One-third of cases in A&E are alcohol-induced problems. Fiona Tyrrell reports
The developments in the Brian Murphy manslaughter case last week has put the high incidence of alcohol-fuelled assaults in the spotlight once more and again this morning hospitals around the State are picking up the pieces after another bank holiday weekend of drink-induced aggression.
This morning, on a Tuesday after a bank holiday weekend, the maxillofacial unit of St James's will be like Beirut, according to consultant maxillofacial surgeon Cliff Beirne who expects to be treating at least 15 serious facial injury cases today - and that's if it's been a quiet weekend.
"It's like Beirut here after a bank holiday weekend. The unit will be full of young males who have been assaulted late at night," he says.
Twenty years ago most of the cases treated at the unit were car crash and sport victims, now the vast majority (83 per cent) of patients treated at the unit are assault cases.
The statistics leave no doubt about the link between alcohol and assault. More than 80 per cent of the assault cases treated at the unit have some relationship with alcohol - either the assailant or the victim has consumed alcohol before the attack, according to Beirne.
Fists, boots, bottles, bars, baseball bats, chairs and hurleys are the weapons of choice.
There has been a significant increase in the number of violent assaults and severity of assaults over the past five years, according to Beirne. Instead of a "couple of punches" the story from patients is now of kickings on the ground, assault with objects and multiple people getting involved in beatings, he says. Alcohol is always a major factor and the unit is always at its busiest after bank holidays, holiday times and Christmas.
"The worst period I have ever seen for facial injuries in my life was during the World Cup in 1990. We had three times the number of cases to deal with."
Treatments can range from a one-hour procedure or a theatre session of six-seven hours followed up by further surgery to treat residual deformities.
The increase in cases has a serious knock-on effect on the service provided by the unit, which has only half of the consultants needed to provide proper care.
All these cases, referred from hospitals around the State, will have to be assessed, booked into theatre and beds. This is at the expense of elective surgery, which will have to be deferred. Not just elective surgeries for maxillofacial speciality, but all other specialities in the hospital can be affected.
Beirne describes last week's suggestion by the HSE of establishing a special A&E unit in Temple Bar to deal with injuries sustained by late-night drinkers as "risible".
The notion of "patching up patients and throwing them back out" on to the streets "is a hare-brained idea", Beirne says.
"It would mean taking away resources from other areas and quite frankly it absolutely sums up the lack of any thought processes going into tackling the problem."
The way to help solve the problem is to try to prevent assaults happening in the first place, he says. Garda presence should be increased at so-called flashpoint areas such as Temple Bar in Dublin and Eyre Square in Galway, he says.
The situation in A&E departments across the State is no better. One-third of people attending casualty are there because of alcohol-induced problems.
A report published late last year revealed that more than half of all the injuries treated at the A&E unit of Dublin's Mater Hospital were alcohol-related. This compares with figures from 2002 which showed that one in four attendances at the hospital's casualty department were as a result of alcohol.
At the five other hospitals covered in the Department of Health-funded study, the percentage of patients attending with alcohol-related injuries stood at 28 per cent in Sligo and Letterkenny General Hospitals, 24 per cent at Galway's University College Hospital, 21 per cent at Beaumont Hospital and 19 per cent at Waterford Regional Hospital.
The research also showed that 42 per cent of these injuries were cuts, bites and open wounds, 29 per cent were broken bones and 6 per cent were head injuries. While most (four out of 10) were as a result of falls and trips, 23 per cent were as a result of being "struck against" and 14 per cent were as a result of blunt force.
As a nation we consume 40 per cent more alcohol than we did 10 years ago, according to Dr Eamonn Brazil, an A&E consultant at the Mater Hospital, so it stands to reason that the number of alcohol-related serious violent assaults have increased.
"We all know we are drinking too much. The big worry is the drinking of young adults today. If we don't address it, now we will have serious long-term problems down the road."
Treating victims of assault who are drunk is a difficult task. At times it is difficult to tell if symptoms are as a result of intoxication or if something more serious is going on but staff must always err on the side of caution.
Any given Friday night, the Mater A&E department will see five to 10 head injuries. Around two of these will have to be scanned and the rest observed every 15 minutes.
City centre hospitals in the major cities suffer the real brunt of the problem, says Dr Chris Luke, consultant in emergency medicine at the Mercy Hospital and Cork University Hospital. After midnight, 75-80 per cent of people attending casualty department in city centre hospitals are intoxicated and 50-70 per cent of assault victims are intoxicated, he explains.
The classic alcohol-related injury is a head injury. The victim could have received one or two punches to the face and fell backwards banging their head on the edge of a curb, wall or chair. This causes a fracture and can result in fatality or a permanent disabling injury.
Another classic injury, according to Luke, is hand injury either as a result of throwing a punch or hitting a wall. "It can be the young male who punches the wall during a row with his girlfriend rather than punching her. We see dozens of these every weekend. It's the archetypical drink-related self-injury."
There are three causes of violence - alcohol, brutality and cocaine/cannabis, he says.
And now when adults of club-going age come to the department with unusual behaviour, disease or suspicious injuries, it is assumed that alcohol or drugs are involved, he says.
A&E patients with alcohol levels three times the driving limit in their blood stream are common, he says. While alcohol is a major issue, the growing problem of drug and substance abuse is a huge cause for concern. For starters, treating patients with alcohol on board is much simpler than patients who have taken drugs.
"We get them after they have peaked and they are beginning to fall asleep or sober up. If they are not sobering up, they are drinking in the toilets or behind cubicle curtains to continue the party." If a patient does not start falling asleep, medical staff need to consider that they may be taking stimulants, he explains.
Drug-related violence is "getting bigger and bigger", Luke says. "Alcohol related-aggression comes with an explosion of rage or stroppiness. There is a crescendo of violence and people usually slink away and over the next hour fall asleep. Cocaine is more sinister. It is more intense and more deliberate."
The Mary-Ann Leneghan case in Reading, in Britain, which involved kidnapping, rape, torture and murder, is a classic example of such behaviour, he says. "The new urban slavery has been fuelled by cocaine, whereas the old was fuelled by alcohol."
Young women are drinking more than young men in Ireland and there is a noticeable increase in girl-on-girl street violence, according to Luke. Recent cases at the Mercy in Cork include a girl who was stabbed with a syringe by two other females, he says.
However, Beirne of St James's says that while the odd case of girls assaulting girls does show up, there has not been a significant increase in this type of assault.
We are a nation in denial of a serious alcohol problem, according to Dr Declan Bedford, a public health specialist with the North Eastern Health Board (NEHB).
Research conducted by Bedford revealed that the number of patients from the NEHB region has increased by 80 per cent over a five-year period between 1997 and 2001.
"We drink too much and we are unwilling to take the steps necessary to prevent the wide range of alcohol-related harm. We need leadership to implement evidence-based strategies, which will be unpopular. Unless we do so, the carnage will continue."
Such strategies include reducing the number of outlets selling alcohol, the introduction of random breath testing and tackling the issue of advertising and promotion of alcohol, he says.