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OBJECTIVE: To determine any impact associated with changes to liquor licensing regulations on emergency department attendances for alcohol-related serious injuries in an inner-city entertainment precinct. DESIGN, SETTING AND PARTICIPANTS: A blinded retrospective analysis of data from the Emergency Department Information System (EDIS) of the major trauma and teaching hospital (St Vincent's Hospital, Darlinghurst) in the Sydney CBD Entertainment Precinct. Data for trauma cases classified as Australasian triage categories 1 (immediately life-threatening) and 2 (imminently life-threatening, important time-critical treatment, very severe pain) in the 12 months before (24 February 2013 - 23 February 2014; period 1) and the 12 months after (24 February 2014 - 23 February 2015; period 2) the 2014 changes to liquor licensing regulations applied to the precinct. MAIN OUTCOME MEASURES: Critically or seriously injured emergency presentations that were identified as related to alcohol use. RESULTS: In the 2-year study period, there were 13 110 triage category 1 and 2 presentations to the St Vincent's Hospital emergency department: 6467 during period 1 and 6643 during period 2. Of these, 1564 (4.3%) were patients who presented with alcohol-related serious injuries: 318 (4.9%) during period 1 and 246 (3.7%) during period 2 (P < 0.05). The proportion of alcohol-related serious injury presentations (triage categories 1 and 2) was much higher (9.1% of presentations) during the high alcohol time (HAT; 6 pm Friday to 6 am Sunday) than during the rest of the week (3.1%). After the introduction of the regulatory changes, there was a significant decrease in the number of seriously injured patients during HAT, from 140 presentations (10.4% of presentations) before the change to 106 (7.8%) after their introduction, a relative reduction of 24.8% (P < 0.05). There was a small increase in the number of patients presenting with alcohol-related injuries between 9 pm and midnight. CONCLUSIONS: There was a significant reduction in the number of alcohol-related serious injury and trauma presentations to the emergency department in the 12 months after the introduction of the new liquor regulations. This change was seen throughout the week, but was especially marked at weekends.

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PURPOSE OF REVIEW: Amphetamine-type stimulants now rank second worldwide in the table of most widely used recreational drugs. Many countries report increased availability and increased purity of the drugs.Surprisingly, while many authors in the last decade have described clinical issues and demographic patterns associated with amphetamine use, there is little published research quantifying the specifics of the impact of 'ICE' use on health resources.It is, therefore, timely to review the available literature on the impact of this group of drugs on emergency medical systems. RECENT FINDINGS: Recent research has focused on the increase in production and availability of metamphetamines. Clinical findings at acute presentation and long-term sequelae have been studied and in particular, the impact of the drugs on mental health and development of long-term neurological problems. Work has also been done unsuccessfully to develop therapeutic agents for the acute management of patients who present under the influence of amphetamines. SUMMARY: It is clear that the use of metamphetamine-type substances places an increasing burden on acute health services. There is a need for preventive and harm-minimization strategies.

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OBJECTIVE: To characterise the nature and impact of World Youth Day (WYD) 2008 on emergency department (ED) presentations at key hospitals. DESIGN, SETTING AND PARTICIPANTS: Retrospective analysis of WYD pilgrims presenting to the EDs of St Vincent's Hospital and Sydney Hospital, 9-23 July 2008. MAIN OUTCOME MEASURES: Frequency of pilgrim ED presentations; presenting complaint, Australasian Triage Scale category, diagnosis, admission to hospital and demographic characteristics. RESULTS: 191 pilgrims presented at the two EDs during the study period, comprising 7.8% of all visits to these EDs. Pilgrims had a median age of 22 years, and most were international visitors. The female-to-male ratio was 1.7 : 1. The most common diagnoses were lower limb strain or sprain, infections, and acute asthma. Pilgrims presented with less severe illnesses (with lower triage scores), and were less likely to be admitted to hospital than other patients. CONCLUSIONS: The pilgrim caseload was small, and these presentations were less acute and less likely to result in admission than non-pilgrim presentations. Thus, the overall impact on the hospitals was very small.

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OBJECTIVE: There is no widely accepted measure of clinical documentation quality in the ED. The present study creates a measure for comparing the quality of clinical documentation of external injuries with autopsy reports. This is used to discuss the advantages and disadvantages of introducing routine photography to improve clinical documentation of injuries. METHODS: This retrospective case series addressed all non-surviving major trauma patients (Injury Severity Score > or =15) presenting to St. Vincent's Hospital ED, Sydney, within the 5 year period from 1 July 2002 to 30 June 2007. Comparison between clinical and autopsy documentation of external injuries was completed for each major trauma patient. RESULTS: Of the 48 major trauma patients, there were an average of 11.6 injuries missed in documentation per patient (P < 0.001, 95% CI 8.6-14.6). ED documentation recorded on average 29% (95% CI 26%-32%) of the external injuries that appeared in the autopsy report. We call this percentage the external injury documentation rate. The external injury documentation rate was influenced by injury count and body region, but was not influenced by age, sex, severity (using the Abbreviated Injury Scale and Injury Severity Score), or whether the clinician used a trauma survey or standard progress notes or not, and there was no visible trend over time. CONCLUSION: Clinical documentation of external injuries in major trauma is poor. This is presumably because of many factors, including time pressures and high-stress environments. A possible strategy to improve this documentation is routine photography, which should offer both clinical and legal benefits.

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OBJECTIVE: To compare demographic and clinical characteristics of methamphetamine users and patients with other toxicology-related problems requiring medical intervention in a hospital emergency department (ED). DESIGN AND SETTING: Prospective observational study of toxicology-related presentations to the ED of St Vincent's Hospital (SVH), Sydney, an inner-city tertiary hospital, between 1 October and 31 December 2006. MAIN OUTCOME MEASURES: Differences between methamphetamine-related and other toxicology-related presentations to the ED in relation to behaviour, mode of arrival, accompaniment, need for scheduling, location of drug use, intravenous drug use history, psychiatric history and demographic characteristics. RESULTS: During the study period there were 10 305 patient presentations to SVH ED; 449 (4%) were toxicology-related presentations, of which 100 (1% of total) were methamphetamine-related. Methamphetamine users were significantly more agitated, violent and aggressive than patients with other toxicology-related presentations and significantly less alert, communicative and cooperative (P < 0.001); 24% of methamphetamine users (24/100) arrived with police accompaniment versus 9% of other toxicology patients (33/349) (P < 0.001). Methamphetamine users were more likely to have a history of intravenous drug use and mental health problems (P < 0.001); 39% of methamphetamine presentations (39/100) required scheduling under the Mental Health Act 1990 (NSW) compared with 19% of other toxicology-related presentations (67/349) (P < 0.001); 43% of methamphetamine-related presentations (43/100) involved drug use on the street compared with 24% of other toxicology-related presentations (83/349) (P < 0.001). Two-thirds of all methamphetamine users were male, and the most common age group for both male and female users was 26-30 years. The mean age and sex distribution of patients with other toxicology-related presentations were not significantly different. Among methamphetamine users, 27% of women (9/33) were in the 21-25-year age group compared with 10% (7/67) of men (P < 0.001). CONCLUSION: There were significant differences between methamphetamine-related and other toxicology-related presentations to SVH ED. Methamphetamine users were more aggressive, violent and dangerous, and thus more likely to pose a risk to health personnel and others. Methamphetamine appeared to be used consistently, rather than as an episodic "party drug".

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