“Nothing’s changed,” – 18 months on and violence in emergency departments across Australia is still too common

As the results of the largest survey of alcohol harm in Australasian emergency departments (EDs) is published today in the Medical Journal of Australia, the Australasian College for Emergency Medicine (ACEM) has indicated that the levels of alcohol-fuelled violence remain unacceptable high, imposing a substantial burden on hospital resources and staff.

The survey, which was undertaken by ACEM over 18 months ago and involved 2002 ED clinical staff, revealed the devastating toll of alcohol-related harm on emergency department clinicians and patients. In the year preceding the survey, more than 90% of ED clinicians had experienced physical aggression from a patient affected by alcohol, with 42% experiencing this aggression weekly or monthly. Verbal aggression from patients affected by alcohol was also an ever-present part of clinical life for ED staff. This violence and aggression has wide-ranging impacts, affecting the care of other patients and the wellbeing of clinicians. Clinicians reported that frequent violence and aggression had a negative effect on their wellbeing, affecting staff retention and recruitment. Such violence and aggression also had adverse impacts on other patients and the effective operation of the ED, diverting hospital resources into the management of alcohol-affected patients, and disrupting or delaying care for other patients. Effects on the welfare of and care for other patients, particularly vulnerable groups, are further exacerbated by the disruptive and antisocial behaviours of alcohol-affected people in EDs.

Since the survey was undertaken, the introduction of lockout laws and other trading restrictions have resulted in improvements in some jurisdictions. However, much more needed to be done, with ACEM expressing concern today that alcohol-related violence and aggression continues to be a pervasive feature of emergency departments.

“The legislative action taken in New South Wales and recently in Queensland is commendable and it’s important to acknowledge that progress,” said ACEM President, Associate Professor Anthony Lawler. “But too many EDs in Australia and New Zealand are still suffering from the blight of alcohol. Since this work was done 18 months ago ACEM has completed further research – including an Australia Day survey, a 7-Day survey and a snapshot survey – and the data is clear: alcohol is still having a disproportionately severe impact on our EDs.”

The release of the MJA survey follows on from the recent visit by Ms Katherine Brown from the UK, who reported on a major survey of emergency workers in the UK. This report echoes the findings of the ACEM report and the experiences of other front-line services in Australia, with up to half of police, paramedic, ED and fire services time spent dealing with alcohol-related incidents. The UK report surveyed approximately 5,000 front-line service staff and found that police spent 53% of their time dealing with alcohol-related incidents, ambulance staff 37% and emergency department personnel 25%. The responses revealed a culture of fear and systematic abuse, with three quarters of police respondents and one in two ambulance crews injured in alcohol-related incidents. Between a third and half of all emergency service personnel reported they had suffered sexual harassment or abuse at the hands of intoxicated members of the public. Reflecting on the report and the parallels with Australia, Ms Brown argued that it is crucial that alcohol is not allowed to continue diverting public resources and to threaten community safety.

 

For further information on the MJA article and ACEM statement on the impact of alcohol-affected patients in emergency departments in Australia and New Zealand:

For further information about the UK Report on alcohol’s impact on emergency services:

Lancet review of substance use in young people highlights burden of alcohol among Australian teens

22 February 2016

A major global review of substance use in young people, published last week in the journal Lancet Psychiatry, confirms that adolescence is a critical period for developing substance use related problems which can affect later health outcomes, and highlights the need for more research and better prevention and intervention worldwide. In Australia, alcohol made up the largest burden among young people, with males being most affected.

The three-part series, led by NDARC Professor Louisa Degenhardt and Professor Wayne Hall of the University of Queensland and co-authored by UNSW Post-Doctoral Research Fellow Dr Emily Stockings, reviewed the evidence for the current nature and patterns of substance use among young people around the world, the potential effects of adolescent substance use later in life, and the effectiveness of prevention, intervention, harm reduction and treatment.

Key findings:

Prevalence and harms

  • Alcohol and illicit drug use account for 14% of the total health harms affecting young people aged 20-24. In this age group in Australasia (Australia, New Zealand and PNG), alcohol and illicit drug use accounted for 22% of health harms.
  • Young adolescence is a period when substance use typically starts and patterns become established, and a large number of adverse health and social outcomes have been associated with substance use. This makes substance use in young people is an important public health concern.

Neurobiological significance of early use

  • Development continues well into the third decade of life and this has heightened the concern over the impact of adolescent use of alcohol and illicit drugs on cognitive and emotional development.
  • A range of studies have suggested that substance ease during adolescence can have a greater neuropsychological effect that substance use later in life, with some suggestion of an increased sensitivity to neurotoxic effects.

Opportunities for prevention

  • Policy interventions such as taxation, controls on minimum age and availability were found to be effective prevention and harm reduction measures for alcohol use.

To read the three papers of the series, click below:

  1. Prevention, early intervention, harm reduction, and treatment of substance use in young people
  2. Why young people’s substance use matters for global health
  3. Prevention, early intervention, harm reduction, and treatment of substance use in young people