SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown.

Summary Overcrowding occurs when emergency department (ED) function is impeded, primarily by overwhelming of ED staff resources and physical capacity by excessive numbers of patients needing or receiving care. Access block occurs when there is excessive delay in access to appropriate inpatient beds (> 8 hours total time in the ED). Access block for admitted patients is the principal cause of overcrowding, and is mainly the result of a systemic lack of capacity throughout health systems, and not of inappropriate presentations by patients who should have attended a general practitioner. Overcrowding is most strongly associated with excessive numbers of admitted patients being kept in the ED. Excessive numbers of admitted patients in the ED are associated with diminished quality of care and poor patient outcomes. These include (but are not limited to) adverse events, errors, delayed time‐critical care, increased morbidity and excess deaths (estimated as at least 1500 per annum in Australia). There is no evidence that telephone advice lines or collocated after‐hours GP services assist in reducing ED workloads. Changes to ED structure and function do not address the underlying causes or major adverse effects of overcrowding. They are also rapidly overwhelmed by increasing access block. The causes of overcrowding, and hence the solutions, lie outside the ED. Solutions will mainly be found in managing hospital bedstock and systemic capacity (including the use of step‐down and community resources) so that appropriate inpatient beds remain available for acutely sick patients.

We evaluated the spatial distribution of otter trawl fishing effort and catches resulting from the imposition in 1994 of year-round and seasonal groundfish closed areas off the NE USA. Vessel locations were available from logbooks, vessel monitoring system (VMS) data from many of the largest vessels, and from observer records. There was high spatial coherence between VMS-and observer-derived trawling locations. Prior to establishment, 31% of trawl effort (1991e1993) occurred within the 22 000 km 2 of area that would eventually be closed year-round. In 2001e2003 about 10% of effort targeting groundfish was deployed within 1 km of the marine protected area (MPA) boundaries, and about 25% within 5 km. Density gradients, consistent with spill-over from MPAs, were apparent for some species. Average revenue per hour trawled was about twice as high within 4 km of the boundary, than for more distant catches, but the catch variability was greater nearer closed area boundaries. Seasonal closed areas attracted more fishing effort after opening than prior to closure even while average cpue was the same or lower. Spatial resolution of traditional data sources (e.g., logbooks) was too crude to discern detailed MPA-related effects, as revealed by high-resolution vessel positions from VMS and catch data obtained by observers.