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Snap survey reveals the pressure of alcohol on our emergency departments

Dr John Bonning in ED for web

Waikato Emergency Department clinical leader Dr John Bonning is worried about the number of people presenting to his department because of alcohol

The sound of heart rate monitors hum rhythmically oblivious to the traumas they observe.

It is Friday night in Waikato Hospital’s Emergency Department – the first week of December 2014.

Emergency Department staff systematically move from one patient to the next.

It is an orchestra of hollow steps on a suspended platform, alarms and quiet murmurs.

But in an instant the rhythm is interrupted – security guards race outside through double doors onto Pembroke Street.

A young man visiting his mate takes off down the hill for a joy-ride in a hospital wheelchair.

He was in emergency with a friend whose knee had been smashed in a drink driving accident.

Between the pair they had drunk between 20 and 40 ready-to-drink (RTD) alcoholic beverages.

Their story would be just one of many to come through the department’s doors as a result of alcohol related injury or illness.

In a snap survey conducted by the department earlier this month it was found one in seven patients were there because of alcohol related harm.

Some were suffering from extreme psychosis, some a result of domestic violence, others from drunken pranks gone wrong.

But the system does not record the primary prognosis as alcohol. It is the injury which the Emergency Department records and not the cause.

Nonetheless emergency physician Dr Choon Boon shows some exasperation at Waikato’s results. He turned to his colleague and said “this is not a typical Friday night”.

While the department was busy treating more than 30 patients, Boon said on a usual Friday night he would typically see more patients as a direct result of alcohol abuse.

But it is only 2am. The city’s bars are still open.  One nurse says it will get busier in an hour when the bars start to close.

“We will start to get all the assaults as people make their way home,” she said.

Triage physician Dr David Levy said it was hard to accrue accurate figures as patients were often too embarrassed or distressed to tell the truth.

“Working in ED for the last 25 years I have seen some really tragic things – young people, 25-years-old or younger, just killed from a situation that could have been prevented.”

Alcohol Healthwatch, a charitable trust dedicated to reducing alcohol harm in New Zealand compiled a series of statistics on alcohol related injury and violence in 2012.

What they found is that in 2010 drink drivers contributed to 105 fatal car crashes, 385 seriously injured people and 993 minor injury crashes.

The report also found excessive alcohol to be a key factor in unintentional falls.

It said acute alcohol was involved in 18 to 53 per cent of fatal falls and between 21 to 71 per cent of non-fatal fall injuries.

Finally the report states that alcohol increases the risk of drowning by 16 times.

“In New Zealand between 2007 and 2011 there were 83 alcohol-related drowning deaths,” the report said.

Last month the Australasian College of Emergency Medicine reported 98 per cent of ED doctors and nurses had experienced alcohol-related verbal aggression.

“This confirms what we have known for a long time,” said lead researcher Dr Diana Egerton-Warburton, “ED clinicians are sick and tired of violence from drunken patients and [are tired of] how it affects their ability to treat other patients.”

The College for Emergency Nursing Australasia executive director Leeanne Trenning said that emergency nurses often bear the brunt of alcohol-related aggression.

“Nurses are being subjected to violence and abuse from the very people they’re trying to help. Intoxicated patients take up too much of our time and their behaviour negatively impacts the entire ED.”

The reality is alcohol harm is causing havoc for emergency departments in both the Waikato and abroad.

Waikato Emergency Department clinical director Dr John Bonning said it had been difficult to change the culture around drinking.

“There was a time when you would just drive home after several drinks, but that culture is slowly changing, I have taught my kids just get a cab and I will pay for it,” he said.

The reality is these deaths and injuries are avoidable; translating that message before it is too late is the hardest part.

Ends

 

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Email: news@waikatodhb.health.nz

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