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One in eight summer ED presentations relate to alcohol


Matt Woodley


20/11/2020 3:10:45 PM

A nationwide ‘snapshot’ of emergency departments has laid bare the burden alcohol and methamphetamines place on Australian hospitals.

Emergency department sign
Alcohol harm remains one of the largest preventable public health issues facing EDs across the country.

The survey results, released by the Australasian College for Emergency Medicine (ACEM), provide new insights into the level of alcohol and methamphetamine harm in Australian and New Zealand emergency departments (EDs) during the busy summer period.
 
The sixth annual Alcohol and methamphetamine harm in emergency departments snapshot survey recorded the proportion of alcohol- and methamphetamine-related presentations at 113 EDs in Australia and 19 in New Zealand on Saturday 21 December 2019.
 
It shows an Australia-wide average of 13% of presentations being alcohol-related at the time of the survey, with Western Australia (22%) New South Wales (13%) and Queensland (12%) recording the highest proportion of alcohol-associated presentations among individual Australian jurisdictions.
 
ACEM President Dr John Bonning said alcohol harm remains one of the most significant preventable public health issues facing EDs across the country, with alcohol-related presentations estimated to cost $630 per patient in Australia – equivalent to more than $789 million in 2018–19 within EDs alone.
 
‘Emergency doctors are still far too frequently facing the terrible, short- and long-term aftermath of high-risk drinking,’ Dr Bonning said.
 
‘This includes seeing patients with injuries related to assaults or fights, vehicle crashes, acute intoxication and mental health issues.
 
‘These impacts can also extend beyond an individual patient, with other patients, their family or carers, and ED staff feeling unsafe and at risk of physical or psychological harm when disruptive or violent intoxicated patients are present.’
 
Alcohol causes more overall harm to the Australian community than any other drug, but addiction medicine specialist Dr Paul Grinzi previously told newsGP the doctor–patient relationship is the best tool when supporting patients experiencing issues with alcohol and other drugs (AOD).
 
‘There is good research showing patients expect us to assess their [AOD] use within a general practice setting,’ he said
 
‘Patients, in general, trust their GP. Avoiding stigmatising language, focusing on the patient’s concerns and asking questions in a non-judgemental manner all go towards the development of that therapeutic relationship.’
 
The ACEM survey also quantified the burden of methamphetamine presentations to EDs, with the results again showing that the drug continues to remain a secondary issue in Australia compared to alcohol.
 
According to the survey, all Australian jurisdictions reported similar percentages of methamphetamine presentations in 2019, with the 2–3.8% range far lower than those related to alcohol.
 
But Dr Bonning said although presentation rates for methamphetamine were not as high as for alcohol harm, this patient group is highly resource-intensive and requires complex care. As a result, the survey highlights the need for more specialised and integrated models of care that address these needs.
 
Dr Bonning also said the design and resourcing of EDs needs to change in order to better prevent, minimise and manage violent behaviours that often accompany AOD presentations, including methamphetamine‐related psychosis.
 
‘Within our hospital EDs there need to be options for and linkages with a range of care options, including mental health, general medical and AOD or toxicological care,’ Dr Bonning said.
 
‘In particular, EDs in regional and rural areas often struggle to find the capacity needed to appropriately treat drug and alcohol presentations, and find linkages to other services.’
 
As summer arrives and COVID-19 restrictions continue to ease in most parts of Australia, Dr Bonning said the alcohol industry should be ‘held to account’ to help dissuade risky drinking, with stronger governance and regulation employed to stem the harm done by the ‘relentless promotion’ and marketing of their products.
 
‘Emergency department staff are already tired from an immensely difficult year dealing with the COVID-19 pandemic, and the many additional complexities it has created,’ he said.
 
‘The last thing we need is another busy summer dealing with preventable alcohol-fuelled ED presentations, and potentially disruptive and violent patients affected by alcohol.’
 
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