Emergency Info

Guidelines on when to call the Emergency Services 999 for unwell recreational drug users

Call 999 if ANY one of the following is present:

Unconsciousness – if the patient does not respond to vocal commands, requires painful stimulus (e.g. pressure across the fingernails) to respond or does not respond at all.

Significant agitation (e.g. pacing around the room) or aggression not settling within 15 minutes.

Seizures (e.g. a convulsion similar to an epileptic fit)

Breathing difficulties such as fast breathing rate which does not settle within 15 minutes.

Heart rate over 140 beats per minute not settling within 5 minutes.

Temperature over 38.5 not settling after about 5 minutes of rest, or if very flushed and feels very hot if no thermometer is available.

Blood pressure – Systolic (“upper pressure”) over 180mmHg, or Diastolic (“lower pressure”) over 110mmHg on two repeated blood pressure measurements.

Other concerns – if there are any other concerns (e.g. severe headache, chest pain).


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Licensing decisions can cut crime

New research funded by the National Institute for Health Research evaluated the effect of individual alcohol licensing decisions on local health and crime. Lead researcher Frank de Vocht reports on a study which aimed to assess a new methodology for evaluating licensing decisions and small area level.

The main way that local authorities in England can reduce the negative impact of alcohol in their area is through the licensing system. Licensing legislation requires that all decisions are informed by evidence relating to the immediate local area or the specific outlets involve. Yet most published or usable data are available only for larger areas and thus cannot inform specific decisions, such as whether to revoke licenses or reduce trading hours.

The research

The researchers conducted three case studies from different regions in England which was selected and developed together with local licensing officers, public health teams and academic colleagues:

  1. The closure of a large town centre pub and club with a nightclub in the basement following a licensing committee review. Following concerns about the amount of crime, anti-social behaviour and overt drunkenness at the premises over a period of months, during which the police tried to work with the license holder, the police decided to review the premises licence. The Director of Public Health provided evidence of ambulance call outs and the relationship between alcohol consumption and accidents, which was considered relevant as the premises is right on the river front. The designated premises supervisor (DPS) was removed and conditions placed on the licence. In effect the nightclub was closed in 2013.
  2. The closure of a co-located restaurant and nightclub following review. Two premises co-located in the same street were closed down following a licence review brought by the police on the grounds of crime and disorder ceased trading in 2016.
  3. The introduction of new local licensing guidance and increased inspections in a city centre. Following a change in central government regulations, local licensing authorities were permitted in 2012 to developed guidance specific to the local area. By enabling the local communities team to develop a relationship with local business, the new guidance in the case study area was intended to improve both the quality of licensing applications and local rates of alcohol-related crime. The developed guidance was in place for a period of about 12 months in 2013/14, during which there was active engagement by local Public Health teams. However, in 2013, local government was subjected to austerity measures put in place by the government, which led to restructuring and the loss of certain projects and teams.

The researchers were interested in the potential impact of these three events on reported numbers of calls for service from police records, alcohol -related hospital admissions and ambulance callouts to the immediate area. To evaluate the impact the licensing decisions, the research team developed the new statistical framework for each case study to create a counterfactual local area by combining the data from several other, comparable localities from the same urban areas. These counterfactuals strengthened the methodology by enabling the researchers to look at what would probably have happened had these decisions to close premises not taken place.

Main findings

The researchers run the data through the then new statistical model and made the following findings:

  • The closure of the nightclub (case study 1) had resulted in a temporary, 4-month, reduction in anti-social behaviour of about 60 incidents averted, but a return to ‘normal’ afterwards.
  • Closure of the restaurant and nightclub (case study 2) did not result in any measurable changes in outcomes in the 12 months after closure.
  • The new licensing guidance (case study 3) led to small reductions in drunk and disorderly behaviour (9 of a predicted 21 events averted), and the unplanned end of the LLG coincided with an increase in domestic violence of 2 incidents per month (an 11% increase).


This study was the first attempt to evaluate the effects of these kind of small-scale licensing interventions, at the levels of individual premises in two of the case studies. The researchers conclude from this work that:

  1. The impact of local alcohol policy, even at the level of individual premises, can be evaluated using this methodology, and importantly,
  2. That local government actions such as closure or restriction of venues and licensing can have a positive impact on health and crime in the immediate surrounding area.

The research team argue that this approach can potentially bridge the gap between the predominantly data-oriented approach by public health teams and the need for contextualised evidence for presentation to councillors. They hope to build a database of such individual evaluations over time which will increase and understanding of the possible impact of a range of different licensing decisions.

This post is heavily based on an original blog post by Frank de Vocht on the Institute of Alcohol Studies website.


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