National Assembly for
Wales / Cynulliad Cenedlaethol Cymru
Health
and Social Care Committee /
Y Pwyllgor Iechyd a Gofal Cymdeithasol
Inquiry into alcohol and substance misuse / Ymchwiliad i gamddefnyddio alcohol a sylweddau
Evidence from Wales College of Paramedics – ASM 03 / Tystiolaeth gan Coleg Parafeddygon Cymru – ASM 03
1. Managing the burden of alcohol on ambulance and paramedic services is of global concern, however it is also an extremely difficult area influenced by many factors, including social and law enforcement. Whilst the College of Paramedics is in favour of attempts to reduce the burden of incidents involving alcohol, we feel that care must be taken to avoid implementing any strategy that could put patients at risk.
2. The College of Paramedics recognises how the damaging effects of alcohol can result in acute medical, surgical and traumatic emergencies. 70% of emergency department admissions at peak times are due to alcohol. As such alcohol related emergencies impact significantly on the Ambulance Service and paramedics in Wales, increasing the potential for anti-social behaviour and violence towards staff [1] and other members of our community. This has resulted in unremitting pressure, which negatively impacts on the ability to response to respond to life threatening situations.
3. In 2011 the College of Paramedics was invited to comment on the WG petitions committee consideration of charging for emergency treatment following alcohol use [2]. The College of Paramedics remains opposed to charging for emergency treatment following alcohol use, for reasons laid out in the previous response. The preferred approach continues to be a thoughtful debate surrounding the issues in Working Together to Reduce Harm: The Substance Misuse Strategy for Wales 2008-2018 [3], in aiming to reduce harm caused by alcohol through mechanisms of support, improved services, education and protecting families of substance misusers, whilst tackling the inappropriate availability of alcohol. The College of Paramedics also recommended in its previous response that this could be achieved by a well coordinated approach involving other agencies, and a realistic change in health and social policy, some of the examples given included:
Ø Engaging with Police and the like to provide safe assessment areas (not necessarily the Emergency Department) staffed by paramedics and police.
Ø Highlighting the public health message of the damaging effects of alcohol, in an attempt to 'modify help seeking behaviour'
4. The Ambulance Service in Wales has developed innovative and collaborative approaches to minimise the harms and negative impact of excessive alcohol consumption. Alcohol Treatment Centres have been established, most notably in Cardiff City which is provided during peak times such as weekends and when big sporting events are taking place. These centres are staffed by nurses, paramedics, advanced paramedic practitioners and volunteers, providing additional capacity to help emergency departments deal with people who have consumed too much alcohol.
5. Alcohol has become increasingly affordable, as its price relative to income has fallen, and the College of paramedics is concerned with the growing number of people drinking excessive amounts of cheap alcohol, such as those socially isolated in their own home, and vulnerable groups such as the young and homeless. In a current study being conducted as part of a Phd in collaboration with Swansea University and the Welsh Ambulance Service, Paramedic participants raised the significant role of alcohol when caring for people who Self Harm. Alcohol dependence and misuse are strongly associated with suicidal behaviour [4], and one study found 46.1% of self harm patients had consumed alcohol within 6 h of their Self harm [5]. Paramedics report difficulties in managing patients who lack capacity and refuse treatment; such is often the case in those who have consumed alcohol. These difficulties can be overcome by education, multidisciplinary support and guidelines which can increase competence and confidence in dealing with such patients, despite this, few such opportunities exist [6].
6. The College of Paramedics feels that paramedics should be seen as a vital contributor to care, policy and strategy in reducing harms from alcohol or substance misuse. Whilst innovations are emerging such as that of alcohol treatment centres, their impact should be evaluated through research to explore safety, benefits and more widespread adoption. As paramedics and ambulance staff are often the first health professionals to encounter patients following alcohol or substance misuse, we feel there are opportunities in areas such as health promotion and modifying help seeking behaviour.
The College of Paramedics would like to express their thanks for considering us in this consultation and look forward to future developments in this area.
Acknowledgements
Nigel Rees for contributing work from PhD studies: Paramedics perceptions of care for people who Self Harm: An Evolved Grounded Theory.
References
1. Rees, N (2005) Violence and Aggression directed towards Ambulance Services personnel: Guidance through application of behavioural sciences. Ambulance UK. Vol 20:3. P. 267-176
2. WAG (2011) College of Paramedics response to petitions committee consideration of charging for emergency treatment following alcohol use. Petitions Committee – Briefing Paper PET(3)-05-11: 15 March 2011 Available from: http://www.assembly.wales/Committee%20Documents/PET(3)-05-11%20%20Paper%201%20%20New%20Petitions%20and%20Updates%20to%20Previous%20Petitions%20(PDF,%209.14MB)%20-15032011-212362/pet_3_-05-11_papers-e-English.pdf#search=nigel%20rees[Accessed on 12/12/14]
3. WG (2008) Welsh Assembly Government: Working Together to Reduce Harm The Substance Misuse Strategy for Wales 2008-2018. Available from: http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Good%20Practice/welshstrategy.pdf[accessed on 17/12/2014]
4. Murphy G (2000) Psychiatric aspects of suicidal behaviour: substance abuse. In: Hawton K, Van Heeringen K (eds) The International handbook of suicide and attempted suicide. Wiley, Chichester, pp 135–146
5. Haw, C. Hawton, K. Casey, D. Bale, E. Shepherd, A. (2005) Alcohol dependence, excessive drinking and deliberate self-harm Trends and patterns in Oxford, 1989–2002 Soc Psychiatry Psychiatr Epidemiol (2005) 40: 964–971
6. Rees, N. Rapport, F. Thomas, G. John, A. Snooks, H. (2014) Perceptions of Paramedic and Emergency Care Workers of those who Self Harm: A Systematic Review of the Quantitative Literature. Journal of Psychosomatic Research. In Press: DOI: 10.1016/j.jpsychores.2014.09.006