An optimization of medical care on the prehospital stage for severe alcohol poisoning does not lose its relevance in Ukraine. Despite many years` experience of treating of the emergency conditions related to the toxic effects of alcohol, diagnosis and emergency care of alcoholic coma remain a challenge for practitioners. Clinical errors in the differential diagnosis cause high rates of mortality and are the reason of the discrepancy in clinical, pathological and forensic diagnoses. Often the difficulties take place in a decision-making process in cases that require consideration of different organizational and juridical norms that are linked to an official registration of the medical forms in cases of health loss due to alcohol toxicity. The implementation of modern approaches to diagnosis in an emergency medical practice will enhance the effectiveness of urgent measures on the prehospital phase and the safety of medical personnel. The authors offer practical recommendations for the prehospital emergency medical care in cases of an acute alcohol poisoning among adults that are complicated by alcoholic coma.