New NHS guidelines on recreational drug use in nightclubs

New guidelines have been written which will assist nightclub staff in deciding whether to call ambulances for unwell clubbers. At present, there is a worry that inappropriate management has lead to clubbers only being referred to hospital after significant problems have occurred - leading to increased risk of injury and death.

The proposed guidelines were co-written by medics, police officers and bar owners and are published in BioMed Central's open access journal Substance Abuse Treatment, Prevention, and Policy. Many clubs have designated 'club medic' rooms where individuals with recreational drug toxicity can be assessed and managed. According to the study's coordinator and consultant physician and clinical toxicologist Dr David Wood from Guy's and St Thomas' Poisons Unit at Guy's and St Thomas' NHS Foundation Trust, "In the past, club owners and promoters have been reluctant to call an ambulance for clubbers with recreational drug toxicity because of concerns that this could affect their license".

Dr Wood describes his research as aiming "to work with key stakeholders in the pre-hospital setting to develop strategies to improve pre-hospital care for these clubbers. This includes developing ambulance-transfer guidelines and the training of 'club medic' staff".

The research team visited club medic rooms in various London nightclubs to assess the resources available and the medical training of the club medic staff.

The guidelines were then developed to advise club medics to call an ambulance if the patient meets any of ten defined criteria, including: being unresponsive; chest pain similar to a heart attack; or high blood pressure/heart rate/temperature. 'If in doubt, call an ambulance' is the last point in the guide. The guidelines were audited and revised using feedback from club medic staff. The authors also ran training in the use of the guidelines and in the management of recreational drug toxicity.

Previous studies by these authors have found the main drugs associated with ill health amongst clubbers in the area studied were GHB and stimulants such as ecstasy and cocaine. Typical effects of GHB include significant depression of central nervous function and respiration and effects seen with stimulant use include high temperature, heart-rate, blood pressure.

Dr Wood added: "The guidelines we have described are designed to ensure that individuals with significant toxicity in these categories are easily identified and that an ambulance is called so that they receive appropriate and timely assessment and management in a hospital environment."