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Alcohol-Related Presentations to Emergency Departments on Days with Holidays, Social, and Sporting Events: An Integrative Literature Review

Published online by Cambridge University Press:  25 October 2023

Stephanie Rae Hagan Open the ORCID record for Stephanie Rae Hagan [Opens in a new window] ,
Julia Crilly Open the ORCID record for Julia Crilly [Opens in a new window]  and
Jamie Ranse
Stephanie Rae Hagan*
Affiliation:
School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
Julia Crilly
Affiliation:
School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
Jamie Ranse
Affiliation:
School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
*
Correspondence: Stephanie Rae Hagan, MAdvNursPrac (Emerg), RN, BN, GradCert EmergNurs School of Nursing and Midwifery Griffith University Parklands Drive, Southport, QLD, AUS, 4215 E-mail: stephanie.hagan2@griffithuni.edu.au
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Abstract

Introduction:

Events, specifically those where excessive alcohol consumption is common, pose a risk to increase alcohol-related presentations to emergency departments (EDs). Limited evidence exists that synthesizes the impact from events on alcohol-related presentations to EDs.

Study Objective:

This integrative review aimed to synthesize the literature regarding the impact events have on alcohol-related presentations to EDs.

Methods:

An integrative literature review methodology was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) Guidelines for data collection, and Whittemore and Knafl’s framework for data analysis. Information sources used to identify studies were MEDLINE, CINAHL, and EMBASE, last searched May 26, 2021.

Results:

In total, 23 articles describing 46 events met criteria for inclusion. There was a noted increase in alcohol-related presentations to EDs from 27 events, decrease from eight events, and no change from 25 events. Public holidays, music festivals, and sporting events resulted in the majority of increased alcohol-related presentations to EDs. Few articles focused on ED length-of-stay (LOS), treatment, and disposition.

Conclusion:

An increase in the consumption of alcohol from holiday, social, and sporting events pose the risk for an influx of presentations to EDs and as a result may negatively impact departmental flow. Further research examining health service outcomes is required that considers the impact of events from a local, national, and global perspective.

Keywords

emergency nursingemergency serviceevidence-based emergency medicinehospitalintegrative review

Information

Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 6 , December 2023 , pp. 764 - 773
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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Introduction

With many emergency departments (EDs) currently at or over capacity, Reference McKenna, Heslin, Viccellio, Mallon, Hernandez and Morley1 understanding the impact of events on alcohol-related presentations to EDs can assist in health promotion and preventative strategies, future ED forecasting, ED planning, and ED resource allocation. Reference Crilly, Ranse and Bost2 Alcohol consumption has contributed to an increasing number of ED visits Reference White, Slater, Ng, Hingson and Breslow3 and a higher proportion of alcohol-related presentations to EDs are evident amongst males Reference Klein, Driver, Miner, Martel and Cole4 and occur overnight and on weekends. Reference Bertholet, Adam and Faouzi5 Furthermore, some people presenting to EDs with alcohol intoxication can have long stays in the ED Reference Klein, Driver, Miner, Martel and Cole4 and can be violent and/or aggressive. Reference Bertholet, Adam and Faouzi5–Reference Kleissl-Muir, Raymond and Rahman8

Alcohol, a central nervous system depressant, alters communication between the brain and body, exhibiting symptoms of poor concentration, slower reflexes, and increases the threat for risk-taking behaviour. Reference D’Angelo, Petrella and Greco9 The impact from the consumption of alcohol in many countries continues to grow Reference Bertholet, Adam and Faouzi5,10,Reference McNicholl, Goggin and O’Donovan11 with alcohol associated with many social and cultural events. 10 It is not uncommon for alcohol to be served and/or consumed at some of these events, and in large quantities. Reference Elgan, Durbeej, Holder and Gripenberg12 With reports suggesting that binge drinking is attributed to 75% of all alcohol consumed 13 and that 25% of people aged 14 and above consume more than four standard drinks in one sitting, at least monthly, 10 continued cause for concern exists. This is especially so when considering the longer-term consequences of excessive alcohol consumption which increases the risk for preventable illness, disease, and adverse health effects such as: alcoholic liver cirrhosis, alcohol dependence, depression, suicide, cardiovascular disease, cancer, road traffic accidents, and assaults. 14

Events that result in changes to alcohol intake volumes external to ED may result in additional patient presentations to ED and disrupt normal operational capacity. Such events may be considered in terms of being planned or unplanned. Examples of planned events include mass-gathering events (MGEs) such as music festivals and sporting events; policy events such as changes in alcohol legislation; and social events such as school leaver celebrations and certain public holidays, like New Year’s Eve. Reference Crilly, Ranse and Bost2,Reference Hutton, Ranse and Zimmerman15–Reference Lippi, Ferrari, Bovo and Cervellin17 Examples of unplanned events include natural disasters such as earthquake, tsunamis, and hurricanes, humanitarian emergencies such as displaced people, and disease outbreaks such as Ebola, Severe Acute Respiratory Syndrome (SARS), and coronavirus disease 2019 (COVID-19). 18

For some planned events, such as MGEs, there can be a recognized impact on local EDs, especially when alcohol is involved. Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19–Reference Kharasch, McBride, Saitz and Myers29 Less is known regarding the impact unplanned events have on alcohol-related presentations to EDs. Today, events are occurring more frequently, posing the risk for an increase in alcohol-related presentations to EDs; however, the specific impact varied events have on alcohol-related presentations to EDs is unknown.

The overarching aim of this integrative literature review was to synthesize the literature regarding the impact events have on alcohol-related presentations to EDs. The research was guided by the following questions: How do events impact alcohol-related presentations to the ED? Are there certain periods where there has been an increase or decrease in these presentations? And how does this impact functioning of the ED?

Methods

Design

This integrative literature review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines Reference Liberati, Altman and Tetzlaff30 for data collection and Whittemore and Knafl’s framework Reference Whittemore and Knafl31 for data analysis. An integrative review design was deemed appropriate as it aims to comprehensively synthesize the literature to generate new insights.

Data Collection

Papers published from January 2012 through May 2021 were retrieved on May 26, 2021 from three sources: Medical Literature Analysis and Retrieval System Online (MEDLINE; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO Information Services; Ipswich, Massachusetts USA); and Excerpta Medica Database (EMBASE; Elsevier; Amsterdam, Netherlands). The search strategy for MEDLINE included different combinations of Medical Subject Headings (MeSH) terms, CINAHL included subject headings and keywords that are relevant to the topic, and EMBASE used keywords by way of EmTree headings. All MeSH terms and keywords are outlined in Table 1. Search strings are presented in Supplementary Table S1, Table S2, and Table S3 (available online only).

Table 1.

MeSH Terms/Key Words

Abbreviation: MeSH, Medical Subject Headings.

The identified papers were screened for eligibility Reference Liberati, Altman and Tetzlaff30 against inclusion and exclusion criteria, as outlined in Table 2. Covidence software 32 was used to support the screening management of the systematic review. The software automatically removed duplicates. One reviewer independently screened 100% of title and abstracts (SH), whilst the other two reviewers independently screened 50% each (JC, JR). Moderation was resolved by the reviewer who did not screen initially. One reviewer (SH) examined 100% of the full-text articles, whilst the other two reviewers independently screened 50% each (JC, JR). Moderation was resolved by the reviewer who did not screen initially. Data were manually extracted and entered into tables in a Word (Microsoft Corp.; Redmond, Washington USA) document (SH). Extracted data were checked by another reviewer (JR). The main outcome of interest was a change in alcohol-related presentations to EDs from an event. Missing information not evident in the included articles when extracting data of interest were left blank in the tables.

Table 2.

Inclusion and Exclusion Criteria

Data Analysis

Analysis was undertaken using the approach from Whittemore and Knafl’s framework. Reference Whittemore and Knafl31 Information extracted from each paper included: a description of the event, inclusive of duration/dates; the impact of alcohol-related presentations to ED (increase, decrease, or no change); demographics, characteristics, and outcomes of alcohol-related presentations to ED with regards to the identified event; and a summary of the study characteristics including author(s), population, alcohol-related definitions, sample, and design.

Results

A total of 23 papers met the criteria for inclusion (Figure 1), identifying 46 events that were grouped into six categories: (1) disasters: eg, earthquakes; (2) music festivals: eg, electronic dance music festivals; (3) policy changes: eg, changes in trading hours; (4) public holidays: eg, Christmas day; (5) social events: eg, birthday celebrations; and (6) sporting events: eg, Rugby World Cup. A summary of articles and study characteristics included in this integrative literature review is displayed in Table 3.

Figure 1.

PRISMA Reference Liberati, Altman and Tetzlaff30 Flow Diagram of Search Results.

Table 3.

Description of Study Characteristics

Note: Population as defined by study authors; sample refers to the cohort of patients included in the study.

Abbreviations: Acute Alcohol Intoxication (AAI); Alternate Care Site (ACS); Alcohol Intoxication (AI); Breath Alcohol Content (BAC); Emergency Department (ED); Emergency Department Information System (EDIS); Dance Music Festival (DMF); Electronic Dance Music Festival (EDMF); International Classification of Diseases (ICD); Medical Health Care Organization (MHCO); New South Wales (NSW); Queensland (QLD); Road Traffic Accident (RTA); United State of America (USA).

Studies included were undertaken in countries including Australia (n = 7), United States (n = 6), New Zealand (n = 2), Canada (n = 1), Denmark (n = 1), England (n = 1), France (n = 1), India (n = 1), Ireland (n = 1), Italy (n = 1), and Japan (n = 1). The design of studies varied, with the majority being retrospective observational cohort studies (n = 12) Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19,Reference Gardener, Parke and Jones20,Reference Ridpath, Driver and Nolan23–Reference Castro-Marin, Maher and Navarro25,Reference Grigoletto, Cognigni and Occhipinti27,Reference Kharasch, McBride, Saitz and Myers29,Reference De Vocht, McQuire and Brennan33–Reference Miller, Mc Donald, Mc Kenzie, O’Brien and Staiger37 and time series analysis (n = 5). Reference Kobayashi, Hayashi and Kuga38–Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 Of the 23 papers, there was only one identified disaster – earthquake. Reference Kobayashi, Hayashi and Kuga38 Four papers focused on music festivals, Reference Ruest, Stephan, Masiakos, Biddinger, Camargo and Kharasch21–Reference Stagelund, Jans, Nielsen, Jans and Wildgaard24 twelve focused on policy changes, Reference Castro-Marin, Maher and Navarro25–Reference Kharasch, McBride, Saitz and Myers29,Reference De Vocht, McQuire and Brennan33,Reference Joseph, Roshan, Sudhakar, Prasanth and Abhilash34,Reference Gale, Muscatello and Dinh39–Reference Kisely and Lawrence41,Reference Fierro-Fine, Harland, House and Krasowski43,Reference Atkinson, Prodan and Livingston44 two focused on public holidays, Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 two on social events, Reference Callaghan, Sanches, Gatley, Liu and Cunningham36,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 and five focused on sporting events. Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19,Reference Gardener, Parke and Jones20,Reference Castro-Marin, Maher and Navarro25,Reference Miller, Mc Donald, Mc Kenzie, O’Brien and Staiger37,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 Two papers were considered to fall into more than one category. Reference Castro-Marin, Maher and Navarro25,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42

Alcohol-related terms used were primarily reported as “alcohol intoxication” (n = 9) Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19,Reference Gardener, Parke and Jones20,Reference Stagelund, Jans, Nielsen, Jans and Wildgaard24,Reference Grigoletto, Cognigni and Occhipinti27,Reference Kharasch, McBride, Saitz and Myers29,Reference Joseph, Roshan, Sudhakar, Prasanth and Abhilash34,Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35,Reference Miller, Mc Donald, Mc Kenzie, O’Brien and Staiger37,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 or “alcohol consumption” (n = 8). Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19,Reference Gardener, Parke and Jones20,Reference Castro-Marin, Maher and Navarro25,Reference Ford, Foulds and Coleman26,Reference Joseph, Roshan, Sudhakar, Prasanth and Abhilash34,Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35,Reference Miller, Mc Donald, Mc Kenzie, O’Brien and Staiger37,Reference Atkinson, Prodan and Livingston44 The terms “alcohol use” (n = 3), Reference Ruest, Stephan, Masiakos, Biddinger, Camargo and Kharasch21,Reference Ridpath, Driver and Nolan23,Reference Fulde, Smith and Forster28 “alcohol misuse” (n = 2), Reference De Vocht, McQuire and Brennan33,Reference Miller, Mc Donald, Mc Kenzie, O’Brien and Staiger37 “alcohol abuse” (n = 1), Reference Grigoletto, Cognigni and Occhipinti27 and “under the influence of alcohol” (n = 1) Reference Joseph, Roshan, Sudhakar, Prasanth and Abhilash34 were also noted. Alcohol was also referred to as ethanol Reference Chhabra, Gimbar, Walla and Thompson22 and ethanol intoxication >20mg/dL. Reference Fierro-Fine, Harland, House and Krasowski43 Diagnosis codes related to alcohol were often used, and these included a range of International Classification of Diseases (ICD)-9 codes and ICD-10 codes (Table 3).

Impact of Events on Alcohol-Related Presentations to EDs

An overview of the identified events and their impact on alcohol-related presentations to ED are outlined in Table 4. The impact was considered in terms of increase, decrease, or no change in alcohol-related presentations to the ED, as elaborated on below.

Table 4.

Description of Event and Impact of Alcohol-Related Presentations to the ED

Note: ↑ = Increase; ↓ = Decrease; ∼ = No Change.

Abbreviations: Emergency Department (ED); Australian Football League (AFL); Australian New Zealand Army Corps (ANZAC); Goods and Services Tax (GST).

Increase in Alcohol-Related Presentations to EDs

Twenty-seven of the 46 identified events impacted the ED by way of an increase in alcohol-related presentations. Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19–Reference Stagelund, Jans, Nielsen, Jans and Wildgaard24,Reference Kharasch, McBride, Saitz and Myers29,Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35,Reference Callaghan, Sanches, Gatley, Liu and Cunningham36,Reference Gale, Muscatello and Dinh39,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42–Reference Atkinson, Prodan and Livingston44 Four papers reported an increase in alcohol-related presentations following a music festival, particularly electronic dance music festivals, Roskilde music festival, and music concerts. Reference Ruest, Stephan, Masiakos, Biddinger, Camargo and Kharasch21–Reference Stagelund, Jans, Nielsen, Jans and Wildgaard24 Four papers reported an increase in alcohol-related presentations following a policy change, such as the implementation of a university policy, Reference Kharasch, McBride, Saitz and Myers29,Reference Fierro-Fine, Harland, House and Krasowski43 introduction of a Goods and Services Tax (GST), Reference Gale, Muscatello and Dinh39 and a change in trading hours. Reference Atkinson, Prodan and Livingston44 Public holidays were documented in two papers Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 with an increased risk and/or increase in alcohol-related presentations noted on: Christmas Eve; Christmas Day; New Year’s Eve; New Year’s Day; Easter Sunday; June Bank Holiday; St. Patrick’s Day; St. Stephen’s Day; the day prior to Australian New Zealand Army Corps (ANZAC) day; and the day prior to New Year’s Day. Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 Two papers focusing on social events reported that birthday celebrations, especially ages 19, 20, 21, and 22, Reference Callaghan, Sanches, Gatley, Liu and Cunningham36 and the last working day before Christmas Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 were associated with an increase in alcohol-related ED presentations.

Three papers focusing on sporting events reported an increase in alcohol-related presentations, most notably from the EURO-16 Football Cup, 2011 Rugby World Cup, Australian Football League (AFL) grand final day, Commonwealth Games and Melbourne Cup Day sporting events, Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19,Reference Gardener, Parke and Jones20,Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 and especially on game days as opposed to non-game days. Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19

No Change in Alcohol-Related Presentations to EDs

Nine papers reported no evident change in alcohol-related ED presentations across 24 events. Reference Castro-Marin, Maher and Navarro25,Reference Ford, Foulds and Coleman26,Reference De Vocht, McQuire and Brennan33–Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35,Reference Miller, Mc Donald, Mc Kenzie, O’Brien and Staiger37,Reference Kisely, Crowe, Lawrence, White and Connor40–Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42 Five papers identified no change in presentations following policy changes pertaining to a change in trading hours, increase in alcopops tax, and the implementation of new licensing laws. Reference Ford, Foulds and Coleman26,Reference De Vocht, McQuire and Brennan33,Reference Joseph, Roshan, Sudhakar, Prasanth and Abhilash34,Reference Kisely, Crowe, Lawrence, White and Connor40,Reference Kisely and Lawrence41 One paper identified no change in presentations from public holidays including August, May, and October bank holidays, and Easter Monday and Saturday. Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35 Two papers identified no change from sporting events including professional golf tournament and Geelong Football games. Reference Castro-Marin, Maher and Navarro25,Reference Miller, Mc Donald, Mc Kenzie, O’Brien and Staiger37 One paper focusing on both public holidays and sporting events reported no change in presentations from the following events: Australia Day; Boxing Day; Christmas Day; Easter; Labor Day; Queen’s birthday; St. Patrick’s Day; Formula 1 Grand Prix; International Soccer matches; and World Cup Soccer matches. Reference Lloyd, Matthews, Livingston, Jayasekara and Smith42

Characteristics, Demographics, and Outcomes of Alcohol-Related Presentations to EDs from Events

Of the included studies, a summary of the characteristics, demographics, and outcomes of alcohol-related ED presentations from events is presented in Supplementary Table S4 (available online only). Nine papers reported on the age of patients with ages ranging from 12 to >65 years. Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19,Reference Ruest, Stephan, Masiakos, Biddinger, Camargo and Kharasch21–Reference Ridpath, Driver and Nolan23,Reference Grigoletto, Cognigni and Occhipinti27,Reference Kharasch, McBride, Saitz and Myers29,Reference Callaghan, Sanches, Gatley, Liu and Cunningham36,Reference Kobayashi, Hayashi and Kuga38,Reference Fierro-Fine, Harland, House and Krasowski43 Where sex (or gender) was included, men were reported as more likely to present in seven studies; Reference Noel, Roch, Michelet, Boiron, Gentile and Viudes19,Reference Chhabra, Gimbar, Walla and Thompson22,Reference Grigoletto, Cognigni and Occhipinti27,Reference Callaghan, Sanches, Gatley, Liu and Cunningham36,Reference Kobayashi, Hayashi and Kuga38,Reference Gale, Muscatello and Dinh39,Reference Fierro-Fine, Harland, House and Krasowski43 women were more likely to present in two studies. Reference Ruest, Stephan, Masiakos, Biddinger, Camargo and Kharasch21,Reference Ridpath, Driver and Nolan23 Four papers included breath or alcohol levels ranging from 104mg/dL to 412mg/dL Reference Ruest, Stephan, Masiakos, Biddinger, Camargo and Kharasch21,Reference Grigoletto, Cognigni and Occhipinti27,Reference Kharasch, McBride, Saitz and Myers29,Reference Fierro-Fine, Harland, House and Krasowski43 and one paper elaborated on other substances such as amphetamines and marijuana used in combination with alcohol. Reference Chhabra, Gimbar, Walla and Thompson22 Eight papers identified outside normal working hours and weekends as busy periods in EDs, specifying times from 5:00pm to 02:15am are considered “high alcohol times,” and individual days such as opening ceremonies for sporting events. Reference Gardener, Parke and Jones20,Reference Chhabra, Gimbar, Walla and Thompson22,Reference Grigoletto, Cognigni and Occhipinti27,Reference Fulde, Smith and Forster28,Reference Griffin, Dillon, O’Regan, Corcoran, Perry and Arensman35,Reference Callaghan, Sanches, Gatley, Liu and Cunningham36,Reference Kobayashi, Hayashi and Kuga38,Reference Fierro-Fine, Harland, House and Krasowski43 The ED length-of-stay (LOS) was only reported in three United States studies where the events were one music festival, Reference Chhabra, Gimbar, Walla and Thompson22 a range of music festivals, Reference Ruest, Stephan, Masiakos, Biddinger, Camargo and Kharasch21 and a university alcohol policy. Reference Kharasch, McBride, Saitz and Myers29 For these studies, ED LOS was noted to be approximately 4.5 hours: median 265 minutes; Reference Chhabra, Gimbar, Walla and Thompson22 mean 250 minutes; Reference Ruest, Stephan, Masiakos, Biddinger, Camargo and Kharasch21 and mean 253 minutes. Reference Kharasch, McBride, Saitz and Myers29

Discussion

This integrative review of the literature explored the impact events have on alcohol-related presentations to EDs. The rate of alcohol-related presentations to EDs was not clearly articulated in the studies included in this review. Key findings that emerged from the review indicate that for some events, such as music festivals, public holidays, social events, and large sporting events, there was an increase in alcohol-related presentations to EDs. Impact tended to be reported in terms of number of presentations, ED LOS, and discharge disposition from ED. For those events where there was no change in alcohol-related presentations, this may reflect the nature of the event, availability of medical services at the event, or that there was an increase in ED presentations from the event, but they were not necessarily alcohol-related or given an ICD-10 code of alcohol intoxication due to other illness and accompanying injuries. In order to support and plan for future events and impacts on EDs from people who are intoxicated from alcohol, the following discussion is framed around considerations of clinical, workforce, and policy strategies.

Clinical Strategies

Strategic planning for the impact events may have on EDs should have set goals and outcomes and be guided by prior evidence. Reference Saaiman, Filmalter and Heyns45 This review found that certain types of events, including music festivals with crowds of >5000, public holidays, especially Christmas Eve, and large sporting events such as the EURO-16 Football Cup, impacted EDs more so than others in terms of alcohol-related presentations. Clinically driven strategies such as in-event health services Reference Crilly, Ranse and Bost2 and community sobering shelters have been reported to reduce ED presentations of alcohol intoxication, Reference Castro-Marin, Maher and Navarro25 and thus warrant consideration during and following these types of planned events.

Workforce Strategies

With a noted increase in ED presentations from particular events, appropriate staffing is needed to meet patient demands. Reference Saaiman, Filmalter and Heyns45,Reference Gul and Celik46 Such resourcing considerations for the ED include staff skill mix; patient acuity; departmental flow of other patients; and the individual needs of the patient. Reference Saaiman, Filmalter and Heyns45,Reference Gul and Celik46 Along with medical and nursing workforce, broader specialist workforce support from social workers and Alcohol and Other Drugs Services (AODS) warrant consideration. The ability to “flex up” the number of these staff and extend usual working hours may be required and should be included in known event planning considerations. Further research regarding the economic benefits of having additional staff at the event versus additional staff in the ED should be explored.

Policy and Education Strategies

When public policy changes were considered as an event, studies included in this review reported either an increase, reduction, or no change in ED impact regarding alcohol-related presentations. Alcohol-related policy measures range from changing liquor licensing opening hours, Reference Fulde, Smith and Forster28,Reference Atkinson, Prodan and Livingston44 reducing the affordability of alcoholic products, Reference Gale, Muscatello and Dinh39–Reference Kisely and Lawrence41,Reference Leal-Lopez, Moreno-Maldonado and Inchley47 and prohibiting the consumption of alcohol and/or possession of open containers in public spaces. Reference White, Azar and Faulkner48 Along with these policy measures, educational efforts to shift the cultural acceptance of alcohol use by advertising the adverse health effects of alcohol should be pursued, especially for the younger, more vulnerable population. Reference Caluzzi, Livingston and Holmes49

Limitations

This integrative review was focused on the impact events have on alcohol-related presentations to EDs. Events can impact EDs in other ways, such as trauma/injury presentations, however the focus of this review was on alcohol intoxication. This review purposefully focused on studies of events and the impact of alcohol-related, specifically intoxication, presentations to the ED. Other reviews have included broader alcohol-related impacts such as accident and injuries that were purposefully excluded here. Findings are limited to those nations for which papers were retrieved, and as such, countries such as low- and middle-income countries may not have been included in the review.

Conclusion

This integrative review explored literature regarding the impact events have on alcohol-related ED presentations. With events grouped into six categories, EDs were most impacted by an increase in presentations from music festivals, public holidays, and in some cases, the day prior to public holidays and large sporting events. Disasters had little impact on alcohol-related presentations to the ED. The consumption of alcohol and binge drinking behaviors at events resulting in an ED presentation is cause for continued efforts to direct public health and emergency care strategies to prevent or minimize alcohol-related harm. Further research examining health service outcomes is required that considers the impact of events on EDs from a local, national, and global perspective.

Conflicts of interest

The authors declare no competing interests for this research.

Acknowledgement

The authors would like to acknowledge and thank Sarah Thorning (librarian at Gold Coast Hospital and Health Service) for assistance with data searches.

Supplementary Materials

To view supplementary material for this article, please visit https://doi.org/10.1017/S1049023X23006507

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Figure 0

Table 1. MeSH Terms/Key Words

Figure 1

Table 2. Inclusion and Exclusion Criteria

Figure 2

Figure 1. PRISMA30 Flow Diagram of Search Results.

Figure 3

Table 3. Description of Study Characteristics

Figure 4

Table 4. Description of Event and Impact of Alcohol-Related Presentations to the ED

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