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BackgroundThe annual cost to the NHS of alcoholrelated injury and illness is estimated to be £2.7 billion. Alcohol-related violence has become a concerning public health issue. This study set out to establish the burden of alcohol-related violence in an inner city UK emergency department (ED). Methods This single centre study was undertaken in the ED of the Bristol Royal Infirmary. This department serves an inner city population. An independent researcher administered a questionnaire to every patient who attended during the study period. A questionnaire was also administered to the treating clinician to ascertain the diagnosis, and whether the patient's attendance was related to alcohol use. Results 14% (n¼111) of participants felt that their attendance at the ED was related to alcohol. 11% of all injured patients felt it was due to alcohol consumption. 3% of patients attended with an alcohol-related illness. The treating clinicians reported that 21% of all patients in this study attended with a problem either directly or indirectly attributable to alcohol. Discussion The number of attendances attributable to alcohol-related injury and illness was at least 14% of all patients. One third of patients presenting with an alcohol-related illness or injury required admission to hospital. If these figures are extrapolated, the number of patients presenting with alcohol-related injury is in excess of 7000 attendances to the Bristol Royal Infirmary annually, or nearly 2 million ED patients every year in England and Wales, resulting in 640 000 admissions.The total cost to the NHS of alcohol-related injuries and illnesses is estimated to be £2.7 billion a year, 1 2 with alcohol-related crime, assaults and disorder costing a further £7.3 billon.3 Alcohol-related harm is estimated to cost society between £17.7 billion and £25.1 billion per year. 4 In a recent study Benger and Carter 5 found that accidents and assaults were the most common cause of alcohol-related attendance to the emergency department (ED). Alcoholrelated violence has become a concerning public health issue.6 7 Hazardous drinking has been defined as the regular consumption of over 5 units a day for men and over 3 units a day for women.8 Uncontrolled drinking leads to public disorder, violence and long-term health problems. Recent research has suggested a sharp increase in harmful and hazardous drinking patterns amongst young adults, and the Chief Medical Officer has warned that Britain's 'binge drinking culture' is damaging greater numbers of young people than ever before.

Aims. This article presents a discussion of emerging non-medical roles in emergency care against the current policy context and the issues of role substitution and interprofessional working. Background. Non-medical roles in emergency care have grown internationally in response to an increasing demand for emergency care services and to address the growing importance of the quality healthcare agenda. The blurring of role boundaries between professional groups has become more common. Data sources. Searches were made of three electronic databases; CINAHL, Medline and EMBASE. The literature relating to interprofessional healthcare roles, and new roles in emergency care was searched from 1980 to 2010 and underpinned the discussion. Discussion. A theoretical framework that has emerged from the literature is that task, role substitution and interprofessional working lie on a spectrum and evolving non-medical roles can be plotted on the spectrum, usually starting at one end of the spectrum under task substitution and then potentially moving in time towards true interprofessional working. Conclusions. There is still a great deal of progress to be made until non-medical roles in emergency care can truly be encompassed under the umbrella of interprofessional working and that a more robust critical mass of evidence is required to substantiate the theory that interprofessional working within teams contributes to effective, cost-effective care and better patient outcomes. Relevance to clinical practice. It is essential to understand the underlying motivation, policy context and key drivers for the development of new nursing and nonmedical roles. This allows services to be established successfully, by understanding and addressing the key predicable barriers to implementation and change.