Impact of Patients Presenting with Alcohol and/or Drug Intoxication on In-Event Health Care Services at Mass-Gathering Events: An Integrative Literature Review

Bullock, M. F. M.; Ranse, Jamie; Hutton, Alison

doi:10.1017/s1049023x1800078x

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…The higher number and proportion of young adults arriving to the ED by ambulance during Schoolies week is clinically important as it indicates potential impact on prehospital and in‐ED resources. The presence of higher qualified medical staff (rather than first responder volunteers) has been noted elsewhere to impact (reduce) the transfer to hospital rate . Further research describing the nature of care delivery and diagnoses for young adults arriving to the ED by ambulance during Schoolies week would be helpful in determining staffing, equipment, resources and economic considerations.…”

Section: Discussionmentioning

confidence: 99%

Emergency healthcare delivery for young adults during a planned mass gathering: A retrospective observational study

Crilly

Ranse

Bost

et al. 2019

Emerg Medicine Australasia

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Objective To describe patient presentation characteristics and outcomes for people aged 16–18 years pre, during and post a planned youth mass gathering event (MGE): ‘Schoolies week’ on the Gold Coast, Queensland, Australia. Methods This was a retrospective observational study, including patient presentations by all young adults requiring care in the ED or in‐event health services (EHS) over a 21‐day period in 2014. Data analysis included descriptive and inferential statistics. Results A total of 1029 patient presentations were made by people aged 16–18 years to the ED and EHS over the 21‐day study period (139 pre, 695 during [275 in ED, 420 in EHS], 195 post Schoolies week). Some ED patient characteristics and outcomes varied between the pre, during and post Schoolies periods, such as patients age (P < 0.001), usual place of residence (P < 0.001) and not waiting for treatment (P = 0.015). Of the 24 375 registered MGE attendees, 420 (1.72% [95% confidence interval 1.57–1.89], 17.2/1000) presented for in‐event care. Most patients were allocated an Australasian Triage Scale category of 4 (n = 162, 65.6%), with toxicology related presentations (n = 169, 44.9%). Transportation to hospital was undertaken for seven MGE attendees (0.03% [95% confidence interval 0.01–0.06], 0.3/1000). Conclusions Establishment of an in‐event model of care for 1 week during Schoolies served as an effective hospital avoidance strategy for a planned youth MGE. Such in‐event models of care may be considered for other similar future MGE.

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Section: Discussionmentioning

confidence: 99%

Emergency healthcare delivery for young adults during a planned mass gathering: A retrospective observational study

Crilly

Ranse

Bost

et al. 2019

Emerg Medicine Australasia

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“…30,31 The availability of alcohol at sporting MGEs has been repeatedly shown to predispose participants to inadvertent injury and harm resulting in increased PPRs to in-event health services. 9,13,[32][33][34] This review, however, has demonstrated that despite alcohol being available at sporting MGEs, less than ten percent of presentations to in-event health services are as a result of alcohol or drug intoxication. Arbon, Bridgewater, and Smith 34 found that one percent of patient presentations to 201 various Australian MGEs were drug and alcohol related, with just under 12% of those people requiring transport to hospital, yet 99% of drug and alcohol related presentations were at MGEs where alcohol was available.…”

Section: Discussionmentioning

confidence: 99%

“…40 Multiple studies have suggested, however, that the presence of highly skilled health professionals at in-event health services reduces the demand on ambulance services and EDs. 33 Peaks in ED presentations related to drugs and alcohol have been identified in the literature to occur more commonly before and after the sporting MGE. 39,41 Similar to the findings reported by Todkill, et al, 26 a peak in presentations due to illicit drug use was observed immediately after the Sydney 2000 closing ceremony; the majority of whom were transported to hospital by ambulance.…”

Section: Discussionmentioning

confidence: 99%

Drug and Alcohol Related Patient Presentations to Emergency Departments during Sporting Mass-Gathering Events: An Integrative Review

Delany

Crilly

Ranse

2020

Prehosp. Disaster med.

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Background:Drug and alcohol consumption at sporting mass-gathering events (MGEs) has become part of the spectator culture in some countries. The direct and indirect effects of drug and alcohol intoxication at such MGEs has proven problematic to in-event health services as well as local emergency departments (EDs). With EDs already under significant strain from increasing patient presentations, resulting in access block, it is important to understand the impact of sporting and other MGEs on local health services to better inform future planning and provision of health care delivery.Aim:The aim of this review was to explore the impact of sporting MGEs on local health services with a particular focus on drug and alcohol related presentations.Method:A well-established integrative literature review methodology was undertaken. Six electronic databases and the Prehospital and Disaster Medicine (PDM) journal were searched to identify primary articles related to the aim of the review. Articles were included if published in English, from January 2008 through July 2019, and focused on a sporting MGE, mass-gathering health, EDs, as well as drug and alcohol related presentations.Results:Seven papers met the criteria for inclusion with eight individual sporting MGEs reported. The patient presentation rate (PPR) to in-event health services ranged from 0.18/1,000 at a rugby game to 41.9/1,000 at a recreational bicycle ride. The transport to hospital rate (TTHR) ranged from 0.02/1,000 to 19/1,000 at the same events. Drug and alcohol related presentations from sporting MGEs contributed up to 10% of ED presentations. Alcohol was a contributing factor in up to 25% of cases of ambulance transfers.Conclusions:Drug and alcohol intoxication has varying levels of impact on PPR, TTHR, and ED presentation numbers depending on the type of sporting MGE. More research is needed to understand if drug and alcohol intoxication alone influences PPR, TTHR, and ED presentations or if it is multifactorial. Inconsistent data collection and reporting methods make it challenging to compare different sporting MGEs and propose generalizations. It is imperative that future studies adopt more consistent methods and report drug and alcohol data to better inform resource allocation and care provision.

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“…Triage is an essential component of providing unscheduled health services, particularly during disasters 1 and at mass gatherings where marked variability in demand is seen. 2 Triage allows efficient utilization of health care resources, which leads to better matching of demand for and supply of health care resources, including in mass-casualty settings. 3 Triage has been a standard part of delivering emergency medicine for decades, and is widely discussed in the disaster management literature.…”

Section: Introductionmentioning

confidence: 99%

Performance of First Aid Trained Staff using a Modified START Triage Tool at Achieving Appropriate Triage Compared to a Physiology-Based Triage Strategy at Australian Mass Gatherings

Douglas

Leverett

Paul

et al. 2020

Prehosp. Disaster med.

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Introduction:Triage at mass gatherings in Australia is commonly performed by staff members with first aid training. There have been no evaluations of the performance of first aid staff with respect to diagnostic accuracy or identification of presentations requiring ambulance transport to hospital.Hypothesis:It was hypothesized that triage decisions by first aid staff would be considered correct in at least 61% of presentations.Methods:A retrospective audit of 1,048 presentations to a single supplier of event health care services in Australia was conducted. The presentations were assessed based on the first measured set of physiological parameters, and the primary triage decision was classified as “expected” if the primary and secondary triage classifications were the same or “not expected” if they differed. The performance of the two triage systems was compared using area under the receiver operating characteristic curve (AUROC) analysis.Results:The expected decision was made by first aid staff in 674 (71%) of presentations. Under-triage occurred in 131 (14%) presentations and over-triage in 142 (15%) presentations. The primary triage strategy had an AUROC of 0.7644, while the secondary triage strategy had an AUROC of 0.6280, which was significantly different (P = .0199).Conclusion:The results support the continued use of first aid trained staff members in triage roles at Australian mass gatherings. Triage tools should be simple, and the addition of physiological variables to improve the sensitivity of triage tools is not recommended because such an approach does not improve the discriminatory capacity of the tools.

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Impact of Patients Presenting with Alcohol and/or Drug Intoxication on In-Event Health Care Services at Mass-Gathering Events: An Integrative Literature Review

Cited by 13 publications

References 21 publications

Emergency healthcare delivery for young adults during a planned mass gathering: A retrospective observational study

Emergency healthcare delivery for young adults during a planned mass gathering: A retrospective observational study

Drug and Alcohol Related Patient Presentations to Emergency Departments during Sporting Mass-Gathering Events: An Integrative Review

Performance of First Aid Trained Staff using a Modified START Triage Tool at Achieving Appropriate Triage Compared to a Physiology-Based Triage Strategy at Australian Mass Gatherings

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