1. LEGAL HIGHS AND THE EMERGENCY DEPARTMENT

2. LEGAL HIGHS Patients Journey Impact on services Case study Effect on staff Improving service

3. LEGAL HIGHS – PATIENT JOURNEY Alert Standby Admission Discharge

4. LEGAL HIGHS – IMPACT ON SERVICES Two resus equipped bays Staff and resources Who’s all involved? Impact on others in ED

5. CASE STUDY Although the case study is based on true events, to protect identity of patients and adhere with the NMC code of conduct regarding confidentiality, no identifying information will be disclosed

6. CASE STUDY Unconscious patient versus conscious and aggressive patient

7. CASE STUDY– UNCONSCIOUS PATIENT Police involved at scene, standby call from crew First patient unconscious Full standby team in place for arrival

8. UNCONSCIOUS PATIENT On arrival patient couldn't maintain their airway Had to be intubated and ventilated Overnight stay in ITU Patient self discharged from hospital the following afternoon

9. CASE STUDY – CONSCIOUS AND AGGRESSIVE PATIENT Alert call for Second patient – aggressive and abusive Unable to safely take vital signs other tests Security and police involved Unable to assess for any underlying injuries

10. LEGAL HIGHS – THE PROBLEM What is in them? Is it purer than ‘illegal‘ equivalent Difficult to identify the substance?

11. WHAT WE DO Try and re-assure other patients about noise and police presence in the department Ensure safety of patients and other members of staff Liaise with police, medical staff

12. EFFECTS ON STAFF AFTER! Stress Emotional

13. HOW CAN WE IMPROVE? Education Work closely with police and other drug groups

14. QUESTIONS?