1. #alcoholharmED

2. Opening address Dr Andrew Walby Director of Emergency Medicine, St Vincent’s Hospital

3. Department of Addiction Medicine “Department of Drug & Alcohol Services” was established in 1964 through the efforts of Professor Carl de Gruchy, Sister Christina Welsford and Dr Jim Rankin Initially founded as a “Special Clinic” Later expanded by Professor Greg Whelan to cover illicit drugs Increased services under Dr Joe Santamaria under the name “Department of Community Medicine” In January 1988, Depaul House, the 12-bed non-medical, community withdrawal unit was opened.

4. Department of Addiction Medicine Current services Residential withdrawal service Inpatient consultation liaison service Ambulatory medical & counselling service Forensic counselling service Drink-drive program Education, training & research services

5. DoH “Better Responses to AOD Presentations in Victorian EDs” 2013 analysis of ED attendances identified that 7.6% had AOD as a factor in their presentation (~3100/year = 8-9/day) 37% higher at weekends Project implementation Extended coverage of specialist service Clarified the interface and pathways in the ED Implemented an AOD screening process Developed a method of measuring the impact on client outcomes Increased ED staff knowledge of AOD

8. #alcoholharmED

9. Alcohol Harm in EDs 2014 Survey Dr Diana Egerton-Warburton Emergency Physician & Lead Researcher, Alcohol Harm in EDs Project

10. Project background ACEM has received funding from the Australian Government for a two-year project to quantify alcohol-related harm presenting to emergency departments in Australia and New Zealand EDs are not required to systematically screen and submit alcohol prevalence data for state/territory/national patient data sets Alcohol-related presentations to EDs are underestimated and data is incomplete.

11. Alcohol Harm in EDs Collect bi-national prospective data of alcohol harm presenting to EDs in Australia and New Zealand Lead an informed community discussion about the harms related to alcohol use and its impact on EDs Provide an evidence base to advocate for government policy change.

12. Alcohol Harm in EDs: “Snapshots” A point-prevalence survey was conducted in 106 EDs in Australia and New Zealand at 2am on 14 December 2013 Snapshot of the number of direct and indirect alcohol-related presentations in the waiting room, ED and short stay or observation units Results: 14% of presentations in Australia were alcohol-related 18% in New Zealand were alcohol-related All regions had EDs with 1 in 3 alcohol-affected patients. Media campaign: AMA, NAAA, PHAA > 8 million audience. The survey will be repeated in December 2014.

13. Alcohol Harm in ED: 24/7 Survey A seven-day survey of alcohol-related presentations in December 2014 Nine EDs in Australia and New Zealand Will generate a rich data set: Direct and indirect harm Percentage of alcohol-related presentations over a one-week period The range of alcohol-related presentations Demographics of alcohol-affected patients Flow on effects to the ED Drinking patterns prior to ED presentation AUDIT scores Validate snapshot survey methodology.

14. Alcohol SBIRT in Emergency Departments ACEM funded literature review underway Recent Australian research suggest feasible and effective with resources High rate of harm and risky drinking but low dependency Teachable moment Impact is product of reach x efficiency 5.7 million adults and adolescents present annually to Australasian EDs 10% alcohol harm and 45% hazardous drinking Potential audience of about 2.5 million Screen alone may be enough of a ‘Brief Intervention’

15. ‘Although BI heads the list of effective and cost–effective evidence based treatment methods, commonly less than 10% of the population at risk of becoming hazardous and harmful drinkers are identified and less than 5% of those who could benefit are offered brief advice.’ (WHO, 2009).

16. Clinician Survey 2014 Over 2000 emergency doctors and nurses were surveyed on their perceptions of alcohol-related presentations in their ED in June 2014 Largest survey of its kind to be undertaken in Australia and New Zealand At this event, we are releasing statistics on: The levels of verbal and physical aggression experienced by staff The effect of alcohol-related presentations on other patients in the ED Clinicians were also asked about: The functioning of the ED Staff job satisfaction and wellness Screening and brief interventions Training to deal with alcohol-affected patients We’ll be releasing more data in 2015.

17. Alcohol Harm in EDs 2014 Survey Findings 98% of respondents had experienced alcohol-related verbal aggression from patients in the last 12 months. “I have been verbally threatened and told that they would be 'waiting for me in the car park when I went home’.”

18. Alcohol Harm in EDs 2014 Survey Findings 92% had experienced alcohol-related physical violence or threats from patients in the last 12 months. “One or two people are removed for physical aggression each shift, a staff member is injured severely enough to have days off every few months, patients are restrained by security every few hours. There is serious property damage every one or two months.”

19. Alcohol Harm in EDs 2014 Survey Findings 87% said they had felt unsafe due to the presence of an alcohol-affected patient while working in their ED. “It is one of the things most likely to drive me away from Emergency Medicine.”

20. Alcohol Harm in EDs 2014 Survey Findings Not surprisingly, 94% said alcohol-related presentations in the ED had a negative or very negative effect on the workload of ED staff. “They are a serious burden because they take up a lot of time and space without much therapeutic benefit.”

21. Alcohol Harm in EDs 2014 Survey Findings 88% said that the care of other patients was negatively or very negatively affected. “Other patients have longer waiting times. They can feel threatened and intimidated in an environment where they should feel safe. They are often shocked and offended by what they see or hear.”

22. Alcohol Harm in EDs 2014 Survey Findings “We as a specialty have come to accept abuse that no other public service would tolerate.” “If I am out of uniform I do not have to tolerate these behaviours and have a course of action; if I am in uniform I am fair game!” “Other patients in the waiting room have been assaulted. Many patients become extremely fearful. Some leave the ED and miss out on needed treatment.”

23. Video Presentation #alcoholharmED

24. The reality of alcohol in the ED Lisa Cox Victorian Branch Treasurer, College of Emergency Nursing Australasia (CENA)

25. #alcoholharmED

26. The reality of alcohol in the ED for doctors: an AMA perspective Dr Stephen Parnis Emergency Physician & Vice-President, Australian Medical Association

28. AMA National Alcohol Summit

30. AMA National Alcohol Summit National leadership on the supply of and access to alcohol Public education campaigns about unsafe drinking and alcohol harms

31. Targeted alcohol prevention and treatment services Specific measures for Aboriginal and Torres Strait Islander people

32. Regulation of alcohol marketing and promotion Research and evaluation and data collection to monitor and measure alcohol use and alcohol-related harm

33. A review of alcohol taxation and pricing arrangements Transparent policy development independent of industry influence www.ama.com.au/alcoholsummit

34. #alcoholharmED

35. ACEM’s alcohol policy recommendations for Government Dr Anthony Cross Emergency Physician & President, ACEM

36. Alcohol policy recommendations ACEM calls on governments in Australia and New Zealand to: 1. Introduce compulsory collection of alcohol-related ED presentation data Add emergency department alcohol-related presentations to patient data sets Mandatory collection of this data would provide: A clearer picture of the extent of alcohol-related presentations to hospital An evidence base to inform and evaluate policy decisions.

37. Alcohol policy recommendations 2. Introduce a preventative health program for emergency departments Screening, brief intervention and referral for treatment (‘Brief Intervention’) program for alcohol-affected patients in emergency departments International research suggests that Brief Intervention can be an effective tool to identify, reduce and prevent problematic use, abuse, and dependence on alcohol and other drugs.

38. Alcohol policy recommendations 3. Address alcohol regulation and advertising International evidence shows that when hours and days of sale are decreased, consumption and harm decrease, and vice versa. Introduce 3am as the latest time for serving alcohol in pubs and clubs Maintain and extend the freeze on granting new late night licenses Introduce 10pm as the latest time for packaged liquor sales.

39. Alcohol policy recommendations 3. Address alcohol regulation and advertising Control the advertising and promotion of alcohol, particularly to young people Young people are regularly exposed to advertisements depicting alcohol consumption as social, fun and inexpensive We would like to see greater efforts made to protect young audiences up to 25 years from alcohol advertising, and the phasing out of alcohol sponsorship in sports Alcohol advertising in Australia is self-regulated by the alcohol and advertising industries. ACEM supports the establishment of an independent regulatory body for alcohol advertising, sponsorship and promotions.

40. Alcohol policy recommendations 3. Address alcohol regulation and advertising Tax alcohol products according to their alcohol content, not their price. Alcohol products in Australia are taxed differently according to type, packaging, alcohol content and cost. The greatest discrepancy in the current system is the wine equalisation tax (WET). Wine is taxed according to its retail price rather than its alcohol content, resulting in cheaper wines attracting far less tax. ACEM supports measures to tax alcohol products according to their alcohol content.

41. Get in contact: Ange Wadsworth Project Manager angela.wadsworth@acem.org.au Get more information: www.acem.org.au Join the conversation: #alcoholharmED Join us for lunch! Thank you