Using ambulance surveillance data to characterise blood-borne viral infection histories among patients presenting with acute alcohol and other drug-related harms.

OBJECTIVE: Preventable transmission of blood-borne viruses (BBV), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV), continue in at-risk populations, including people who use alcohol and drugs (AODs). To our knowledge, no studies have explored the use of ambulance data for surveillance of AOD harms in patients with BBV infections. METHODS: We used electronic patient care records from the National Ambulance Surveillance System for people who were attended by an ambulance in Victoria, Australia between July 2015 and July 2016 for AOD-related harms, and with identified history of a BBV infection. Descriptive and geospatial analyses explored the epidemiological and psychosocial characteristics of patients for these attendances. RESULTS: The present study included 1832 patients with a history of a BBV infection who required an ambulance for AOD-related harms. Amphetamines were reported in 24.7% of attendances where the patient identified HIV history, and heroin was reported more often for patients with viral hepatitis history (HCV: 19.2%; HBV: 12.7%). Higher proportions of attendances with a viral hepatitis history were observed in patients from the most socially disadvantaged areas. Geospatial analyses revealed higher concentrations of AOD attendances with a BBV history occurring in metropolitan Melbourne. CONCLUSIONS: Our study describes the utility of ambulance data to identify a sub-population of patients with a BBV history and complex medical and social characteristics. Repeat attendances of BBV history patients to paramedics could present an opportunity for ongoing surveillance using ambulance data and possible paramedic intervention, with potential linkage to appropriate BBV services.

Adolescent Suicidal Behaviors During the COVID-19 Pandemic in Australia: Analysis of Acute Harms Assessed via Ambulance Data.

PURPOSE: This study investigated changes in suicidal ideation, attempts, and nonsuicidal self-injury (NSSI)-related ambulance attendances among adolescents during the COVID-19 pandemic. METHODS: An interrupted time series analysis using data from the National Ambulance Surveillance System, a globally unique mental health and suicide surveillance system. Patients aged 12-17 years from the state of Victoria, Australia who were attended by ambulance for suicide attempts, suicide ideation, and NSSI between January 2016 and October 2021 were included. Monthly ambulance attendances during the pre-COVID period (January 2016-March 2020) were compared to those in the peak period of COVID-19 (April 2020-October 2021). RESULTS: There were 20,125 ambulance attendances for suicide ideation, suicide attempt, and NSSI in adolescents over the study period. During the pre-COVID period, the number of suicide ideation, attempts, and NSSI attendances was increasing by 1.1% per month (incidence rate ratio [IRR]:1.011; 95% confidence interval [1.009-1.013], p < .001). There was no change in the rate of all suicide ideation, attempt, and NSSI for all adolescents during the period of COVID-19. However, when disaggregated by gender, there was a 0.7% increase in the monthly rate of attendances for females (IRR: 1.007 [1.001-1.013], p = .029), and a 3.0% decrease for males (IRR: 0.970 [0.964-0.975], p < .001). DISCUSSION: Adolescent female suicide ideation, attempt, and NSSI attendances increased during the COVID-19 period, compared with males in the same time period. These findings suggest tailored intervention strategies may be needed to address the increasing trends of self-harm among young people.

Description of Trends over the Week in Alcohol-Related Ambulance Attendance Data.

Alcohol harms are often determined using a proxy measure based on temporal patterns during the week when harms are most likely to occur. This study utilised coded Australian ambulance data from the Victorian arm of the National Ambulance Surveillance System (NASS) to investigate temporal patterns across the week for alcohol-related ambulance attendances in 2019. These patterns were examined by season, regionality, gender, and age group. We found clear temporal peaks: from Friday 6:00 p.m. to Saturday 3:59 a.m. for both alcohol-involved and alcohol-intoxication-related attendance, from Saturday 6:00 p.m. to Sunday 4:59 a.m. for alcohol-involved attendances, and from Saturday 5:00 p.m. to Sunday 4:49 a.m. for alcohol-intoxication-related attendances. However, these temporal trends varied across age groups. Additionally, hours during Thursday and Sunday evenings also demonstrated peaks in attendances. There were no substantive differences between genders. Younger age groups (18-24 and 25-29 years) had a peak of alcohol-related attendances from 7:00 p.m. to 7:59 a.m. on Friday and Saturday nights, whereas the peak in attendances for 50-59 and 60+ years was from 5:00 p.m. to 2:59 a.m. on Friday and Saturday nights. These findings further the understanding of the impacts of alcohol during different times throughout the week, which can guide targeted policy responses regarding alcohol use and health service capacity planning.

The Incidence and Temporal Patterns of Use of Amphetamine-Type Stimulant Use in Traffic-Related Ambulance Attendances From 2015 to 2020 in Victoria, Australia.

OBJECTIVE: Amphetamine-type stimulants are increasingly implicated in road trauma incidents. Although ambulances are typically first to attend these emergencies, limited research has used paramedic clinical data to examine the contribution of amphetamine use to road trauma-related ambulance attendances. We describe the clinical and temporal risk profiles associated with amphetamine-related harm in road trauma incidents requiring paramedic attendance in the Australian state of Victoria. METHOD: This cross-sectional, retrospective observational study examined the Victorian component of a national surveillance data set (National Ambulance Surveillance System) of alcohol and other drug (AOD)-related ambulance attendances to determine the incidence and temporal profile of amphetamine use in traffic-related ambulance attendances from January 2015 to December 2020. RESULTS: Throughout the observation period, Victorian paramedics attended 8,163 alcohol, pharmaceutical, or illicit drug-related cases involving a road trauma. More than one quarter (2,161 cases, 27.4%) of these attendances were deemed related to the use of pharmaceutical and/or illicit drugs. Amphetamine alone was involved in nearly one third (640 cases, 29.6%) of non-alcohol-related road trauma attendances, and co-consumption of amphetamine with drugs other than alcohol occurred in more than one third (35.3%) of all AOD-related traffic incidents. Amphetamine-related road trauma attendances predominantly occurred on the weekend (Fri-Sun) during late night/early morning in metropolitan Melbourne. Between 2015 and 2020, the incidence of amphetamine-related road trauma ambulance attendances increased by 86.8%, from 1.1 per 100,000 population in 2015 to 1.9 per 100,000 population in 2020. CONCLUSIONS: Amphetamine-type stimulants are increasingly implicated in road trauma. Co-consumption with other potentially impairing substances reflects a concerning trend of polysubstance use among Victorian drivers.

Adverse outcomes of GHB use: Analysis of ambulance attendances in metropolitan and regional Victoria.

BACKGROUND: Gamma-hydroxybutyrate (GHB) use and attributable harms have been increasing in Australia, however changes over time, including the impact of COVID-19 lockdowns and restrictions on harms requiring an ambulance attendance, are unknown. This study utilised a novel population-based surveillance system to identify the types of GHB-related harms between January 2018 and 31 December 2021 in Victoria, Australia. METHODS: A cross-sectional, retrospective analysis of all GHB-related ambulance attendances between January 2018 and 31 December 2021 in Victoria, Australia was undertaken. Paramedic clinical notes and Glasgow Coma Scale scores were used to assess conscious state. Event codes were classified using dispatch information available in the database. Crude rates (per 100,000 population) and descriptive analyses were calculated for metropolitan and regional settings. Adjusted Odds ratios (aOR) with 95% confidence intervals [95% CI] were used to assess the relationship between GCS severity and polysubstance combinations with GHB. RESULTS: There were 6,836 ambulance attendances for GHB recorded during the study period. A statistically significant increase in GHB-related attendance numbers was observed State-wide in 2019 (n = 1,402, p<0.001) and 2020 (n = 2,622, p<0.001), when comparing year on year attendances. While both numbers and rates (per 100,000 population) of GHB-related attendances were significantly lower in regional areas, significant increases were evident in both metropolitan and regional areas in 2019 and 2020 (both p<0.001). Attendances involving GHB and alcohol had higher odds of a severe GCS score (aOR:1.25; 95%: 1.04-1.49; p<0.019). A high proportion of GHB-attendances involved harms of significant concern including: overdose (56%) and a loss of, or altered state of consciousness (45%). CONCLUSIONS: We observed increases in GHB-related ambulance attendances over time in both metropolitan and regional areas, placing a significant burden on ambulance services. Our study demonstrates the value of using ambulance surveillance to obtain representative data on acute GHB-related harms.

Changes in alcohol intoxication-related ambulance attendances during COVID-19: How have government announcements and policies affected ambulance call outs?

BACKGROUND: In response to COVID-19, government-mandated health directives including widespread lockdowns were implemented. Changes in alcohol purchasing were reported, with growing concern that alcohol may be consumed as a way to cope with pandemic-associated stressors. Hitherto, there have been limited studies examining alcohol-related harms, including acute harms requiring an ambulance, and their relationship to government announcements or policies related to COVID-19. METHODS: Analyses were conducted between January and September 2020, with matched months in 2019, using Victorian data from the National Ambulance Surveillance System in Australia. Interrupted time series (ITS) models with odds ratios (OR) were used to map alcohol-related harms as a function of government policies for both metropolitan and regional areas. FINDINGS: A total of 43,003 alcohol intoxication-related ambulance attendances occurred between January 2019 and September 2020. Attendances in the home increased in 2020 by 9% compared to matched 2019 months. The most socioeconomically advantaged cases showed the highest percentage change. ITS models showed decreased odds of alcohol-related attendances at the beginning of each COVID-19 wave in metropolitan (OR:0•77; 95%CI: 0•71-0•83; p<0•001) and regional Victoria (OR: 0•72; 95%CI: 0•67-0•79, p<0•001) separately, and increased odds following the introduction of harsher restrictions in metropolitan Melbourne (OR:1•07; 95%CI:1•01-1•11, p=0•005). A 19% increase in odds of alcohol-related harms was observed at the end of the second wave lockdown period in regional Victoria (OR:1•19; 95%CI: 1•01-1•41, p=0•004). INTERPRETATION: Alcohol-related attendances during COVID-19 restrictions showed a displacement to home settings. Changes in patterns of harms were evident in specific sociodemographic groups, and geographic regions when mapped to government health directives. This study is one of the first to investigate alcohol-related harms at the population level in response to a global pandemic. FUNDING: Commonwealth Department of Health and Victorian Department of Health.