by substances
of abuse are examined and observed according to the
observational chart. An assigned nurse observes the
patient every 15–30 min. No toxicological screening
tests are used, apart from breath analysis of ethanol.
Point of care tests for haemoglobin, C-reactive protein
and urine stick are available, as are electrocardiograms,
CT head scans and regular X-rays. Blood gas levels are
not measured. The main criterion for hospitalisation is
finding a condition requiring acute medical or psychiatric
care at hospital level. If the respiratory rate falls below ten
per minute and SpO2 falls below 90 %, antidote
should be given when opioid or benzodiazepine poisoning
is suspected. When naloxone is administered,
the patient should be observed for two hours in case
of heroin poisoning, or hospitalised in case of long
acting opioids. Patients with benzodiazepine poisoning
in need of flumazenil should be hospitalised. Patients
with respiratory depression caused by agents with no
antidote or not responding to antidote should be hospitalised.
Patients with suspected gamma-hydroxybutyrate
(GHB) poisoning are often in a condition considered too
unstable for observation at the OAEOC, with level of consciousness
fluctuating from coma to agitation in need of
sedation. Hence, the threshold for hospitalising these patients
is low. Patients with hyperthermia due to central
stimulant poisoning should be hospitalised, as should patients
with psychosis. At the time of the study, comatose
patients with a GCS score > 3, normal vital signs and
nothing alarming on the minimum clinical examination
were observed locally. The GCS threshold was later raised
to a score > 6, based on the work of Forsberg et al. [15]. In
either case, patients should be hospitalised if their level of
consciousness is declining, or if they fail to regain consciousness
within four hours. The maxim of the procedure
is that conditions in need of treatment will show up in the
clinical examination dictated by the observational chart.