evaluation