Emergency medicine conference highlights
Emergency medicine conference highlights
Monday 21 November, Millennium Hotel, NZ
The harm caused by alcohol and other drugs is a major focus of the Annual Scientific Meeting of the Australasian College for Emergency Medicine being held at the Millennium Hotel in Queenstown, New Zealand from Monday 21 to Thursday 24 November.
At 11.15am Dr Emma Lawrey will tell the conference that use of steroids in New Zealand’s gyms is on the rise but people are unaware of the associated health risks.
At 2.00pm Dr Paul Quigley will reveal a survey of a Wellington emergency department (ED) that showed over 10% of patients presenting to the ED demonstrated features of harmful alcohol-related behaviour.
Steroids on the rise in NZ
Anabolic steroid use in New Zealand’s gyms is growing and people aren’t aware of the health risks involved.
That’s the subject of a presentation to be given by Dr Emma Lawrey at 11.15am on Monday 21 November at the Annual Scientific Meeting of the Australasian College for Emergency Medicine (ACEM) at the Millennium Hotel, Queenstown, NZ.
“The seizure of performance- and image-enhancing drugs (PIEDs) coming into New Zealand has increased five-fold since 2008,” Dr Lawrey said. “Over the last two years we’ve seen hundreds of packages of performance enhancing drugs picked up annually, over half of which are androgenic anabolic steroids.”
Steroid users increase their risk of myocardial infarction (heart attack), upper limb tendon rupture, liver disease,and other drastic consequences.. Research also suggests that long-term steroid use may result in neurodegeneration (presenting with features similar to dementia) as users age, Dr Lawrey said.
“These are generally males 20 to 40 who are wanting to look good, rather than elite athletes looking for ` edge in performance,” Dr Lawrey said. “They may not be aware that steroids can be dangerous.”
Dr Lawrey noted a recent survey of male gym-goers in Kuwait in which 70% said they didn’t believe it was possible to get a good body without using steroids.
Only 18% of those surveyed were able to accurately describe the adverse effects of steroid use.
Study shows over 10% of Wellington ED patients with alcohol disorder
A study at the Wellington emergency department (ED) has found that 11% of screened patients have alcohol use disorder.
“This shows that a significant proportion of our community is engaging in a level of alcohol intake that is harmful,” said Dr Paul Quigley, lead researcher of the study, who will present his findings at 2.00pm on Monday 21 November at the Millennium Hotel, NZ.
The screening program ran concurrently with the seven day Alcohol Harm in Emergency Departments (AHED) study from 1 to 8 December, 2014.
As well as alcohol harm, the study also found that 6% of participants suffered from depression and 3% had thoughts of suicide.
Nine patients required acute referral to mental health services.
“This study demonstrates that there’s a significant hidden health burden that we’re seeing annually in the ED – including hundreds of cases of depression – that can only be uncovered through dedicated screening.” Dr Quigley said.
Other presentations today include:
Black Friday: one year on
Almost exactly a year ago Paris was struck by the worst terrorist attacks in its history. On ‘Black Friday’, 13 November 2015, the city was hit by the first in a series of coordinated attacks that left 130 dead and over 350 injured.
On Monday afternoon at 2.30pm at the Millennium Hotel in Queenstown, NZ, Dr Eric Revue, Chief of the Emergency Department, Hospital Le Coudray, Chartres will revisit the tragic events of that night to explore how emergency services reacted and what lessons can be learned.
French authorities had been planning for the possibility of a multi-site attack on the capital for some time. This preparation turned out to be crucial as it allowed emergency services to respond strategically on the night of 13 November.
By 5.30am the following morning, over 600 victims of the attacks had presented to emergency departments in Paris and beyond.
“Looking back there are lessons to be learned and things that could have been done better, but a lot of things in the plans worked very well,” says Dr Revue, “Most of all, the spirit of people to help each other is very strong and to think back to what the doctors and nurses and other medical staff did to help their patients is very moving.”
Treated with dignity: older patients in the ED
In both New Zealand and Australian emergency departments (EDs), the prime force driving overcrowding is population ageing.
At 11.00am on Monday 21 November, Associate Professor Glenn Arendts from the Centre for Clinical Research in Emergency Medicine at the University of WA will outline how the current orthodox ED approach to ‘risk management’ conspires to deprive elderly ED patients of their dignity and identity.
“Nearly half of all hospital bed days are devoted to people aged 65 and over and the proportion of people in this age bracket will double by 2050,” says Associate Professor Arendts.
Because older patients tend to be more complex and fare worse the longer they spend in an ED, current processes are biased towards admitting them to hospital. This can lead to a loss of control and independence and also exposes them to the dangers of a stay in hospital, all in the name of ‘reducing’ risk that the older person themselves may have little concern about.
In order to deal adequately with these important issues, changes need to take place both inside and outside the ED.
“Emergency medicine staff will increasingly need the skills and resources to be able to help older patients make decisions about treatment that’s right for them,” says Associate Professor Arendts.
“Current ED practices are contributing to rather than reducing high hospital occupancy in older people and this benefits neither the patients nor the community.”
GP patients not to blame for busy EDs
A recent study in Western Australia has indicated that low-acuity – popularly and misleadingly referred to as ‘GP-type’ patients – are not a major contributor to emergency department (ED) overcrowding.
The research was undertaken at three metropolitan hospitals in Perth by Dr Yusuf Nagree, who will present his findings to the conference at 2.30pm on Monday 21 November at the Millennium Hotel in Queenstown, NZ.
“In 2016, the Western Australian Government launched an extensive advertising campaign advising people to see their GP instead of the ED,” says Dr Nagree. “We wanted to find out if the campaign had been successful in reducing ED overcrowding and congestion.”
GP-type patients did show a small decrease, with 8.1% of patients considered GP-type in May-October 2015 compared to 7.2% in 2016.
But the proportion of patients who remained in the ED for less than four hours (NEAT performance) actually worsened, from 74% in May-October 2015 to 63% in May-October 2016. Patients spent almost 20% longer in the ED during 2016 period.
The work burden on Emergency Departments related to GP-type patients remained virtually unchanged accounting for 4.0% of ED length of stay in 2015 compared to 3.6% in 2016.
“Although the number of GP-type patients coming into our ED did fall slightly, there wasn’t any improvement in performance or a reduction in overcrowding,” Dr Nagree said, “This is because GP patients only account for a small workload in EDs and reducing their number does not improve overcrowding.”
Dr Nagree said the research was consistent with other studies undertaken on the impact of GP patients on ED overcrowding.