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Emergency services under pressure from alcohol at Christmas


Emergency services under pressure from alcohol at Christmas

Posted 20/12/19

If you can’t wait until Christmas, spare a thought for emergency services in the North East who are bracing themselves for one of the busiest times of the year.

A&E wards, ambulance crews and police are today warning of the consequences of excessive drinking, placing additional pressures on services who already find themselves more stretched than ever during the winter months. The Friday before Christmas (this year Friday 20 Dec) can often be the busiest one of the year for 999 crews.

It comes as new research out this week from Balance, the North East Alcohol Office, shows that 87% of North East adults associate alcohol with disorderly behaviour in towns and cities, 75% with domestic abuse, 63% with violent crime and 68% with ill health.

Alcohol was estimated to cost North East public services and employers around £1.01bn in 2015/16, including £209 million to the NHS and healthcare for services such as hospital admissions, A&E attendances, ambulance callouts and also treatment for alcohol dependency, and £331 million in crime and disorder, including 55,300 cases of criminal damage, 154,900 cases of theft and 20,000 cases of violence against the person.

These figures would equate to £386 per head for every man, woman and child in the North East – nearly half of the average £800 extra that a typical household spends during December.

Kate Lambert, Consultant in Emergency Medicine at Sunderland Royal Hospital, said: “Alcohol creates problems for us all year round, but it gets worse at Christmas. The Emergency Department is the place people require after they’ve injured themselves or got so intoxicated that they are semi-conscious. Alcohol is a factor in many of the assaults that we see, in and outside the home.

“We see a lot of patients who use alcohol as a coping mechanism and who are drinking most days, often drinking more than they would like to, and not really enjoying their drinking. Underneath it there can be a lot of unhappiness, either with work or relationships, and sometimes anxiety and depression. The stresses of Christmas can often make this a difficult time and so we see more people coming in with the physical effects of drinking, such as liver disease or a rise in mental health presentations, with people feeling at risk of harming themselves or actually harming themselves.

She added: “When people are drunk, they often say things or behave in ways they normally wouldn’t. It can include swearing, physical assaults or even inappropriate sexual comments and I think the nurses get a great deal of that as well. Of course we have security, we have the police and they are regularly in the emergency department. So that creates an extra burden on them as well.”

North East Ambulance Service (NEAS) reports that last year they saw a 50% increase in calls overall from 6pm-6am on the evening of Friday 21 Dec-Saturday 22 Dec compared to other Fridays in 2018. NEAS also received 1650 calls on New Year’s Day compared to around 1000 on an average day.

Colin Shevills, Director of Balance, said: “What we see at Christmas is in many ways the “big brother” of the type of disorder we see in our town and city centres every weekend. Our survey shows that people in the North East clearly recognise the problems that it causes.

“At this time of year we are drawing attention to the police officers, A&E doctors and nurses and paramedics who are already working flat out with winter pressures but who have to clear up the additional mess caused by excessive drinking.

“If we are to prioritise our police, paramedics and NHS we need long term to reduce the demand on them throughout the year and that means tackling the availability of cheap alcohol. We have a new Government – now we need a new evidence-based alcohol strategy which has Minimum Unit Price at its heart.”

Douglas McDougall, Strategic Head of Operations at North East Ambulance Service, said: “Alcohol-related call outs place a huge additional burden on our call handlers and crews at a time when they are already under immense pressure. When we’re called out to someone who is intoxicated, it takes vital resources away from patients when they need us the most.

“Of course we want people to have fun and enjoy themselves over the festivities. Our concern is that what starts as an enjoyable experience can quickly lead to falls, injuries and people ending up in A&E.

“When people are intoxicated, they often lose their inhibitions and can become aggressive and threatening towards others. This is felt both in-person by our frontline crews, but also verbally by our call handlers.

“For our staff, this is more than a job. They work tirelessly throughout the festive period, often at the expense of spending Christmas with their own families. They come to work to help protect and care for the public and should feel safe in doing so.

“This is our busiest time of the year and you can help us by taking care and drinking in moderation so that you are not putting yourselves or others at risk.”

Dr Jennifer Rhodes, Consultant in Emergency Medicine and Paediatric Emergency Medicine, and EM Clinical Lead for Paediatrics at the Queen Elizabeth Hospital Gateshead, said: “For those of us working in A&E and other wards, excessive alcohol use over Christmas creates extra demands on top of the intense pressures we already have during the winter months.

“We already have a lot of sick patients in the emergency department who require our attention and treatment, but then we have to factor in the time taken in dealing with people who have been drinking heavily. Some of these patients may become aggressive and abusive, or through alcohol lack the capacity to make decisions about themselves. That has huge implications on our time, on available resources and for the security of staff. It also impacts on other patients – some of whom are vulnerable - and it and it can mean it takes us longer to see and treat them.

“We obviously see a lot of patients who have drunk too much in a short space of time, but we also regularly see patients who suffer from serious alcohol related problems as a result of long term heavy drinking. They can present with collapse episodes, confusion and bleeding from the stomach or oesophagus which may require blood transfusion or emergency endoscopy. Some people with alcohol addictions may need attention as a result of alcohol withdrawal symptoms such as seizures or hallucinations.

“One of the worst things is that we are seeing younger patients in their 20s and 30s suffering from these long term conditions like alcohol related liver disease and chronic pancreatitis, which is a painful and debilitating condition and can be irreversible. These patients often need regular hospital admissions. We often see an increase at Christmas as people drink more over Christmas, even though it is putting their health at severe risk.

“Christmas is also a time when mental health issues can come to the fore. It can be a difficult time for some people, resulting in them drinking more and alcohol is often linked to people self-harming. We also have a responsibility for any children that may be under the care of these patients and may be at risk of neglect or abuse. We liaise with social services and the police to ensure their safety. The toxic trio of substance misuse, mental health and domestic violence is particularly concerning.”

Paul Atkinson – Domestic Abuse Advisor in The Queen Elizabeth Hospital added: “Nationally it is recognised that incidents of domestic abuse spike over the festive period, and often patients access our health services seeking support for the physical and psychological impact that it has. Alcohol often has a part to play in these presentations.

“My post as Domestic Abuse Advisor is there to advise and train staff who support victims of domestic abuse; as well as providing support to staff who are victims. In keeping with the national picture we see an increase in domestic abuse disclosures around Christmas; and currently we’re on track to have the busiest month to date since coming in to post in May 2018; receiving on average one referral per day for someone seeking support. My role has helped increase staff confidence in dealing with domestic abuse disclosure, supporting the services who face so many pressures over the winter period, and most importantly improving our response, offering better support and signposting to victims.”

Superintendent Richie Allen, from Durham Constabulary, added: “Everyone wants to have an enjoyable Christmas and that goes for our police officers too. Just like every Friday, we will be out in our communities across the force area to make sure that everyone in County Durham and Darlington stays safe. People can help with that by making sure they don’t drink too much, look after each other and know how they are getting home at the end of the night.”

A major report by the Institute of Alcohol Studies in 2015 highlighted the impact of alcohol on emergency services in England. The report was based on an extensive survey of nearly 5,000 police officers, ambulance and paramedic staff, accident & emergency department consultants and fire officers, demonstrating both the financial burden on the emergency services and the human cost to frontline staff.

It found:

• Violence against emergency services is ubiquitous, with 76% of police, and 50% of ambulance staff having been injured on the job as a result of drunken violence
• Up to 80% of weekend arrests are alcohol-related and just over half of violent crime is committed under the influence.
• In 2009/10 there were 1.4 million alcohol-related ambulance journeys, which represents 35% of the overall total.
• Estimates for the proportion of Emergency Department attendances attributable to alcohol vary, but figures of up to 40% have been reported, and it could be as much as 70% at peak times.