Alcohol-related encounter surveillance using emergency medical service records in Massachusetts, 2013-2023

Alcohol is one of the most used substances in the United States. It can be hard to accurately assess alcohol use through self-report or medical records because it is a widespread mainstream legal substance. Identifying alcohol-related encounters in emergency medical services (EMS) records provides additional data on alcohol use.

We used the Massachusetts Ambulance Trip Record Information System (MATRIS) to develop a definition for alcohol-related encounters (AREs) in EMS encounters based on alcohol-related words and symptoms. An additional definition flagged AREs related to alcohol withdrawal or detoxification (ARE WD).

Reviewers assessed over 450 cases to refine definitions resulting in a correct characterization of 95 % of cases (Cohen's Kappa= 0.95, 95 % Confidence Intervals: 0.89, 1.00). The ARE definitions were applied to all Massachusetts emergency EMS encounters between 2013 and 2023 (n = 8530014). Of those, 3.28 % (95 % CIs: 3.27 %-3.29 %) were AREs while 15.29 % of AREs (95 % CIs: 15.16 %-15.42 %) had symptoms of alcohol withdrawal or detoxification. Both types of alcohol-related encounters increased during the COVID-19 pandemic (2020-2021, p < 0.05). Compared to non-ARE EMS encounters, AREs had a greater proportion of Asian/Pacific Islander non-Hispanic/Latine (nH/L) (1.2 % of non-AREs versus 1.3 % of AREs), Black nH/L (5.0 % versus 6.4 %), and Hispanic/Latine patients (6.4 % versus 8.4 %) (p < 0.001).

AREs document alcohol use broader than problematic use or addiction but are subject to observation bias since not all use results in an EMS call. Alcohol use can be identified in existing EMS records however additional research is needed to understand the relationship between AREs and other alcohol use indicators.