Growing emergency the tip of the ICE-berg

Published 20 August 2019

Current crystal methamphetamine or ICE use is exacting a toll not just on individuals and families. First responders and frontline medical and nursing staff in hospital emergency departments are also struggling with the growing number of unpredictable and dangerous patients.

The University of New England (UNE) is investigating methamphetamine-related presentations and the impact this highly addictive stimulant is having on emergency departments (EDs), their staff and ambulance and police officers. Researchers have found that ICE users are labour intensive in emergency departments, spend protracted periods in hospital and their behaviour can mask serious injuries. They also require a higher rate of first responder escorts to emergency departments compared to people with non-methamphetamine-related injuries.

Researcher and nurse Rikki Jones, who has herself worked in rural ED units, said her analysis of data collected by 32 Queensland public hospitals from 2005-2017 has shown that methamphetamine users often require complex care. "Many are experiencing psychosis, hallucinations, depression and anxiety when admitted to hospital, and violent outbursts are common," she said. "These are predominantly younger males, who present with serious injuries, who are triaged as needing emergency (triage 2) or urgent (triage 3) treatment.

"Methamphetamine users frequently require one-on-one and sometimes two-on-one care, which can tie up first responders and hospital staff, and resources for extended periods, delaying treatment for other patients. This is especially pronounced in rural and regional hospitals, where the number of admissions of ICE users has grown and resources in EDs are limited, particularly on weekends.

"Importantly, admission to an ED may be an ICE user's first opportunity for health treatment and many departments lack the specialist drug and alcohol services those patients need."

In 2010 the crystallised form of methamphetamine constituted 22% of all reported methamphetamine use, according to the Australian Institute of Health and Welfare. By 2015 this had increased to 50%, and to 57% by 2016. The Australian Drug Trends Report of 2018 reported that methamphetamine use overall has been steadily declining, however, users have reported an increase in the frequency of use since 2017. The estimated number of methamphetamine-related ED presentations in NSW has rapidly increased from 531 in 2009 to 4,478 in 2016/17, according to the Centre for Epidemiology and Evidence.

Rikki said ICE users are presenting to EDs with increasingly complex injuries. "Our results suggest that 17.6% presented to Queensland EDs with intentional self-harm, 6% had been involved in an assault and 42.4% had an accident related to their methamphetamine use – which included overdose, falls, and puncture wounds," she said. "Hospital staff could be dealing with injuries that have resulted in multi-organ injuries as well as psychological issues."

Victorian hospital ED figures suggest that this may be a national trend. Rikki's current analysis of state-wide methamphetamine presentations to 38 Victorian public hospitals with 24-hour emergency departments showed that presentations have increased by 113% from 2005 to 2015. Other drug-related presentations have increased by 124%, while the remaining presentations have only increased by 29%.

The two ICE studies build on the strong body of UNE research into drug and alcohol admissions to emergency departments in NSW, Queensland and Victoria over the past three years.

Professor Kim Usher, Dr Cindy Woods and Rikki Jones have just completed an analysis of the impact of alcohol-related falls on Victorian EDs, showing that their incidence increased by 93% over the 13 years to 2013, mostly among young males aged 20-24. With most suffering head injuries, emergency staff needed to be vigilant about the need for neurological assessments for the early diagnosis of traumatic brain injuries, however a drunken state often made such assessments challenging.

"It can be very hard for medical staff to know whether the symptoms a patient is exhibiting are due to the effect of alcohol or the injury," Professor Usher said. "ED units are under increasing pressure due to the rise in alcohol and drug-related admissions. ICE-related presenters, especially, often need to be put into isolation cubicles and resuscitation bays. The ED environment is usually totally unsuitable for people exhibiting violent, aggressive and disorienting behaviour."

Professor Kim Usher said she hopes the team's findings help guide hospital staff in how best to manage and treat drug and alcohol patients, and highlight ways to alleviate pressure on first responders, ED staff and hospital resources.

"EDs are struggling to cope with their current workload, let alone the rising incidence of drug and alcohol-related injuries," Professor Usher said. "Triaging such patients is very complex because the person is either incommunicative or difficult, posing major challenges for early diagnosis.

"Our work highlights the need for public education policies, to highlight this drain on public resources, but also education for health professionals and improved hospital guidelines for the management of these patients."

The UNE researchers are now interviewing police officers and paramedics who have been required to escort patients under the influence of methamphetamines to emergency departments.

The impact of unintentional alcohol-related falls on emergency departments

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