Precarious ICE: Patterns and features of methamphetamine-related presentations to emergency departments and police and paramedic experiences of escorting patients under the influence of methamphetamines-a mixed methods study

Abstract

<p><b>Background:</b> Acute behavioural disturbance (violence and aggression) and mental health illness (psychosis and paranoia) are negative side effects of methamphetamine use. In general, illicit use of methamphetamines in Australia has reportedly decreased but there has been a change in the use of methamphetamines with an increase noted in the use of the crystallised form of methamphetamines (also known as 'ICE'). Illicit methamphetamine use, particularly "ICE", leads to erratic and unpredictable behaviour in some people.</p> <p><b>Aim:</b> The first aim of this study was to explore the patterns and features of methamphetamine-related presentations to emergency department (ED) and callout events attended by police and paramedics. The second aim was to understand the nature and pattern of methamphetamine-related callouts attended by police and paramedics by exploring their perceptions of deservingness and their experiences of interacting with persons under the influence of methamphetamines.</p> <p><b>Methods:</b> A mixed methods explanatory sequential design was conducted. Quantitative data collection followed a convenience sampling approach and utilised both large datasets and a survey. Quantitative data were entered into a statistical software package (SPSS version 25) and analysed using descriptive and bivariate statistics. Quantitative findings guided the development of interview questions. Qualitative data collection adopted purposeful sampling and semi-structured interviews. Data were analysed using a thematic analytic approach. The pillar integration process was utilised in the final stage to integrate and interpret the overall study findings.</p> <p><b>Results:</b> This dissertation uniquely explored methamphetamine-related presentations and callout events using a mixed methods approach. To our knowledge this is the first study to look at this issue using this methodology, including ED's, police and paramedics as an area of focus. The pillar integration process identified six main themes to interpret the separate streams of inquiry. Acuity, complexity of care, coordinated approach, deservingness and compassion, rural care, and prevalence of presentations/callouts. Features of presentations to ED had a higher acuity and mainly presented for poisoning/toxic effect. Interview data explored the features of presentations further, reporting methamphetamine-related callout events were complex, involved traumatic situations, and increased risk to safety of staff, patients and families. Complexity of care was affected by an inability to communicate effectively with the patient, acute behavioural disturbances, co-occurring mental health issues, ineffectiveness of de-escalation techniques, and patients presenting in a state of crisis. The study reported a significant increase in presentations to ED which was confirmed by Victorian (VIC) ambulance data reporting an increase in methamphetamine-related callout events requiring transport to ED and a significant increase in co-attendance (police and paramedics) responding to methamphetamine-related callout events. Interview participants highlighted when co-responding to persons under the influence of methamphetamine, a standardised approach was lacking. The standardised approach needed to include a co-ordinated approach between police, paramedics and EDs to improve management and care provided, and streamline services. Survey results reported perceptions of deservingness provided an understanding of police and paramedics current perceptions and attitudes towards people who use methamphetamines. Interview participants reported despite complexity of care and the negative experience, participants expressed compassion towards persons under the influence of methamphetamines.</p> <p><b>Conclusion:</b> Methamphetamine-related callout events are increasing and there is an increased need for police and paramedics to transport patients to an ED for assessment. A standardised approach to coordinating care between police and paramedics in the pre-hospital environment and the emergency department is required to help improve care between services and streamline processes. It is important to ensure debriefing and support services are available to mitigate the dysfunctional affect methamphetamine use has on families (i.e. early recognition and support services), the traumatic effect on police and paramedics managing dangerous and unpredictable situations, and for patients who are presenting in states of crisis. In addition, the use of low stimulant, safe rooms or areas in EDs for fast tracking triage and rapid assessment of acute behavioural disturbance and patients experiencing psychosis could help to streamline care provided between pre-hospital and ED environments.</p>