Wood David M, Greene Shaun L, Alldus Graham, Huggett Denise, Nicolaou Michelle, Chapman Kerry, Moore Fionna, Heather Kim, Drake Nicola, Dargan Paul I
Guy's and St, Thomas' Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, Avonley Road, London, SE14 5ER, UK.
Subst Abuse Treat Prev Policy. 2008 Jun 6;3:14. doi: 10.1186/1747-597X-3-14.
Previously developed 'club guidelines' developed for club owners and promoters have tended to focus more on the legislative aspects of clubs, rather than the medical management of unwell clubbers within club environments. Despite this lack of guidance on the management of unwell clubbers, a significant proportion of clubs have 'club medic' rooms for managing these individuals. However, due to the lack of specific guidance on the training of staff working in these rooms and guidelines on when an ambulance should be called for an unwell clubber, there have been instances previously where clubbers have been inappropriately managed within the club environment, and often referred to hospital only after significant physiological derangement has occurred, thereby leading to an increased risk of morbidity and mortality.
We identified owners and promoters of local club venues within the catchment area of our Emergency Department and working jointly with them and other key stakeholders, in particular the London Ambulance Service and Metropolitan Police, identified strategies to improve pre-hospital care for clubbers who become unwell as a result of recreational drug use. These included developing guidelines detailing indications for ambulance transfer to hospital for clubbers with recreational drug toxicity and the training of club medic staff to use the guidelines
Following the initial development of a pilot set of guidelines, an audit of their use identified training needed relating to the assessment of unwell clubbers with recreational drug toxicity and revisions required to the pilot version of the guidelines. After training related to the revised guidelines, all the club medic staff were confident in their ability to assess unwell clubbers with recreational drug toxicity, the use of the guidelines and also when to call an ambulance.
Working with key stakeholders in the local community, we have developed guidelines that can be used to improve the pre-hospital care of clubber unwell with recreational drug toxicity, and demonstrated that individuals with a variety of medical knowledge can be trained to use these guidelines. Wider dissemination of these guidelines, both regionally, nationally and potentially internationally, may help to reduce the pre-hospital morbidity and mortality associated with recreational drug toxicity encountered in club environments.
先前为俱乐部老板和推广人制定的“俱乐部指南”往往更侧重于俱乐部的立法方面，而非俱乐部环境中身体不适的夜店顾客的医疗管理。尽管缺乏针对身体不适的夜店顾客管理的指导，但相当一部分俱乐部设有“俱乐部医务室”来管理这些人。然而，由于缺乏对在这些医务室工作的员工培训的具体指导以及关于何时应为身体不适的夜店顾客呼叫救护车的指南，以前曾出现过夜店顾客在俱乐部环境中得到不恰当管理的情况，而且往往在出现严重生理紊乱后才被送往医院，从而导致发病和死亡风险增加。
我们确定了我们急诊科服务区域内当地俱乐部场所的老板和推广人，并与他们以及其他关键利益相关者，特别是伦敦救护车服务公司和伦敦警察厅合作，确定了改善对因使用娱乐性药物而身体不适的夜店顾客的院前护理的策略。这些策略包括制定详细指南，说明因娱乐性药物中毒而需救护车转送至医院的夜店顾客的指征，以及培训俱乐部医务室工作人员使用这些指南。
在初步制定一套试点指南后，对其使用情况的审核发现，在评估因娱乐性药物中毒而身体不适的夜店顾客方面需要进行培训，并且试点版指南需要修订。在接受与修订后的指南相关的培训后，所有俱乐部医务室工作人员对他们评估因娱乐性药物中毒而身体不适的夜店顾客的能力、使用指南的能力以及何时呼叫救护车都充满信心。
通过与当地社区的关键利益相关者合作，我们制定了可用于改善对因娱乐性药物中毒而身体不适的夜店顾客的院前护理的指南，并证明具有各种医学知识的人员都可以接受培训以使用这些指南。在区域、国家乃至国际范围内更广泛地传播这些指南，可能有助于降低与俱乐部环境中遇到的娱乐性药物中毒相关的院前发病率和死亡率。
