A report investigating the impact of alcohol on the emergency services was carried out in 2015 (Institute of Alcohol Studies (IAS), 2015). The report found that alcohol was the leading cause of call-outs, and that most ambulance staff feel that they are at risk in their line of duty (IAS, 2015). It revealed that 96% of ambulance staff had been verbally abused or threatened in their line of duty, 50% have actually been injured on duty by alcohol-intoxicated individuals, and 54% of staff feel unsafe in their own ambulances (IAS, 2015). More than half of ambulance service workers (52%) claimed to have been the victim of intoxicated sexual harassment or assault.
Ill-equipped
An interesting and concerning point raised by the research was that staff felt they were not equipped appropriately to deal with intoxicated individuals, with 50% noting that they felt they lacked the relevant training. The final main point summarised that many ambulance staff felt there should be tougher policies on intoxicated individuals. Three-quarters (76%) of staff supported the idea of an NHS policy that would charge people for ambulance call-outs when their own intoxication was the cause for requiring an ambulance.
On the rise
Government figures from 2009/2010 show that there were about 1.4 million alcohol-related ambulance or paramedic journeys, accounting for 35% of all emergency journeys (NHS, 2012). This figure is set to increase as alcohol use continues to rise in the UK. It was also calculated that the Scottish Ambulance Service has to respond to a call-out every 21 minutes to an intoxicated individual (Beatson, 2015). The problem is a growing epidemic in the UK. The types of incidents that commonly occur, resulting in an ambulance call-out to an individual being intoxicated, include:
At risk
It was noted that not all call-outs resulted in hospital attendance, with some being treated at the scene. Risk of encountering a hostile or threatening/potentially dangerous environment is increased for the ambulance staff, when they are called to intoxicated individuals, as most incidents relating to alcohol intoxication involve some violence or threatening/self-harming behaviour that could lead to a potentially harmful situation for others.
The cost
It is also important to note that the impact on alcohol services can be quantified more easily by considering the time and resources dedicated to attending to, transporting and referring patients who present with alcohol-related problems. The majority of ambulance staff opting in favour of charging people for call-outs that relate to the individual concerned being intoxicated are right to be concerned. Official government figures estimate that each ambulance/paramedic journey (that is alcohol-related) costs £321.30, with the total cost to the NHS in England from 2009 to 2010 for alcohol-related emergency journeys totalling £449 million (NHS, 2012).
Staff abuse
Violence and drug-related incidents are common in the call-outs that ambulance service staff attend, posing a risk for them. Martin et al (2012) carried out a study in the North East of England, which found that alcohol-related call outs were three times more likely to involve verbal or physical abuse of staff compared with general ambulance work. Drugs and alcohol played a part in 300 violent attacks on crews in the East Midlands in 2013. Many areas now use police resources; where ambulances are called to areas well known for violence, ambulance/paramedic staff only attend if accompanied by a police officer (IAS, 2015).
Time to regroup
After violent/threatening events, as are experienced frequently when a person is intoxicated, ambulance crew may need to take time off from their line of duty to recover from the incident. While this time may be necessary and should be encouraged for the wellbeing of staff (and also their patients), this could essentially lower the number of staff on the streets that are there to perform within their capacity as ambulance or paramedic crew.
Knock-on effect
This may also have a knock-on effect to response time attending to serious injuries or cardiac arrest, to name two examples, where help is required immediately and alcohol intoxication is not a factor (IAS, 2015). Many alcohol-related incidents also require immediate attendance as a result of the seriousness of the situation. For example, the rapid and professional response of ambulance crew are required to deal with drink-driving accidents, overdoses and severe injuries caused by assault (IAS, 2015). These situations are therefore preventable if the person was not intoxicated.
The intoxication that led to the serious injury leads to yet another strain on resources while paramedic staff respond with urgency to each situation, further facing a risk to themselves.
The impact
Speaking to the House of Commons Health Select Committee in 2010, Brian Hayes, a London Ambulance Paramedic, gave evidence of the impact that treating intoxicated patients could have on an ambulance crew:
‘The first thing most of them do as we leave the scene is vomit. That then renders the ambulance off the road for an hour once that call has been finished because it has to be deep cleaned because of infection and so on. Hopefully none of the vomit has gone over the ambulance crew because if that happened—shower, change your uniform. So you can be looking at that ambulance being unavailable to deal with anything else for two hours, two and a half hours because of alcohol. Then you will get the ones where the ambulance crews have been assaulted…We have had cases of paramedics being sliced with knives, punched, kicked, ambulances being nicked just as a prank through somebody being drunk and driving it into a row of cars’.
Taking responsibility
More than half of those ambulance staff and paramedics (52%) expressed the view that they should not be responsible for dealing with the consequence of the excessive consumption of alcohol in patients that they are called out to treat (IAS, 2015). As mentioned, 76%, believe that people who are solely using the ambulance services because of intoxication by alcohol alone, should be charged for the fees induced by their actions (IAS, 2015). An interesting point was made by a person surveyed:
‘Charges made for intentional drunkeness [sic]. Fine pubs and clubs who are repeat offenders and expect the NHS to deal with the problem once money has been spent at their establishments. In repeat offenders remove their licences.’
A complex situation
This point recognises that addiction plays a part and that some individuals are in fact encouraged by establishments that are purely there to make money from people buying alcohol. The problem is therefore a complex one. It involves the government's ability to market and make money from the trading of alcohol across the country, which effectively can enable an alcohol addiction, and the knock-on effect of the intoxicated person then needing ambulance attention. It is clear that the front-line staff that have to attend such scenes are frustrated that resources, while strained, are being used in situations that need not have happened had alcohol not been to blame.
This costs money to the NHS and therefore the tax payer. It also potentially slows down services to those who are not intoxicated, but require an immediate response. The situation is complex and the government has yet to place charges or fines against intoxicated people who require an ambulance.