1. Drugs & Alcohol In the Emergency Department Dr Sam Perry Emergency Medicine Consultant Western Infirmary Glasgow

2. History of Emergency Medicine Referred to as Casualty/A&E/Em Med Casualty derived from ‘casual’ Workhouse term for: ‘irregular & unexpected caller who may need temporary help’ may need temporary help’

3. Attendances at Emergency Department

5. Proportion of Alcohol/ Drug related attendances September 2008-February 2009 GRI& WIG 67,000 new attendances Total of alcohol/drug/deliberate self harm 2,730 (4%)

6. Illicit drug use 193 (0.2%) Alcohol 1,372 (2%) Opiate overdoses 73

7. All Attendances by age

8. Reasons why figures are probably an underestimate Diagnostic recording system Doctors choose ‘best guess’ diagnosis Do have an option to add more diagnoses but don’t System is not very user friendly

9. Attitudes of ED staff Often negative Patients also report attendances as a negative experience Very little undergraduate education Attitudes become more positive following education

10. Many drug related conditions will not be included

11. DVT

12. Abscess

13. Trauma

14. Blood Born Viruses

15. Cocaine use

16. Case History

17. Standby call 17 year old girl 38wks pregnant ‘Fitting’ Had taken 6 E’s earlier that evening

18. Eclampsia Ecstasy poisoning Seizure

19. Ecstasy Poisoning Hypertension Seizures Confusion Nausea/abdo pain Eclampsia Hypertension Seizures/coma Confusion Proteinuria Epigastric pain

20. Drug related deaths & attendance in the ED

21. Number of contacts 200320042006 Range1-351-171-14

22. Mode 1 for all years

23. Attendances prior to death

24. 2006 Number of those attending with OD prior to death

25. Lessons Perception that drug users place a drain on emergency services not true Alcohol much more of a problem Only a minority of those who die present to ED prior to death Staff should identify drug users presenting with other conditions & refer to appropriate addiction team