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We visited on a number of occasions and talked at length with the much-loved Dave McGreavy, who was our first
aider and who tragically died in June 1999. Dave gave us the records of three or four years of his work in Cream
and, unsurprisingly, this was how it broke down: about half of the cases coming to the first aid room were due to
intoxication with drugs and with drink; about a quarter of the problems they were seeing were soft tissue injuries
such as sprains and cuts; and the other quarter was a mixture of panic attacks, asthma, demand for ventolin and
paracetamol and so on. It was not a surprising spectrum of illnesses. Predictably, the media made much
trivialisation of this. They promptly reported night-club nipple and PVC bottom and undermined the whole issue.
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provide a chill out area and free water then you are bound to have your licence revoked. Taking over heatrelated illnesses has been the growing numbers of mitsubishi poisonings. Mitsubishis are hugely popular in
Liverpool and in a recent month there were three, four or five extremely sick young people coming in as a result of
taking mitsubishi, amongst other things, each weekend.
10. GHB is becoming an increasing problem along with ketamine in the UK. Although alcohol should be avoided
with it, inevitably when we get them in people have had at least ten pints of beer before they have drunk the GHB.
The GHB is causing a lot of problems, such as unexpected collapses and pressure on breathing which is very,
very dangerous. The delirium in young clubbers when they come to hospital is very, very difficult to treat because
it is unlike schizophrenic or manic delirium or the delirium associated with drink. These young people increasingly
have taken four, five or six different substances. They normally have three or four bottles of designer larger, a few
lines of cocaine, some ketamine, an ecstasy pill or two and perhaps other things. We can no longer keep up with
what is in their blood stream. For example, we do not test for ketamine or GHB, so we have no idea except for the
scale of the problem in Liverpool. Cocaine is our real worry because of the rise in the growth of use. Recently we
have seen a lot of heart attacks and cardiac arrests in young people, with a whole series of young deaths, which
happily were not hyped in the media. Of course, cocaine is also associated with a great deal of violence inside
and outside the clubs.
Impacts on hospitals
It may be useful to note a few simple but worthy figures from the Accident and Emergency Department in
Liverpool, which is already struggling with its workload. In 1997, 0.6 % of our work load of ninety five thousand
cases were due to clubbing and by 1998 that had risen to nearly one percent, that is about a thousand cases a
year. A group of 1,200 or so clubbers over a period of two years were analysed for a number of issues. 40% of
them took an ambulance from the club to the hospital, and that is a considerable use of resources. Assaults
accounted for more than half of the presentations, although happily those caused by doormen had been reduced
by at least half since the introduction of the door supervisor registration scheme in Liverpool. Accidental injuries
were divided equally between people falling down stairs in clubs and people sustaining glass injuries in darkened
night clubs. In terms of major clinical intoxication, it was obvious that drink was a major problem in at least a third
of the cases but interestingly drugs were only a major problem in about 4% of cases. The key message is that
alcohol continues to be the major scourge of the health care system within modern clubbing.
The treatment required is very simple wound care for half, x-rays for about a fifth and medication for about
another fifth of cases, and the rest divide up loosely between walking aids and tetanus injections and so forth. In
terms of the actual main medical problems, face wounds (which can be disfiguring) account for a quarter of cases,
head injuries sometimes requiring neuro surgery accounts for about a fifth, limb injury about a fifth, intoxication
about 11% and a variety of miscellaneous medical problems another 10%. Finally, in terms of follow up, just over
half of the clubbers discharged themselves from the hospital department or required no follow up, about 15% of
them were actually admitted to the hospital so 15% had a fairly significant injury or illness.
Lessons
First and foremost, it is important to have a broad understanding of the health care requirements of clubbers.
Alcohol is still a major health care concern around clubbing in the UK, followed by accidents, glass related
violence and drug abuse. These are followed by panic attacks, exacerbation of chronic ailments like asthma,
over-exertion and problems with the environment like CS gas, dry ice and cigarette burns.
A potential solution to reduce the burden on a struggling healthcare system in the UK is a national code of
practice: a code of practice which demands certain environmental safety measures. For example, these involve
the provision professional healthcare by experienced Accident and Emergency nurses in decent facilities in all the
big clubs, which encourages collaborations in the private and public sectors. The clubs should provide the funding
and we give them the advice. I would like to see the clubs looking after 99% of their clubbers on-site, and that
would be something very popular with the clubbers and immensely popular with the health care system. There are
already published guidelines in the North and South of England at the local level.
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Another important collaboration in Liverpool is between that of HIT, the brewing companies, the hospitals and the
clubs, who launched a poster campaign illustrating the very real complications and horrors of glass related
attacks. Happily, since this was introduced in June 1999, the number of glass injuries have started to decline and
also interestingly the brewing companies were persuaded to launch plastic bottles for the beer in Liverpool and in
a year or two years time we will reap the rewards of this.
In terms of medical approaches to some of the problems it is also very important that we keep an eye on local
intelligence, including urine toxicology results so that we can anticipate the development of problems with GHB
and other new substances. The reason clubs should provide this level of care, why they should pay attention to
the health hazards of clubbing, are twofold. A strategy for reducing the healthcare cost implications of clubbing
offers major opportunities in terms of better customer care, lower healthcare and legal costs and it will reduce the
problem of crime and violence within the clubs which threatens licences and gives rise to litigation. Moreover, an
honest and constructive approach by all parties concerned from the police through to the health authorities and
the clubbers themselves will basically eliminate the cavern that otherwise will open up between them and us.
http://www.drugtext.org/library/articles/luke.htm
1/20/2010