How alcohol fills hospital wards every weekend

A nurse's monitor displays the range of injuries and complaints to be dealt with on a typical weekend night in accident and emergency…

A nurse's monitor displays the range of injuries and complaints to be dealt with on a typical weekend night in accident and emergency.

"Chest pains . . . ankle sprain . . . breathing difficulties. . . cuts and bruises."

The most common listing of all, however, is "C2H5OH" - the chemical formula for alcohol.

"All the time we are dealing with drink-related stuff: if not people with too much alcohol or drugs on board then those who have got into fights on the way home from the pub," says Dr Stephen Lynch, casualty registrar at Beaumont Hospital.

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It can be frustrating, he says, particularly as such cases are so time-consuming. "Contrary to public perception, we don't pump people out anymore. We observe. And that can take you away from more important matters."

One of three acute hospitals in north Dublin, Beaumont has a catchment area stretching from Finglas to Balbriggan. More than 50,000 people attend the A&E department each year, or roughly 140 a day.

Approaching midnight last Friday night, it seemed relatively calm. But then as Dr Lynch points out "the nature of the work means it's very unpredictable."

He is already seven hours into his shift and has two hours left, after which he will remain on call for a further six hours. "Last night, I left at 3 a.m., which wasn't bad."

Night sister Ms Catherine Galvin, by contrast, won't be clocking off until 8 a.m. Saturday. It will mark the end of an 84-hour week.

"I like it, even though it can be hectic. You get busy nights and quiet ones . . ."

Her voice tails off as she spots two paramedics approaching with a man being led between them. He has a blood-stained bandage wrapped round his neck and is walking unsteadily. The medical staff know him all too well.

"One of our regulars," sighs Ms Galvin before addressing the man by his first name, and helping him into a seat in the main casualty hall.

As she walks back, she whispers to a colleague: "Ring security. He might have a knife on him."

The patient in question had cut his throat. No knife was found but, as a safety precaution, two security men stayed with him for several hours as the effects of the drink or drugs he had taken wore off.

The team approach between nursing, medical and security staff is what keeps the department going, says Ms Galvin.

The threat of physical assault is never far away. A male nurse was recently headbutted by a patient. Ms Galvin herself recalls one man tried to strangle her some years ago by twisting a chain round her neck.

"You get sustained verbal abuse all the time," she adds.

It's the downside of working in what is regarded as one of the most exciting and fast-paced hospital environments.

"Some people have left in the last 18 months because they can't handle the stress," says A&E consultant Mr Aidan Gleeson, "and justifiably so. I could have left myself but there is a job to be done.

"It can be very busy but that is part of the buzz of the job."

It says a lot about the type of people who work in casualty that their main complaints relate, not to security or the threat of violence, but resources, and particularly the lack of beds for admissions.

"What really makes the job hard is having all these people on trolleys who shouldn't be in the department. It really compromises patient care because it's not a safe environment," says Mr Gleeson.

"It is not safe to be one of 20 or 30 patients in a very busy A&E department. Mistakes do and will be made. People fall off trolleys, become unwell and there are so many people in the area you can't keep an eye on all of them."

The only reason patients end up on trolleys in casualty, sometimes for several days, is because there is no room in the main hospital. "I don't have a problem with ward sisters who say it's unacceptable to have to look after patients in an unacceptable environment," says Mr Gleeson. "But for some reason the same logic never extends to A&E."

He says Beaumont, like other acute hospitals, has tried to deal with the problem. But without significant investment in hospital beds, "it's like shifting chairs on the Titanic."

The department's overcrowding difficulties are exacerbated by the fact that up to a quarter of attendances are from people who could be seen "and dealt with appropriately by their GPs", says Mr Gleeson.

"We've had people coming in complaining that their rings were on too tight," recalls Ms Galvin. "One guy called an ambulance out for trapped wind."

Others, she notes, are using the ambulance service for a taxi home. "They arrive in here, don't even give their name and just go straight out."

But no matter how spurious some of the injuries are, and no matter how many are self-inflicted, all are treated in the same manner, says Dr Lynch. "Alcohol is almost inevitably involved in the incidents we see at weekends. But that doesn't change the way we deal with people."