1. Zara Quigg: Violence and TIIG Research Manager Centre for Public Health WHO Collaborating Centre for Violence Prevention Alcohol-related data collection in emergency departments: The Wirral model

2. Objectives Trauma and Injury Intelligence Group (TIIG) The Wirral Model – Alcohol-related attendances – Reporting mechanisms – Interventions – Outcome TIIG development across the North West

3. TIIG Funding: local partners Injury surveillance system – Intentional / unintentional Informing injury prevention strategies Brings together a variety of data sources Focus: ED data sharing Childhood injuries Falls Violence / alcohol 4/4 5/5 6/6 12/12 4/4

4. ED data Existing data items – Injury group Assault, sports injury, RTC, self harm – Patient demographics Gender, age, area of residence – Date / time of attendance – Location of incident e.g. public place / home – Arrival / referral method – Disposal method (e.g. admitted) Additional fields Violence Core 1.Time / date 2.Location assault (e.g. pub name) 3.Assault type (e.g. weapon used) Enhanced 4.Relationship with attacker 5.Number of attackers 6.Gender of attackers 7.Reported to the police 8.Attacker consumed alcohol 9.Motive Expansion of existing fields - Injury group: Fall / burns - Location: where in the home -e.g. Kitchen / stairs Additional fields Alcohol 1.Had you been drinking alcohol within three hours prior to the incident occurring? 2.Where did you consume / purchase your last drink?

5. The Wirral Model Figure 1: Proportion of injury attendances that are alcohol-related by year, Arrowe Park ED ED data collection 02/03 (baseline 03/04) PCT / CSP strategies Target: reduce alcohol-related assault attendees by 15% over three years

6. The Wirral Model Figure 2: Assault attendances by time and day of attendance, Arrowe Park ED 2008/09 40% of assault cases have been drinking 74% between 2am and 4am weekend nights

7. The Wirral Model Figure 3: Proportion of attendances to Arrowe Park ED identified as alcohol- related, under 18s only by age, Arrowe Park ED, 2007/08

8. The Wirral Model AgeGenderAlcoholCircumstancesOutcome 13Male2-3 litres Cider Street With friends Purchased from shop Drank previously Birthday Discharged Referred to RESPONSE 13Female3 glasses wine (Lambrini) Street With friends Purchased from shop Drinks regularly Known repeat attendee Friends drinking Assault-related injury Admitted to hospital Safeguarding concerns identified - referred to social services 15Female4 units Cider Park With friends Drank previously Socialising Referred to Paediatrics for observation overnight Head injury assessment No injuries identified 14Female2 glasses wine (Lambrini) Offered Whizz and vodka Street With friends Obtained from friends Drank previously Peer pressure to drink and fight Assault-related injury Discharged Safeguarding concerns identified - referred to social services 15FemaleCider / Alcopop House party With friends Obtained from friends House party Assault-related injury Admitted to hospital Safeguarding concerns identified - referred to social services Table 1: Alcohol-related attendances by demography, alcohol consumed, circumstances surrounding consumption and outcome, Arrowe Park ED Two week alcohol audit Electronic data collection identified 13 alcohol-related attendees (<18) 1.6% of all attendees Audit identified 5 Female Cider / Lambrini Drank in street / park Purchased from shop 3/5 admitted to hospital

9. Reporting

10. Tackling Knives Action Programme (TKAP) project to Enhance Violence Prevention through ED Data Sharing [Wirral BCU (Arrowe Park data only)]

11. Overview of ED Data [10/05/10 to 23/05/10] Injuries Volume in reporting period Average ageMaleFemale Variation on previous period Knife related0--- Other sharp implement0---Same Gun related0--Same Blunt implement1191--2 Physical assault (no weapon)3325267Same Glass22111+1 Other0---Same Unknown/refused to answer2322-2

12. ‘Hot’ Locations in Reporting Period LocationWeaponDate/Time of assaultNAggregate Woodville Road Bottle10/05/10 / 10/05/1009:45/ Unknown25 New Brighton Promenade 14/05/10 / 22/05/1023:00 / 22:1522 Birkenhead Central Train Station 14/05/1015:3012 Borough Road 23/05/1017:4513 Bebington Road 15/05/1007:0011 Ben Nevis Road Unknown 11 Bentinck Street 22/05/1003:0011 Bidston Leisure Centre 12/05/1020:3011 Bidston Moss B&Q 19/05/1008:3011 Chamberlain Street 20/05/1020:3011 Grange Place 20/05/1018:3011 Hoole Road Blunt Object16/05/1017:3011 Larch Road Unknown 11 Neston Kebab House 23/05/1001:3011 North End 13/05/1023:0011 Pembroke Court 11/05/1016:3011 RJs 23/05/1013:0016 Seabank Road 15/05/1022:0011 St Caths Hospital O/S 22/05/1022:3011 St John Plessington School 13/05/10Unknown11 St Pauls Road Bottle22/05/1021:0011 Ward 18 APH 13/05/1001:4011 West Kirby Train Station 22/05/1021:0011 Whiteheath Way 18/05/1021:0011

13. Violence occurs in Town and City Centres yet perpetrators and victims live elsewhere Assault Presentation to Accident & Emergency by Deprivation of Residence Reports

14. Intervention CCTV Street Lighting Licensing Alleygates Development, implementation and monitoring of local alcohol and violence prevention strategies / prevention initiatives Targeted policing and licensing enforcement AMEC / TCVP / TKAP Pubwatch Best Bar None / Think 21 campaign Targeted social marketing campaigns

15. Event Planning Prevention England match days (EMD) 33% increase assault attendances Saturday / Thursday 50% No increase during World Cup period only (accounting for EMD)

16. Operation Xchange Partnership approach – ED, police, primary care – 14 th to 23 rd Dec 2009 – ED data used to guide police operation – Targeted policing / licensing enforcement Outcomes – 3 knives recovered – 21% reduction in wounding offences within the city centre – 57% reduction in ED assault attendances

17. Marketing Campaigns Prevention

18. AMEC weeks for 2005/06 Non-AMEC weeks Rate of assault attendances/week 2002/03 2003/04 2004/05 2005/06 Financial Year AMEC 2005/06 Licensing Act and Alcohol Misuse Enforcement Campaign Evaluation

19. Arrowe Park, Wirral: 03/04 - 09/10 03/04 = 3,299 / 1,48509/10 = 2,035 / 975 (38% / 34% reduction) Trends Est. £40,800 saved (PCT) through reduction in ED alcohol-related assault attendances Est. £24,000 saved (provider) through reduction in alcohol-related assault admissions

20. North West data collection / sharing AreaViolenceAlcohol Cumbria2/3 Cheshire1/4 Greater Manchester7/124/12 Lancashire2/5 Merseyside5/7 North West17/3114/31 Number of EDs collecting and sharing alcohol and violence data with TIIG, by area

21. www.tiig.info

22. Contact details For and more information please contact: Zara Quigg, Violence and TIIG Research Manager 0151 231 4359, z.a.anderson@ljmu.ac.ukz.a.anderson@ljmu.ac.uk www.tiig.info Centre For Public Health Liverpool John Moores University WHO Collaborating Centre for Violence Prevention 5 th Floor, Kingsway House, Hatton Garden, Liverpool, L3 2AY