This blog post is in reply to and inspired by the BBC Radio 1 Newsbeat article More nightclub paramedics needed say A&E doctors.
I’m sure no one is any doubt alcohol related incidents do place a big drain NHS resources. Many of these incidents would not be occurring if people drank more responsibly and there was less of a binge drinking culture. This report says that many of these incidents end up going to A&E when they don’t need to, and nightclubs should be employing nightclub [para]medics to take the strain away from the NHS.
Nightclubs do have a legal responsibility for the health and safety for people who come into their clubs in the same way that a business has the same responsibility for visitors to its offices. There is no requirement for night clubs to provide medical staff over and above calling 999 for an ambulance therefore placing the burden onto the NHS. For the nightclubs it’s a win win situation.
Some nightclubs, particularly the bigger ones do have some provision for medical cover, weather that being a member of staff being a first aider, or contracting in a private ambulance service to provide a night club [para]medic. The qualifications of this medic could literally be anything from a couple of days first aid training up to an registered healthcare professional such as a nurse or paramedic however usually it’s closer to the couple of days first aid training, maybe with the title of EMT – which is infinitely ambiguous but still highly converted because of this ambiguity.
The real question is how many people can actually avoid A&E. For many people an NHS ambulance will be called to won’t actually be in need of medical attention, instead they are drunk and incapable. Everyone knows that there are lots of things that present similarly to being intoxicated and therefore can justify in their own minds calling for an ambulance when they can’t deal with them themselves, possibly because they are only slightly less drunk and incapable themselves. Nightclubs simply don’t want the liability to fall onto them, and I would question how much training you get in a first aid course on dealing with someone who is drunk and incapable. Dealing with your drunken friend isn’t something that is even in the first aid manual. Being able to deal with these jobs takes common sense, experience and assertiveness. The challenge with these people is getting them to a safe environment with someone who is capable of watching over them. Sometimes, and as frustrating as this is, this isn’t possible and therefore there is either two options: a police cell or A&E, however usually it ends up being the latter. Maybe if it was universally a police cell in this situation then there would be less desire to go that far with alcohol.
Dealing with someone who is drunk and incapable isn’t something you can do on your own. If they are capable enough to walk unaided or with some assistance so they can get to get to a designated first aid room, otherwise an ambulance would be needed anyway. This would be the same situation on a NHS rapid response car as it would be for a nightclub [para]medic; it has little to do directly with the level the level of training.
There are of course people from night clubs who are in need of medical attention. These patients need to be sifted out from those that are just drunk and incapable. This is something that could go have a bad outcome if the wrong decision is made. The most common will be wounds. Some wounds do not need any more management than cleaning, maybe dressing, and self-care advise. Many however do need further management such as wound closure. There are paramedics who can do this, but it is very unlikely that a night club would have someone who is capable of this level of care. Also a suitably clean environment is needed for wound closure and most of the first aid rooms in night clubs are little more than storage rooms with a sink and a first aid room sign on the door. Also there is the question of those that do need to go to A&E how do they get there. Oh yes, call an ambulance. *sigh*.
Let’s be realistic. Every nightclub having a paramedic is unrealistic and unnecessary. It’s unlikely to have a massive impact on the number of ambulances going to night clubs or how many drunk and incapables end their night on an A&E trolley. Where would all the paramedics come from? The NHS don’t have a surplus to hire out to night clubs. Also I don’t know many paramedics that would want to work in a night club even on overtime. Multi-agency projects such as The Norwhich SOS BUS is a far more suitable, cost effective and successful model.