Management of alcohol intoxication and aggressive behaviour: a tale of two cities

Violence and aggressive behaviour are a growing problem in emergency departments on both sides of the Atlantic, and alcohol intoxication is often involved. A wide range of management options is available, and policies vary considerably.

We compared the management of alcohol intoxication and aggressive behaviour in four New York and four London emergency departments, using a semi-structured interview which covered 15 issues.

Differences were apparent between New York and London emergency departments in the method used for diagnosis of alcohol intoxication, the investigations carried out and discharge criteria. Chemical and physical restraints were readily and frequently used in New York in order to prevent intoxicated patients leaving the department, while in London disruptive patients tended to be ejected.

The marked transatlantic differences, while partly due to cultural and historic reasons, are largely due to the pressures to limit the risk of litigation in the United States and the constraints of a cost-limited health service in Britain. The management of violent and intoxicated patients deserves further refinement.