ED doctors want custodial treatment service for arrested meth patients

ED doctors are facing 60 violent meth-affected patients every day in SA – and want police to put those under arrest into a special custody area when they’re being treated.

Frontline emergency department doctors say they are treating more than 60 meth-affected patients a day in SA and have called for people arrested under the influence of the drug to be kept in guarded cells for treatment – away from mainstream EDs.

They want a custodial health service to ensure arrested people affected by drugs and alcohol who need treatment do not pose a safety threat to staff and other patients in mainstream hospital emergency departments.

A survey by the Australasian College for Emergency Medicine (ACEM) found South Australia has the highest percentage of methamphetamine presentations compared with the other states and territories, at almost one in 25 – or about 3.8 per cent of presentations.

In 2020-21 SA hospital EDs had 580,575 presentations according to Australian Institute of Health and Welfare data.

Royal Adelaide Hospital emergency department. Picture: David Mariuz

The ACEM 3.8 per cent estimate means more than 22,000 arrivals affected by meth, or just over 60 per day.

According to ACEM members this rate has not changed substantially, and alcohol and drug-affected individuals continue to form a significant part of clinicians’ workload.

However, what clinicians are seeing come though the door is not matched by official SA Health statistics.

SA Health’s Drug & Alcohol Services SA (DASSA) says there were just 167 methamphetamine presentations at metropolitan EDs in 2021-22, down from 198 the previous year but up from 141 presentations in 2019-20.

Australasian College for Emergency Medicine SA faculty chair Dr Michael Edmonds.

“We are pleased to see methamphetamine-related emergency department presentations are decreasing,” a DASSA statement says.

“DASSA has strategies in place to address methamphetamine use in the community and increase access to treatment including withdrawal management, rehabilitation, inpatient and outpatient care and clean needle services.”

ACEM state chair Dr Michael Edmonds said emergency doctors are on the frontline when treating patients affected by alcohol and drugs, including methamphetamines.

“We recognise the risk some drug-affected patients can present in emergency departments,” Dr Edmonds said. “We believe the safety of staff and patients must always be the top priority and encourage increased efforts to ensure a reliable security presence in all EDs in South Australia.

“ACEM supports the implementation of a custodial health service, which would provide healthcare for those under arrest, while reducing the strain on police and ED resources. We note the success of this approach will be highly contingent on the resourcing and structures made available to deliver this service.”

Dr Edmonds said telehealth services such as the virtual care service could be used as part of a hospital avoidance strategy and said it was essential police had training and guidance from health professionals to safely manage some drug-affected patients.

Australian Nursing and Midwifery Federation state secretary Elizabeth Dabars supported the custodial push saying: “If an individual is arrested by SAPOL and under the influence of drugs and alcohol or claims to have a mental health condition, the cell sergeant will not allow them in the cells prior to having a medical clearance.

“This clearance does not need to occur in an emergency department unless the alleged offender has a life-threatening condition or emergent condition based on the Australasian Triage standards.”

Ms Dabars said workplace safety was a legal right.