CJEM Articles: Bjug Borgundvaag

Objective: With the proclamation of Bill 110 in September 2005, Ontario became the first jurisdiction in Canada to mandate that gunshot wounds (GSWs) be reported to authorities. We sought to evaluate the impact of Bill 110, including the awareness of, experience with and opinions about the new law among Ontario emergency physicians (EPs), the public and the police.

Methods: An online survey was distributed to all members of the Section on Emergency Medicine at the Ontario Medical Association. The public survey consisted of 3 closed questions and was performed by the polling firm Ipsos-Reid by telephone. Police opinion was requested through the Ministry of Community Safety and Correctional Services of the Ontario government.

Results: The physician response rate was 25%. The great majority of respondents were aware of the law (93%) and willing to comply (88%), but only half were sure of their obligations and the penalties. Since the law had been proclaimed, the majority (51%) had seen at least 1 GSW victim. Seventy-nine percent reported no problems with either the police or the bill, and 86% perceived no change in relations with patients. Six incidents of patients delaying care were reported. Of the public surveyed, two-thirds were aware of the law. After being informed of the law, almost all (95%) expressed support, and the majority (80%) felt it would not change their relationship with their treating physician. All 47 members of the Ontario Provincial Police who were surveyed agreed that Bill 110 is helpful for shooting investigations, 8 reported that they had personally been involved in cases initiated by a report and 6 had been involved in cases where charges were laid or weapons confiscated. Data on actual reports and results of investigations were not available.

Conclusion: Bill 110 seems to have been broadly accepted by the emergency community and endorsed by the public.

Objective: Evidence suggests that symptom-triggered benzodiazepine treatment for patients with alcohol withdrawal reduces complication rates and emergency department lengths of stay. Our objective was to describe the management of alcohol withdrawal in 2 urban emergency departments.

Methods: A structured chart audit was performed for patients with alcohol-related problems who presented to 2 Toronto hospitals over a 2-year period.

Results: A total of 209 emergency department charts were audited. Patient characteristics were similar in both hospitals. None of the patients had been assessed using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Patients at one hospital received substantially higher mean diazepam doses (64 mg v. 26 mg; p < 0.001) than did the patients at the other hospital, and the patients at the first hospital had fewer seizures during their emergency department stay (1% v. 9%; p = 0.012). Patients spent an average of 9 hours and 40 minutes in the emergency department.

Conclusion: There is significant variability in the documentation and treatment of alcohol withdrawal. Lower benzodiazepine doses are associated with higher rate of withdrawal seizures and prolonged emergency department length of stay. A standardized approach using symptom-triggered management is likely to improve outcomes for patients presenting with alcohol withdrawal.