The College is also again urging greater regulation of alcohol promotion and advertising as part of strategies to reduce harm in the community and to promote cultural change.
The new data, from late last year and earlier this year, is part of the Driving Change project, which asks adults who present to the ED whether they drank alcohol before their attendance, where they bought the alcohol, and the location of the last drink.
Findings from St Vincent’s Hospital in central Melbourne and three Monash Health campuses (Clayton, Casey and Dandenong), showed that on Friday and Saturday nights almost one in four ED patients presenting at St Vincent’s, and about one in 10 presentations across the Monash Campuses had consumed alcohol in the 12 hours prior to arriving.
Alcohol intoxication, psychiatric issues, open wounds and fractures were among the most common alcohol-fuelled health issues.
The largest proportion of patients across all campuses who reported consuming alcohol in the preceding 12 hours had purchased it from packaged liquor outlets such as supermarkets and bottle shops. This highlights the ongoing issue of ‘pre-loading', where drinks can be bought ahead of time while a person is sober, and consumed to excess when no ‘safe service’ levels apply. This number is also likely to be under-reported because of the number of people who were unable to recall the purchase location, or who were unconscious or refused to respond.
St Vincent’s
Over the period from mid-November 2018 to mid-January 2019, about one in every 12 patients had consumed alcohol in the 12 hours prior to requiring treatment in the ED. Of significant concern, this figure jumped to almost one in four on Friday and Saturday nights.
The majority of attendances where patients had consumed alcohol were attributed to packaged liquor, with patients indicating a range of purchase locations including large and small bottle shops, supermarkets and pub/hotel bottle shops.
Almost 50% of patients who had consumed alcohol reported consuming packaged alcohol but were unsure where the purchase location was. This could have been as a result of patient intoxication, unconsciousness or refusal to answer the question.
Crown Casino was identified as a recurring venue, named by patients as the location of their last drink prior to admission. There were other venues linked to other presentations but none had more than one case, meaning they didn’t warrant individual naming. Among these were separate licensed venues located within the Crown complex, but not part of the casino itself.
Monash Health
Overall, during the period from April to the end of June 2019, about one in 20 (Casey) and one in 25 (Dandenong and Clayton) patients had consumed alcohol in the 12 hours before seeking assistance at an ED. On Friday and Saturday nights this more than doubled to more than one in 10 (Clayton and Casey) and almost one in 10 (Dandenong).
All told, 50% (Clayton), 53.82% (Dandenong), and 66% (Casey) of people attending the ED who reported consuming alcohol in the preceding 12 hours had purchased their alcohol from packaged liquor outlets. The actual proportion is likely to be higher, if accounting for the group of patients who did not disclose the purchase or consumption location.
Overall, males had consumed alcohol more frequently compared to female attendees, and this trend was consistent across age brackets.
Action needed
ACEM President Dr Simon Judkins said: “Time and time again we see studies telling us about the harm of high risk drinking, but for ED staff these are much more than just studies.”
“For ED staff, the harm caused by high risk drinking represents not just threats to an individual patient’s health but to the broader public as well. For medical professionals, it means an increased risk of assaults and physical and verbal threats from patients who have engaged in high risk drinking, all while they’re simply trying to do their jobs in already stressful and strained environments.
“Having to put up with this every single weekend is incredibly confronting, stressful and draining. We are all fed up and it is clear that strong leadership from government is needed to better regulate the availability of alcohol.
“With the Spring Racing Carnival reaching its conclusion for another year, now is a good time for Australians to consider their use of alcoholic products, and to consider changes to the way alcohol is promoted and advertised, particularly around sporting events.
“With alcohol being heavily promoted at sporting events, excessive drinking around these occasions will continue contributing to the alcohol-fuelled harm, which we see in the ED every day. Clearly there are cultural attitudes which need to shift, but given the alcohol industry will only ever care about making more profits, regulation is needed to tackle the way alcohol is so readily available and heavily promoted.”
Background
The Driving Change project is led by Professor Peter Miller at Deakin University, with funding from the National Health and Medical Research Council. In addition to the Melbourne EDs, there are participating hospitals in Canberra, Geelong, Sydney and Warrnambool. Central Queensland University, the University of New South Wales, Australian National University and Cardiff University (Wales) are also partners in the project.
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au
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