TIIG Merseyside and Cheshire Themed Report - champs · TIIG Merseyside and Cheshire Themed Report...

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TIIG Merseyside and Cheshire Themed Report Winter Injuries across Merseyside and Cheshire (2011/12 to 2013/14) December 2014 Jennifer Brizell, Stuart Cole, Karen A Critchley and Mark Whiield Centre for Public Health Research Directorate Faculty of Educaon, Health and Community Liverpool John Moores University 2nd Floor, Henry Coon Building 15-21 Webster Street Liverpool L3 2ET Tel: 0151 231 4314 Fax: 0151 231 4552 [email protected] www.ig.info www.cph.org.uk www.twier.com/ig_cph ISBN: 978-1-908929-85-3 (web)

Transcript of TIIG Merseyside and Cheshire Themed Report - champs · TIIG Merseyside and Cheshire Themed Report...

TIIG Merseyside and Cheshire Themed ReportWinter Injuries across Merseyside and Cheshire (2011/12 to 2013/14)

December 2014

Jennifer Brizell, Stuart Cole, Karen A Critchley and Mark WhitfieldCentre for Public Health Research Directorate Faculty of Education, Health and Community Liverpool John Moores University 2nd Floor, Henry Cotton Building 15-21 Webster Street Liverpool L3 2ET

Tel: 0151 231 4314 Fax: 0151 231 4552

[email protected] www.tiig.info

www.cph.org.uk www.twitter.com/tiig_cph

ISBN: 978-1-908929-85-3 (web)

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CONTENTS  

Foreword  .............................................................................................................................................................................................  4  

Acknowledgements  .............................................................................................................................................................................  4  

Key  findings  .........................................................................................................................................................................................  5  

Introduction  .........................................................................................................................................................................................  6  

Methods  ..............................................................................................................................................................................................  6  

Winter  injury  attendances  across  Merseyside  and  Cheshire  ..............................................................................................................  8  

Number  of  injury  attendances  and  trends  ......................................................................................................................................  8  

Area  of  residency  ..........................................................................................................................................................................  10  

Patient  demographics  ...................................................................................................................................................................  15  

Injury  group  ...................................................................................................................................................................................  17  

Incident  location  ...........................................................................................................................................................................  20  

Referral  source  ..............................................................................................................................................................................  20  

Arrival  mode  ..................................................................................................................................................................................  21  

Disposal  method  ...........................................................................................................................................................................  21  

Winter  injury  attendances  by  local  authority  districts  ......................................................................................................................  23  

Cheshire  East  .................................................................................................................................................................................  24  

Cheshire  West  and  Chester  ...........................................................................................................................................................  26  

Halton  ............................................................................................................................................................................................  28  

Warrington  ....................................................................................................................................................................................  30  

Knowsley  .......................................................................................................................................................................................  32  

Liverpool  .......................................................................................................................................................................................  34  

Sefton  ............................................................................................................................................................................................  36  

St  Helens  .......................................................................................................................................................................................  38  

Wirral  ............................................................................................................................................................................................  40  

Ambulance  call  outs  across  Merseyside  and  Cheshire  ......................................................................................................................  42  

Number  of  call  outs  and  trends  ....................................................................................................................................................  42  

Location  of  call  out  ........................................................................................................................................................................  42  

Patient  demographics  ...................................................................................................................................................................  45  

Incident  type  .................................................................................................................................................................................  46  

References  .........................................................................................................................................................................................  47  

 

 

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FOREWORD  

Increasing   pressures   on   hospitals   during   winter   are   not   confined   to   A&E   departments.   Whilst   A&E   injury   attendances   are  

generally   lower  during  winter   periods,   the  number  of   patients  who  are   admitted   into  hospital   peak  over  winter  months   and  

often  those  patients  requiring  sustained  care  over  winter  periods  are  those  who  are  elderly.  Apparent  from  this  report  is  that  

whilst  those  aged  60  years  and  over  do  not  form  the  majority  of  winter  injury  A&E  attendances  they  do  account  for  the  largest  

proportion  of  those  who  are  admitted  into  hospital,  highlighting  pressures  not  just  on  A&E  department  but  on  numerous  other  

departments  throughout  hospitals  across  Merseyside  and  Cheshire.  

This   report   offers   vital   evidence   in   highlighting   those  most   at   risk   of   injury  during  winter,   the  most   prevalent   types  of   injury  

which  occur  and  geographically  where  these  injuries  are  most  likely  to  occur.  

For  those  working  in  the  field  of  accidental  injuries  and  particularly  those  working  in  elderly  care,  I  hope  this  report  is  useful  for  

you  in  taking  action  to  reduce  injuries  during  the  winter  period.    

Dr  Fiona  Lemmens  

Aintree  Park  Group  Practice  

Liverpool  CCG  Urgent  Care  Lead  

Chair  of  the  North  Mersey  System  Resilience  Group  

 

ACKNOWLEDGEMENTS  

With  thanks  to  the  emergency  departments  involved  with  the  collection  of  the  data  used  in  this  report  and  to  the  North  West  

Ambulance   Service   for   providing   ambulance   call   out  data.   Thank   you  also   to   the   Trauma  and   Injury   Intelligence  Group   (TIIG)  

Merseyside   and  Cheshire   Steering  Group   for   their   continued   involvement   in   TIIG.   Finally,   thank   you   to   our   colleagues   at   the  

Centre  for  Public  Health;  Howard  Reed  for  his  assistance   in  producing  the  maps;  and,  Sarah  Birtwistle,   Jamie  Deville  and  Jane  

Harris  for  their  assistance  in  proof  reading  this  report.    

 

 

 

 

 

 

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KEY  FINDINGS  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There  were  a  total  of  236,413  winter   injury  attendances  to  Merseyside  and  Cheshire’s  emergency  departments  

(EDs)  between  2011/12  and  2013/14;  of  which,  216,997  were  residents  of  Merseyside  and  Cheshire  (92%).    

Liverpool   local  authority  had  the  highest  number  of  attendances  across   the  whole  of  Merseyside  and  Cheshire  

representing  24%  of  all  winter  injuries  made  by  Merseyside  and  Cheshire  residents.    

The  crude   rate  of  attendances   to  Merseyside  and  Cheshire’s  EDs  was  8,961.6  per  100,000  resident  population.  

Local  authority  districts  significantly  worse  than  the  average  for  Merseyside  and  Cheshire  were  Knowsley,  Sefton,  

Liverpool  and  Halton.    

January  consistently  saw  the  most  injury  attendances  across  all  three  reported  winter  periods  (n=81,952).    

Just  over  half  (51%)  of  winter  injury  attendees  were  male.    

One-­‐third  (33%)  of  attendees  were  aged  between  30  and  59  years,  followed  by  one-­‐quarter  (25%)  aged  60  years  

plus,  24%  were  aged  between  15  and  29  years  and  18%  were  aged  14  years  and  under.    

Almost  three-­‐quarters  (74%)  of  attendances  were  recorded  as  ‘other  injury’.      

Falls  accounted  for  10%  of  winter   injury  attendances;  winter  2011/12  had  the  highest  number  of   falls   (n=8,034  

attendances)  and  patients  aged  60  years  plus  accounted  for  45%  of  all  fall-­‐related  injuries.    

Road  traffic  collisions  accounted  for  5%  of  injury  attendances;  of  which,  43%  were  aged  between  30  and  59  years.    

The  primary  incident  location  was  the  home  (53%).      

Over  three-­‐fifths  (63%)  of  attendees  self-­‐referred  and  just  under  one-­‐tenth  (9%)  were  referred  by  the  emergency  

services.    

Thirty-­‐six  per  cent  of  winter  injury  attendees  arrived  at  the  department  by  private  transport  while  28%  arrived  by  

ambulance.    

Thirty-­‐nine  per  cent  of  attendees  were  discharged  with  no  follow-­‐up  treatment  required,  35%  required   further  

treatment  for  their  injuries  and  21%  were  admitted  to  hospital.    

There   were   53,131   ambulance   call   outs   due   to   injury   during   winter   between   2011/12   and   2013/14   across  

Merseyside  and  Cheshire.    

Almost  one-­‐quarter  (23%)  of  ambulance  call  outs  were  to  Liverpool  local  authority.    

Over  half  (55%)  of  all  ambulance  call  outs  were  due  to  injuries  sustained  by  a  fall.    

 

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INTRODUCTION  

Winter  is  often  associated  with  a  rise  in  patient  numbers  during  the  cold  weather,  thus  having  an  impact  on  health  services.  The  

very  young,  chronically  ill  and  the  elderly  are  those  among  the  most  vulnerable  during  the  winter  months  (The  British  Medical  

Association   [BMA],  2013),  and  patients  presenting   to  emergency  departments   (EDs)  and  general  practitioners   (GPs)  with  cold  

and  flu  symptoms  peak  during  this  time,  putting  additional  strain  on  health  services  (Dean,  1997).    

Elderly  attendees  to  an  ED  are  more  likely  to  require  a  hospital  bed  than  younger  attendees.  The  NHS  reported  that  there  is  an  

over  80%  chance  of  persons  over  the  age  of  75  years  requiring  admission  to  hospital  from  an  A&E  attendance,  compared  to  just  

a   20%   chance   of   those   aged   under   30   years   (NHS   2013a).   The  Department   of   Health   have   recently   reported   that   an   ageing  

population   was   putting   pressure   on   ED   services   over   winter   and   that   extra   doctors   would   help   reduce   this   burden   (British  

Broadcasting  Corporation  [BBC],  2014).  In  response,  the  Health  Secretary,  Jeremy  Hunt,  has  announced  plans  to  recruit  an  extra  

260  doctors  to  help  ease  pressures  on  EDs  during  winter  2014/15  (BBC,  2014).  

The   Trauma   and   Injury   Intelligence  Group   (TIIG)   Injury   Surveillance   System  warehouses   data   collected   by   the   EDs   across   the  

North  West   of   England   and   the  North  West  Ambulance   Service   (NWAS).  Using   data   collated   by   TIIG,   this   report   provides   an  

indication  of  the  burden  of  winter  injuries  on  health  services  and  residents  of  Merseyside  and  Cheshire  between  2011/12  and  

2013/14.  It  can  be  used  by  local  partners  to  inform  prevention  strategies  and  support  local  work  in  relation  to  injuries  sustained  

during  winter.    

METHODS  

The  following  data  were  extracted  from  the  TIIG  Injury  Surveillance  System:    

All   injury   attendances   to   the   EDs   across  Merseyside   and   Cheshire   (see   Box   1)A  during  winter   between   2011/12   and  

2013/14B;    

Ambulance   call   outs   due   to   injury   across   Merseyside   and   Cheshire   during   winter   between   2011/12   and   2013/14B  

(sourced  through  the  North  West  Ambulance  Service).    

ED  attendances  were  analysed   to  explore  and   report  on   the  extent  of   injuries   across  Merseyside  and  Cheshire  over   the  past  

three  winter  periods.  Data  are  presented  to  show  an  overall  picture  of  winter  injury  attendances,  and  then  broken  down  by  each  

local   authority   district   to   assist   local   partners.   Ambulance   call   outs   during  winter   between   2011/12   and   2013/14   have   been  

analysed  and  included  to  supplement  this  report.  

                                                                                                                                       A  Due   to   a   high   volume   of   Merseyside   residents   (particularly   from   Sefton   local   authority)   attending   Ormskirk   District   General   Hospital   in  Lancashire  (n=3,035),  attendances  to  this  hospital  have  been  included  in  the  analyses.    B  Winter  attendances  are  categorised  as  those  which  occurred  in  December,  January  and  February  of  each  financial  year.  

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Figures  do  not  relate  to  individuals,  but  to  the  number  of  ED  attendances  and  the  number  of  ambulance  call  outs;  for  example,  

an   individual  could  present  to  an  ED  more  than  once  during  the  three-­‐year  period  but  all  attendances  made  by  the   individual  

have  been  included  in  the  analyses.  Where  figures  have  been  presented  for  Merseyside  and  Cheshire  residents  only  presenting  

to  an  ED,  this  is  based  on  the  postcode  of  residency  where  complete  and  correctC.    

Please  note  that  this  report  looks  at  data  for  injury  and  trauma  only;  data  for  non-­‐trauma  ED  attendances  and  ambulance  call  

outs  (e.g.  generally  unwell,  influenza,  coughs  and  colds,  viruses  etc.)  are  not  reported,  except  for  Aintree  University  Hospital  due  

to   the  way   the   IT   system  records  data.   Figures   for  Aintree  University  Hospital   therefore  will   skew   the   results,  particularly   for  

Knowsley,  Liverpool  and  Sefton  local  authorities  as  residents  of  these  areas  tend  to  present  to  this  ED.    

Crude   rates  were   calculated   for   each   local   authority   per   100,000   resident   population   across  Merseyside   and   Cheshire   (using  

Office  for  National  Statistics  mid-­‐2013  population  estimates).  To  identify  where  there  were  significant  differences  between  areas,  

95%  confidence  intervals  (CIs)D  were  calculated.    

For  all   tables,  numbers   less  than  five  have  been  suppressed  (with  ***)   in   line  with  patient  confidentiality.   If   there   is  only  one  

number   less  than  five   in  a  category  then  a  second  number  has  been  suppressed  to  prevent  back  calculations  from  totals  (e.g.  

<15).  Also  note  that  percentages  may  not  add  up  to  100%  due  to  rounding.  

 

 

                                                                                                                                       C  The  following  hospitals  do  not  provide  TIIG  with  the  patients’  full  postcode;  however  the  Lower  Super  Output  Area  (LSOA)  and  Middle  Super  Output  Area   (MSOA)  are  reported:  Southport  and  Formby  District  General  Hospital,  Macclesfield  District  General  Hospital,  Ormskirk  District  General  Hospital,  The  Royal  Liverpool  University  Hospital  and  Whiston  Hospital.    

Super  Output  Areas  (SOAs)  are  used  in  the  reporting  of  small  area  statistics;  for  more  information  visit:  http://www.ons.gov.uk/ons/guide-­‐method/geography/beginner-­‐s-­‐guide/census/super-­‐output-­‐areas-­‐-­‐soas-­‐/index.html.    D  Confidence  intervals  (CIs)  are  a  range  of  values  indicating  the  uncertainty  there  is  around  the  estimation  of  a  calculated  rate;  the  wider  the  CI,  the  more  uncertainty  there  is.  CIs  are  normally  calculated  at  a  95%  confidence  level,  representing  the  range  in  which  the  true  population  value  will  lie  95  out  of  100  times  (Association  of  Public  Health  Observatories,  2008).  

Box  1:  Hospitals  included  in  analyses  

Location   Hospital   Service(s)  (ED/UCC)^  

Merseyside  

Aintree  University  Hospital   ED  Alder  Hey  Children’s  Hospital   ED  Arrowe  Park  Hospital   ED  Southport  and  Formby  District  General  Hospital                                   ED  The  Royal  Liverpool  University  Hospital   ED  Whiston  Hospital   ED  

Cheshire  

Countess  of  Chester  Hospital   ED  &  UCC  Leighton  Hospital   ED  &  UCC  Macclesfield  District  General  Hospital   ED  Warrington  Hospital   ED  

Lancashire   Ormskirk  District  General  Hospital   ED  &  UCC  

^ ED  =  Emergency  Department;  UCC  =  Urgent  Care  Centre.  For  the  purpose  of  this  report,  ‘EDs’  refer  to  all  the  hospitals  listed  in  this  table,  whether  ED  and/or  UCC  services  are  provided.    

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WINTER  INJURY  ATTENDANCES  ACROSS  MERSEYSIDE  AND  CHESHIRE  

NUMBER  OF  INJURY  ATTENDANCES  AND  TRENDS  

There  were   a   total   of   236,413   attendances   to   the   EDs   across  Merseyside   and   Cheshire   during  winter   between   2011/12   and  

2013/14  (Table  1).  January  consistently  saw  the  highest  number  of  attendances  over  the  three  winter  periods  (n=81,952).  There  

was  a  slight  increase  (<1%)  in  attendances  in  2012/13  compared  to  the  previous  year,  though  attendances  decreased  between  

2012/13  and  2013/14  (-­‐7%).  Overall,  there  was  a  6%  reduction  in  the  number  of  winter  injury  attendances  across  the  three-­‐year  

period.    

Table  1:  Number  of  ED  attendances  by  winter  month  and  year  (winter  months  2011/12  to  2013/14)  

Year   December   January   February   Total  2011/12   25463   27684   27211   80358  2012/13   25999   28253   26443   80695  2013/14   25559   26015   23786   75360  Total   77021   81952   77440   236413    

Figure  1  shows  the  number  of  ED  injury  attendances  between  April  2011  and  March  2014.  Winter  month  injury  attendances  are  

generally  lower  than  non-­‐winter  months.  

Figure  1:  Number  of  ED  attendances  by  month  and  year  (all  months  2011/12  to  2013/14)  

 

 

 

 

3146

0  32

105  

3137

7  32

813  

3008

7  30

464  

3033

1  28

196  

2546

3  27

684  

2721

1  32

245  

2845

1   3295

5  30

217  

3188

3  31

017  

3067

6  29

692  

2853

4  25

999  

2825

3  26

443   29

545  

3017

2  31

865  

3135

0   3434

8  29

505  

2885

2  28

582  

2692

3  25

559  

2601

5  23

786  

2866

7  

0  

5000  

10000  

15000  

20000  

25000  

30000  

35000  

40000  

Num

ber  o

f  ao

enda

nces

 

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Table  2  presents  the  number  of  attendances  to  each  of  the  Merseyside  and  Cheshire  EDs.  Aintree  University  Hospital  had  the  

highest  number  of   attendances   (n=61,125),   representing   just  over  one-­‐quarter   (26%)  of   all  winter   attendances;  however   this  

figure  includes  all  attendances,  not  just  injury  attendances  due  to  the  way  the  IT  system  records  data.    Of  the  other  EDs  where  

data  do  not  include  non-­‐trauma  attendances,  Whiston  Hospital  saw  the  highest  number  of  winter  injuries  (n=30,979).    

Table  2:  Number  of  ED  attendances  by  hospital  (winter  months  2011/12  to  2013/14)    

^  Data  for  Aintree  University  Hospital  is  inclusive  of  all  attendances,  not  just  injury  and  trauma.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hospital  ED                Number  of  attendances   %  Aintree  University  Hospital^   61125   26%  Whiston  Hospital   30979   13%  Warrington  Hospital   25595   11%  The  Royal  Liverpool  University  Hospital   24051   10%  Arrowe  Park  Hospital   23657   10%  Leighton  Hospital   23553   10%  Macclesfield  District  General  Hospital   15567   7%  Alder  Hey  Children's  Hospital   10717   5%  Countess  of  Chester  Hospital   10402   4%  Southport  and  Formby  District  General  Hospital   7732   3%  Ormskirk  District  General  Hospital  (Lancashire)   3035   1%  Total   236413   100%  

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AREA  OF  RESIDENCY  

Merseyside  and  Cheshire  residents  accounted  for  92%  of  all  attendances  between  the  winter  periods  of  2011/12  and  2013/14  

(n=216,997).  The  number  and  crude  rate  per  100,000  resident  population  of  ED  attendances  during  the  winter  months  between  

2011/12  and  2013/14  are  presented  in  Table  3  and  Figure  2.  The  crude  rate  of  attendances  across  Merseyside  and  Cheshire  was  

8,961.6  per  100,000  population.  Whilst   Liverpool   local  authority  accounted   for   the  highest  number  of  attendances,  Knowsley  

local  authority  had  the  highest  crude  rate  at  15,258.1  per  100,000  population.  As  well  as  Knowsley,  Sefton,  Liverpool  and  Halton  

local  authorities  were  all  significantly  worse  than  the  average  for  Merseyside  and  Cheshire.    

It   should  be  noted   that  many   residents  of  Knowsley,   Liverpool  and  Sefton   local  authorities  attend  Aintree  University  Hospital  

which  includes  all  attendances,  not  just  injury  and  trauma,  due  to  the  way  the  IT  system  records  data;  therefore  data  for  Aintree  

University  Hospital  will  skew  the  results,  particularly  for  these  local  authority  districts.    

Table  3:  Number  and  crude  rate  of  ED  attendances  by  local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

Local  authority   Attendances   Crude  rate  (per  100,000)   95%  CI  (lower)   95%  CI  (upper)  Liverpool   52917   11240.3   11144.7   11336.5  Sefton     34581   12657.4   12524.4   12791.6  Cheshire  East   28796   7726.2   7637.2   7815.9  Wirral   22476   7017.3   6925.8   7109.6  Knowsley   22290   15258.1   15058.5   15459.8  Cheshire  West  and  Chester   15880   4797.2   4722.9   4872.4  Halton   13644   10831.2   10650.2   11014.4  Warrington   13549   6605.8   6495.0   6717.9  St  Helens   12864   7300.0   7174.3   7427.2  Total   216997   8961.6   8924.0   8999.4  

Figure  2:  Crude   rate  of   ED  attendances  by   local   authority  of   residency,  Merseyside  and  Cheshire   residents   (winter  months  2011/12  to  2013/14)  

 

15258.1  

12657.4  

11240.3  

10831.2  

7726.2  

7300.0  

7017.3  

6605.8  

4797.2  

8961.6  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

Halton  

Cheshire  East  

St  Helens  

Wirral  

Warrington  

Cheshire  West  and  Chester  

Merseyside  and  Cheshire  

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

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Table   4   shows   the   20  wards  with   the   highest   number   of   attendees  presenting   to   an   ED  with   injuries   during  winterE.   A   large  

proportion  of  attendees  were  resident  in  Liverpool  and  Sefton  local  authorities.  

Table   4:   Number   of   ED   attendances   by  ward   of   residency,  Merseyside   and   Cheshire   residents   (winter  months   2011/12   to  2013/14)  

Ward  name   Ward  code   Local  authority   Number  of  attendances  Warbreck   00BYGJ   Liverpool   4118  Gillmoss   00BYFS   Liverpool   3973  Fazakerley   00BYFR   Liverpool   3468  County   00BYFL   Liverpool   2949  Pirrie   00BYGB   Liverpool   2916  St  Oswald   00CAGW   Liverpool   2894  Linacre   00CAGL   Sefton   2864  Netherton  and  Orrell   00CAGR   Sefton   2580  Derby   00CAGF   Sefton   2535  Ford   00CAGH   Sefton   2279  Molyneux   00CAGQ   Sefton   2241  Melrose   00BYFX   Liverpool   2220  Clubmoor   00BYFK   Liverpool   2206  Church   00CAGE   Sefton   2206  Tower  Hill   00BXFU   Knowsley   2065  Croxteth   00BYFM   Liverpool   2051  Park   00CAGT   Sefton   2041  Litherland   00CAGM   Sefton   1998  Sudell   00CAGX   Sefton   1963  Tuebrook   00BYGF   Liverpool   1874  

 

 

 

 

 

 

 

 

                                                                                                                                       E  A  full  ward  breakdown  is  available  upon  request.    

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Map  1  illustrates  the  number  of  attendances  by  ward  of  residency,  overlaid  by  local  authority  boundaries.    

Map  1:  Number  of   ED  attendances  by  ward  of   residency,  overlaid  by   local   authority  boundaries,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

Key  (number  of  attendances):  

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Table   5   shows   a   breakdown   of   attendances   by   ED   attended   and   the   local   authority   in   which   the   patient   resides.   Aintree  

University  Hospital  received  the  highest  number  of  ED  attendances  by  patients  who  reside  in  Merseyside  (n=58,457).  Cheshire  

residents  mainly  attended  Warrington  Hospital  (n=22,478)  and  Leighton  Hospital  (n=21,573).    

Forty-­‐four  per  cent  of  Liverpool  local  authority  residents  attended  Aintree  University  Hospital  (n=23,166)  and  36%  attended  The  

Royal   Liverpool  University   (n=19,040).   Residents   of  Cheshire   East   local   authority   divided   their   attendances  between   Leighton  

Hospital   (n=15,410;   54%)   and   Macclesfield   Hospital   (n=13,067;   45%).   Knowsley   local   authority   residents   attended   Whiston  

Hospital   in   45%   of   attendances   (n=10,105)   and   Aintree  University   Hospital   in   41%   (n=9,197).   Forty-­‐five   per   cent   of   Cheshire  

West   and  Chester   local   authority   residents   attended   the   Countess   of   Chester  Hospital   (n=7,196)   and   38%  attended   Leighton  

Hospital  (n=6,030).      

In  some  local  authority  areas,  the  majority  of  attendances  were  to  one  hospital:  95%  of  Wirral  local  authority  residents  attended  

Arrowe  Park  Hospital  (n=21,269),  95%  of  Warrington  residents  attended  Warrington  Hospital  (n=12,841)  and  85%  of  St  Helens  

residents  attended  Whiston  Hospital  (n=10,976).    

Table  5:    Number  of  ED  attendances  by  local  authority  of  residency  and  ED  of  attendance,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)F  

Local  authority  

Live

rpoo

l  

Sefton

 

Cheshire  East  

Wirr

al  

Know

sley

 

Cheshire  W

est  

and  Ch

ester  

Halton  

Warrin

gton

 

St  Helen

s  

Merseyside  

total  

Cheshire  to

tal  

Total  

Aintree  University  Hospital    

23166   25356   58   292   9197   122   187   157   446   58457   524   58981  

Whiston  Hospital   3421   259   44   77   10105   80   4456   281   10976   24838   4861   29699  Warrington  Hospital  

105   29   81   56   77   901   8655   12841   1084   1351   22478   23829  

Arrowe  Park  Hospital  

159   55   15   21269   33   1282   10   14   11   21527   1321   22848  

The  Royal  Liverpool  University  Hospital  

19040   804   31   491   1033   132   134   73   143   21511   370   21881  

Leighton  Hospital   32   ***   15410   34   <25   6030   42   91   24   113   21573   21686  Macclesfield  Hospital  

13   <10   13067   ***   ***   107   ***   18   6   30   13195   13225  

Alder  Hey  Children's  Hospital  

6847   1824   19   66   1580   20   101   41   94   10411   181   10592  

Countess  of  Chester  Hospital   45   17   67   177   9   7196   50   27   8   256   7340   7596  

Southport  and  Formby  District  General  Hospital  

63   4896   ***   9   39   10   <10   ***   27   <5035   <25   5057  

Ormskirk  District  General  Hospital   26   1333   ***   ***   193   0   0   ***   45   <1595   ***   1603  

Total   52917   34581   28796   22476   22290   15880   13644   13549   12864   145128   71869   216997    

                                                                                                                                       F  Data  for  Aintree  University  Hospital  is  inclusive  of  all  attendances,  not  just  injury  and  trauma.  

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SELF-­‐TREATMENT:  EASING  THE  STRAIN  THROUGH  PHARMACIES  

Many  patients  suffering  ill-­‐health  during  the  winter  months  will  visit  a  primary  care  centre.  GPs  are  currently  seeing  more  

patients   than  ever  before,  as  data   from  2009   shows  an   increase  of  80  million  GP  consultations  since  1995   (Health  and  

Social  Care  Information  Centre,  2009).  This  was  estimated  at  120  million  more  in  2013  compared  to  1995,  at  around  340  

million  GP  consultations  per  year  (NHS,  2013b).  

Patients  visiting  GPs  for  cold  and  flu  symptoms  during  the  winter  months  are  estimated  to  cost  the  NHS  £35.2  million  per  

year,   with   the   vast   majority   of   such   consultations   reported   as   unnecessary   (NHS,   2013a).   According   to   data   from  

Doctors.net.uk   Limited   (2013),   86%   of  GPs   believed   that   patients  who   presented   during   the  winter   period   could   have  

received   the   same   treatment   from   a  pharmacist.   Furthermore,   99%   of  GPs   reported   receiving   unnecessary  visits   from  

patients   suffering   from   colds   during   winter   and   over   two-­‐fifths   of   people   (44%)   visited   their   GP,   expecting   to   be  

prescribed  antibiotics,  which  would    have  no  effect  on  cold  and   flu   illness  (Proprietary  Association  of  Great  Britain  and  

Pharmacy  Voice,  2013).  

In   response   to   the   suggestion   that   patients   may   be   unnecessarily   contributing   to   the   strain   on   GPs   and   EDs,   the  

Proprietary  Association  of  Great  Britain  and  Pharmacy  Voice  launched  the  Treat  Yourself  Better  campaign.  As  little  as  one  

in   five   (21%)   adults   currently   use   their   local   pharmacy   for   expert   advice,   rather   than   visiting   their   GP.   The   campaign  

provides  an  online  resource  to  inform  those  suffering  from  cold  and  flu  symptoms  on  how  to  access  treatment  and  advice  

from  a  pharmacist,  as  opposed  to  a  GP  or  walk-­‐in   centre  (Proprietary  Association  of  Great  Britain  and  Pharmacy  Voice,  

2013  and  2014).  Research  on  patient  beliefs  and  expectations  regarding   the  prescription  of  antibiotics  shows  that  one-­‐

fifth  of  people  experiencing  a  respiratory   tract   infection  expected  to   receive  antibiotics.    Almost  everyone   in   the  study  

who   requested   their   GP   to   prescribe   antibiotics   were   given   them,   although   one-­‐quarter   of   patients   who   received  

antibiotics,  did  not  finish  the  prescribed  course  (McNulty  et  al.,  2013).  

In  2013,  the  NHS  rolled  out  the  Examine  Your  Options  campaign  in  Merseyside.  This  campaign  aims  to  inform  the  public  

about   health   care   and   treatment   options   available   to   them   during   the  winter   months.   The   campaign,   which   includes  

posters  on  public   transport,   reminds  people   to  make  use  of  NHS  walk-­‐in   services,  GP  out  of  hours   service,  NHS  Direct,  

pharmacists  and  the  NHS  website  (Liverpool  Clinical  Commissioning  Group,  2013).    

For  more  information  visit:    

www.treatyourselfbetter.co.uk  and  http://www.liverpoolccg.nhs.uk/News/2013/november/examine_your_options.aspx.      

 

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PATIENT  DEMOGRAPHICS  

There  were  slightly  more  males  than  females  (males=111,079;  51%)  presenting  with  injuries  during  winter  between  2011/12  and  

2013/14G.  One-­‐third  (33%)  of  attendees  were  aged  between  30  and  59  years  (n=72,169),  followed  by  one-­‐quarter  (25%)  aged  60  

years  plus  (n=54,089)  and  24%  aged  between  15  and  29  years  (n=52,400;  Figure  3).  Nearly  one-­‐fifth  (18%)  were  aged  14  years  

and  under  (n=38,330).    

Figure  3:  Number  of  ED  attendances  by  age  group,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)H  

 

Figure  4  provides  a  more  detailed  age  breakdown  by  five-­‐year  age  categories.  The  largest  proportion  of  attendances  came  from  

the  20  to  24  year  age  group  (n=19,415),  followed  by  15  to  19  years  (n=17,099)  and  25  to  29  years  (n=15,886).    

Figure  4:  Number  of  ED  attendances  by  five-­‐year  age  groups,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)H  

 

                                                                                                                                       G  There  were  13  records  without  the  gender  recorded.  H  There  were  9  records  without  the  age  recorded;  these  have  been  omitted  from  the  chart.    

38330  

52400  

72169  

54089  

0  

10000  

20000  

30000  

40000  

50000  

60000  

70000  

80000  

0-­‐14   15-­‐29   30-­‐59   60+  

Num

ber  o

f  ao

enda

nces

 

Age  group  

1438

3  

9485

 

1446

2   1709

9   1941

5  

1588

6  

1303

5  

1139

1  

1282

9  

1310

1  

1199

3  

9820

 

8728

 

8295

 

7822

 

8388

 

8723

 

6950

 

5183

 

0  

5000  

10000  

15000  

20000  

25000  

0-­‐4  

 5-­‐9

 

 10-­‐

14  

15-­‐1

9  

20-­‐2

4  

25-­‐2

9  

30-­‐3

4  

35-­‐3

9  

40-­‐4

4  

45-­‐4

9  

50-­‐5

4  

55-­‐5

9  

60-­‐6

4  

65-­‐6

9  

70-­‐7

4  

75-­‐7

9  

80-­‐8

4  

85-­‐8

9  

90+  

Num

ber  o

f  ao

enda

nces

 

Age  group  

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Table  6  shows  attendances  by  age  group  and  gender  for  each  ED.  There  were  more  males  than  females  aged  between  59  years  

or   less  across  all  hospitals,  except  for  Aintree  University  Hospital  where  there  were  slightly  more  females  than  males  aged  14  

years   and  under   and  between  15   and  29   years.   Almost   three   in   five   (58%)   attendees   aged  60   years   and   above  were   female  

(n=31,350),  with  more  females  than  males  presenting  to  all  EDs  within  this  age  category.    

Table  6:  Number  of  ED  attendances  by  age  group,  gender  and  hospital,  Merseyside  and  Cheshire   residents   (winter  months  2011/12  to  2013/14)I  

Age  group   0-­‐14   15-­‐29   30-­‐59   60+   Total  Gender   Male   Female   Male   Female   Male   Female   Male   Female   Male   Female  Aintree  University  Hospital   1448   1478   6832   7008   11655   10949   8915   10678   28856   30114  

Alder  Hey  Children's  Hospital   5467   4272   508   326   ***   <20   ***   ***   5978   4614  

Arrowe  Park  Hospital   2682   2188   3270   2204   3815   3220   2047   3422   11814   11034  Countess  of  Chester  Hospital  

762   565   1446   928   1344   1127   546   878   4098   3498  

Leighton  Hospital   2887   2319   3437   2263   3768   3296   1432   2283   11525   10161  Macclesfield  Hospital   1545   1203   1582   1241   2129   2124   1372   2028   6628   6596  Ormskirk  District  General  Hospital   802   566   153   82   0   0   0   0   955   648  

Southport  and  Formby  District  General  Hospital  

11   6   726   506   <930   <885   <745   <1260   2408   2648  

The  Royal  Liverpool  University  Hospital  

35   30   3565   3136   4887   3965   2816   3447   11303   10578  

Warrington  Hospital   3059   2404   3721   2650   4135   3813   1572   2475   12487   11342  Whiston  Hospital   2586   2015   3745   3067   5408   4707   3288   4883   15027   14672  Total   21284   17046   28985   23411   38071   34097   22732   31350   111072   105904  

There  were  consistently  more  males  than  females  from  each  local  authority  district  aged  less  than  60  years;  however  attendees  

aged   60   years   and   over   were   mostly   female   (58%;   Table   7).     Sefton   (females=17,474)   and   Knowsley   (females=11,241)   local  

authorities  were  the  only  two  districts  where  there  were  more  females  than  males  overall.  

Table  7:  Number  of  ED  attendances  by  age  group,  gender  and  local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)I  

Age  group   0-­‐14   15-­‐29   30-­‐59   60+   Total  Gender   Male   Female   Male   Female   Male   Female   Male   Female   Male   Female  Liverpool   4225   3479   6806   6203   9877   8500   6297   7525   27206   25707  Sefton     2251   1834   3942   3643   6034   5636   4868   6361   17099   17475  Cheshire  East   3640   2912   4073   2908   4841   4429   2369   3622   14924   13871  Wirral   2593   2102   3270   2234   3819   3185   1988   3285   11670   10806  Knowsley   2022   1656   2628   2499   3956   3682   2442   3404   11048   11241  Cheshire  West  and  Chester   1773   1381   2678   1696   2702   2475   1226   1949   8379   7501  Halton   1751   1356   1935   1484   2262   2241   1082   1533   7030   6614  Warrington   1763   1345   2154   1516   2363   2041   887   1479   7168   6381  St  Helens   1266   981   1499   1228   2217   1908   1573   2192   6555   6309  Total   21284   17046   28985   23411   38071   34097   22732   31350   111079   105905  

                                                                                                                                       I  There  were  13  records  without  the  gender  recorded  and  9  records  without  the  age  recorded;  these  have  been  included  in  the  totals.    

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Winter  injury  attendances  by  injury  group  and  age  group  are  presented  in  Table  10.  Of  the  specified  injury  groups,  patients  aged  

60   years  plus  were  most   commonly  presenting  with   injuries   sustained  by  a   fall,   accounting   for  45%  of   all   fall-­‐related   injuries  

(n=9,770).  RTC-­‐related  injury  attendances  were  most  common  in  the  30-­‐59  years  age  category  (n=4,321),  accounting  for  43%  of  

all   RTC   attendees.   Assaults   (n=4,507;   46%)   and   sports   injury   (n=3,610;   47%)   were   more   likely   experienced   by   those   aged  

between   15   and   29   years   and   those   aged   14   years   and   under   accounted   for   the   largest   proportion   of   injuries   sustained   by  

ingestion  (n=296;  40%).        

Table  10:  Number  of  ED  attendances  by   injury  group  and  by  age  group,  Merseyside  and  Cheshire  residents   (winter  months  2011/12  to  2013/14)L,M  

Injury  group   0-­‐14   15-­‐29   30-­‐59   60+   Total  Other  injury   30195   35190   53306   41578   160269  Fall   3097   2874   5960   9770   21701  RTC   1151   3543   4321   1132   10147  Assault   1104   4507   3699   572   9882  Sports  injury   1945   3610   1768   355   7678  Deliberate  self-­‐harm   173   1659   1795   213   3840  Bites  and  stings   262   231   434   216   1143  Overdose   ***   454   486   <55   994  Ingestion   296   170   181   84   731  Burns  and  scalds   93   124   153   52   422  Firework  injury   5   23   45   50   123  Inhalation   <10   15   21   <20   58  Total   38330   52400   72169   54089   216988  

Fall-­‐related  winter  injury  attendances  are  presented  in  Table  11.  Attendances  peaked  in  December  2012  (n=2,834)  and  February  

2012  (n=2,791),  though  overall,  winter  2011/12  had  the  highest  number  of  fall  attendances  (n=8,034).  

Table   11:   Number   of   fall-­‐related   ED   attendances   by  month   and   year,  Merseyside   and   Cheshire   residents   (winter   months  2011/12  to  2013/14)M  

Year   December   January   February   Total  

2011/12   2690   2553   2791   8034  

2012/13   2834   2117   1892   6843  

2013/14   2363   2292   2169   6824  

Total   7887   6962   6852   21701  

 

 

 

                                                                                                                                       L  There  were  9  records  without  the  age  recorded;  these  have  been  omitted  from  the  table.  M  Only   the   following  hospitals   record   falls   as   a   specific   injury  group:  Aintree  University  Hospital,  Arrowe  Park  Hospital,   The   Royal   Liverpool  University  Hospital  and  Whiston  Hospital;  all  other  hospitals  record  falls  under  ‘Other  injury’.    

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Winter  injury  attendances  by  injury  group  and  age  group  are  presented  in  Table  10.  Of  the  specified  injury  groups,  patients  aged  

60   years  plus  were  most   commonly  presenting  with   injuries   sustained  by  a   fall,   accounting   for  45%  of   all   fall-­‐related   injuries  

(n=9,770).  RTC-­‐related  injury  attendances  were  most  common  in  the  30-­‐59  years  age  category  (n=4,321),  accounting  for  43%  of  

all   RTC   attendees.   Assaults   (n=4,507;   46%)   and   sports   injury   (n=3,610;   47%)   were   more   likely   experienced   by   those   aged  

between   15   and   29   years   and   those   aged   14   years   and   under   accounted   for   the   largest   proportion   of   injuries   sustained   by  

ingestion  (n=296;  40%).        

Table  10:  Number  of  ED  attendances  by   injury  group  and  by  age  group,  Merseyside  and  Cheshire  residents   (winter  months  2011/12  to  2013/14)L,M  

Injury  group   0-­‐14   15-­‐29   30-­‐59   60+   Total  Other  injury   30195   35190   53306   41578   160269  Fall   3097   2874   5960   9770   21701  RTC   1151   3543   4321   1132   10147  Assault   1104   4507   3699   572   9882  Sports  injury   1945   3610   1768   355   7678  Deliberate  self-­‐harm   173   1659   1795   213   3840  Bites  and  stings   262   231   434   216   1143  Overdose   ***   454   486   <55   994  Ingestion   296   170   181   84   731  Burns  and  scalds   93   124   153   52   422  Firework  injury   5   23   45   50   123  Inhalation   <10   15   21   <20   58  Total   38330   52400   72169   54089   216988  

Fall-­‐related  winter  injury  attendances  are  presented  in  Table  11.  Attendances  peaked  in  December  2012  (n=2,834)  and  February  

2012  (n=2,791),  though  overall,  winter  2011/12  had  the  highest  number  of  fall  attendances  (n=8,034).  

Table   11:   Number   of   fall-­‐related   ED   attendances   by  month   and   year,  Merseyside   and   Cheshire   residents   (winter   months  2011/12  to  2013/14)M  

Year   December   January   February   Total  

2011/12   2690   2553   2791   8034  

2012/13   2834   2117   1892   6843  

2013/14   2363   2292   2169   6824  

Total   7887   6962   6852   21701  

 

 

 

                                                                                                                                       L  There  were  9  records  without  the  age  recorded;  these  have  been  omitted  from  the  table.  M  Only   the   following  hospitals   record   falls   as   a   specific   injury  group:  Aintree  University  Hospital,  Arrowe  Park  Hospital,   The   Royal   Liverpool  University  Hospital  and  Whiston  Hospital;  all  other  hospitals  record  falls  under  ‘Other  injury’.    

 

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Table  12  shows  the  number  of  winter  injury  attendances  by  local  authority  district  for  each  injury  group.  Wirral  local  authority  

residents   accounted   for   over   two   in   five   (44%)   fall-­‐related   injuries   (n=9,598)   and   over   one-­‐third   (35%)   of   assaults   (n=3,476).    

Residents  of  Cheshire  East  (n=685)  and  Sefton  (n=640)  local  authorities  accounted  for  18%  and  17%  of  deliberate  self-­‐harm  (DSH)  

respectively.    

Table   12:  Number   of   ED   attendances   by   injury   group   and   local   authority   of   residency,  Merseyside   and   Cheshire   residents  (winter  months  2011/12  to  2013/14)N  

Injury  group  

Live

rpoo

l  

Sefton

 

Cheshire  

East  

Wirr

al  

Know

sley

 

Cheshire  

West  a

nd  

Chester  

Halton  

Warrin

gton

 

St  Helen

s  

Total  

Other  injury   42885   29423   24846   5423   17007   12014   10183   10358   8137   160276  Fall   4035   1353   15   9598   2551   605   1003   64   2477   21701  RTC   1248   1165   1165   1451   1117   1043   1029   1034   897   10149  Assault   1679   844   883   3476   578   765   487   694   476   9882  Sports  injury   1096   1000   1061   1397   398   818   599   969   340   7678  DSH   569   640   685   467   215   516   194   403   151   3840  Bites  and  stings   147   34   136   231   213   85   76   16   205   1143  Overdose   926   14   ***   16   26   ***   ***   ***   ***   994  Ingestion   153   44   0   121   155   8   67   7   176   731  Burns  and  scalds   142   12   ***   243   5   16   ***   0   0   422  Firework  injury   <40   <50   ***   5   25   ***   ***   ***   ***   123  Inhalation   ***   ***   0   48   0   6   0   0   0   58  Total   52917   34581   28796   22476   22290   15880   13644   13549   12864   216997  

 

 

 

 

 

 

 

 

 

                                                                                                                                       N  Only   the   following  hospitals   record   falls   as   a   specific   injury   group:  Aintree  University  Hospital,  Arrowe  Park  Hospital,   The  Royal   Liverpool  University  Hospital  and  Whiston  Hospital;  all  other  hospitals  record  falls  under  ‘Other  injury’.  

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INCIDENT  LOCATION  

The  primary  incident  location  was  recorded  as  the  home  (n=99,667;  53%)  and  17%  of  winter  injuries  occurred  in  a  public  place  

(n=30,924;  Figure  5).      

Figure   5:   Number   of   ED   attendances   by   incident   location,  Merseyside   and   Cheshire   residents   (winter  months   2011/12   to  2013/14)O  

 

REFERRAL  SOURCE  

Over   three   in   five   (63%)  attendees   self-­‐referred   (n=136,654)  and   just  under  one   in   ten   (9%)  were   referred  by   the  emergency  

services  (n=19,419;  Table  13).  

Table  13:  Number  and  percentage  of  ED  attendances  by  source  of  referral,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

Source  of  referral   n   %  Self   136654   63%  Other   21956   10%  Emergency  services   19419   9%  Friend/relative   12170   6%  GP   12168   6%  Other  health  care  professional   11220   5%  Police   1289   1%  Work   1021   0%  Educational  establishment   816   0%  NHS  Direct   147   0%  Unknown   137   0%  Total   216997   100%  

                                                                                                                                       O  Whiston  Hospital  does  not  record  incident  location  (n=29,699).    

7375  

99667  

34017   30924  

7616   7699  

0  

20000  

40000  

60000  

80000  

100000  

120000  

Educawonal  establishment  

Home   Other   Public  place   Unknown   Work  

Num

ber  o

f  ao

enda

nces

 

Incident  locawon  

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ARRIVAL  MODE  

Over  one-­‐third  (36%)  of  patients  arrived  at  the  ED  by  private  transport  (n=77,105)  while  under  three  in  ten  (28%)  arrived  by  

ambulance  (n=59,972;  Figure  6).      

Figure   6:   Number   of   ED   attendances   by   mode   of   arrival,   Merseyside   and   Cheshire   residents   (winter   months   2011/12   to  2013/14)  

 

DISPOSAL  METHOD  

Figure   7   presents   the   disposal   method   following   a   winter   injury   attendance.   Just   under   two   in   five   (39%)   patients   were  

discharged   with   no   follow-­‐up   treatment   required   (n=85,428),   while   over   one-­‐third   (35%)   required   a   referral   for   follow-­‐up  

treatment  (n=75,964)  and  just  over  one-­‐fifth  (21%)  were  admitted  to  hospital  (n=46,433).    

Figure   7:   Number   of   ED   attendances   by   disposal   method,   Merseyside   and   Cheshire   residents   (winter  months   2011/12   to  2013/14)P  

 

                                                                                                                                       P  There  were  33  records  without  the  disposal  method  recorded;  these  have  been  omitted  from  the  chart.    

77105  

63236  

59972  

7983  3605  

3526   835   735  

Private  transport  

Other  

Ambulance  

Foot  

Taxi  

Public  transport  

Unknown  

Police  

85428  

75864  

46433  

9239  

Discharged  

Follow-­‐up/  Referral  

Admioed  

Other  

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The  disposal  method  is  presented  by  age  group  in  Table  14.  Over  half  (51%)  of  those  admitted  to  hospital  were  aged  60  years  

and   above   (n=23,901).   Attendees   aged   between   30   and   59   years   accounted   for   the   largest   proportions   of   those   discharged  

(n=27,650;  32%)  and  those  who  required  follow-­‐up  treatment  (n=26,761;  35%).  

Table  14:  Number  of  ED  attendances  by  disposal  method  and  age  group,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)Q  

Age  group   0-­‐14   15-­‐29   30-­‐59   60+   Total  

Discharged   21018   22850   27650   13905   85423  

Follow-­‐up/  Referral   14355   19823   26761   14924   75863  

Admitted   2308   6495   13729   23901   46433  

Other   636   3224   4023   1353   9236  

Total   38317   52392   72163   54083   216955                                                                            

                                                                                                                                       Q  There  were  33  records  without  the  disposal  method  recorded  and  9  records  without  the  age  recorded;  these  have  been  omitted  from  the  chart.      

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WINTER  INJURY  ATTENDANCES  BY  LOCAL  AUTHORITY  DISTRICTS  

The   following   sections   of   this   report   explore   ED   attendances   during   winter   2011/12,   2012/13   and   2013/14   by   each   local  

authority  district  across  Merseyside  and  Cheshire  (local  authority  data  tables  are  available  upon  request).    

It   should  be  noted   that  many   residents  of  Knowsley,   Liverpool  and  Sefton   local  authorities  attend  Aintree  University  Hospital  

which  includes  all  attendances,  not  just  injury  and  trauma,  due  to  the  way  the  IT  system  records  data;  therefore  data  for  Aintree  

University  Hospital  will   skew   the   results,   particularly   for   these   local   authority  districts.  Unless  otherwise   stated,   the  numbers  

reported  in  this  section  are  the  cumulative  total  of  ED  attendances  across  the  three  winter  periods.    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CHESHIRE  EAST  

The  number  of  winter  injury  attendances  made  by  Cheshire  East  local  authority  residents  to  a  Merseyside  and  Cheshire  ED  was  

28,796,  representing  13%  of  all  winter  injury  attendances  made  by  Merseyside  and  Cheshire  residents.  In  2011/12,  there  were  

9,362  winter  injury  attendances  which  increased  slightly  by  3%  to  9,688  in  2013/14.    

Cheshire  East  had   the  highest  number  of  attendances  across  all  Cheshire   local  authorities,  but   the  second  highest   crude   rate  

(7,726.2   per   100,000   resident   population;   Figure   8).   Across   Merseyside   and   Cheshire,   Cheshire   East   had   the   third   highest  

number  of  attendances  and  fifth  highest  crude  rate.    

Figure  8:  Crude   rate  of   ED  attendances  by   local   authority  of   residency,  Merseyside  and  Cheshire   residents   (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

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Within  Cheshire  East  local  authority,  the  highest  number  of  winter  injury  ED  attendances  came  from  Macclesfield  South  (n=645),  

Congleton  Central  (n=605),  Macclesfield  Central  (n=603),  Congleton  South  (n=576)  and  Congleton  West  (n=559;  Map  2).    

Map  2:  Number  of  ED  attendances  by  ward  of  residency,  Cheshire  East  local  authority  residents  (winter  months  2011/12  to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

Males  from  Cheshire  East  local  authority  made  up  just  over  half  (52%)  of  attendees  (n=14,924)  and  just  under  one-­‐third  (32%)  

were  aged  between  30  and  59  years  (n=9,270).  

 

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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CHESHIRE  WEST  AND  CHESTER  

The  number  of  winter   injury   attendances  made  by  Cheshire  West   and  Chester   local   authority   residents   to   a  Merseyside   and  

Cheshire   ED   was   15,880,   representing   7%   of   all   winter   injury   attendances   made   by   Merseyside   and   Cheshire   residents.   In  

2011/12  there  were  5,606  attendances  compared  to  4,959  in  2013/14;  a  12%  decrease.  

Cheshire  West  and  Chester  had  the  second  highest  number  of  attendances  across  all  Cheshire  local  authorities,  but  the  lowest  

crude  rate  (4,797.2  per  100,000  resident  population;  Figure  9).  Across  Merseyside  and  Cheshire,  Cheshire  West  and  Chester  had  

the  fourth  lowest  number  of  attendances  and  lowest  crude  rate.    

Figure  9:  Crude   rate  of   ED  attendances  by   local   authority  of   residency,  Merseyside  and  Cheshire   residents   (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

TIIG Merseyside and Cheshire Themed Report Page 24

 

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Within  Cheshire  West  and  Chester   local  authority,   the  highest  number  of  winter   injury  ED  attendances  came   from  Frodsham  

North  (n=421),  Blacon  Hall  (n=392),  College  (n=335),  Blacon  Lodge  (n=308),  and  Stanlow  and  Wolverham  (n=300;  Map  3).    

Map  3:  Number  of  ED  attendances  by  ward  of  residency,  Cheshire  West  and  Chester  local  authority  residents  (winter  months  2011/12  to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

 

Males   made   up   53%   of   winter   injury   attendances   (n=8,379)   and   one-­‐third   (33%)   of   all   attendees   from   Cheshire   West   and  

Chester  were  aged  between  30  and  59  years  (n=5,177).    

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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HALTON  

The  number  of  winter  injury  attendances  made  by  Halton  local  authority  residents  to  a  Merseyside  and  Cheshire  ED  was  13,644,  

representing   6%   of   all   winter   injuries   made   by   Merseyside   and   Cheshire   residents.   Winter   injury   attendances   in   2013/14  

(n=4,282)  decreased  by  8%  compared  to  4,659  attendances  in  2011/12.  

Halton  had  the  third  highest  number  of  attendances  across  all  Cheshire  local  authorities  and  the  highest  crude  rate  (10,831.2  per  

100,000  resident  population;  Figure  10).  Across  Merseyside  and  Cheshire,  Halton  had  the  third  lowest  number  of  attendances,  

but  the  fourth  highest  crude  rate.      

Figure  10:  Crude  rate  of  ED  attendances  by   local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

TIIG Merseyside and Cheshire Themed Report Page 26

 

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Within  Halton   local   authority,   the   highest   number   of  winter   injury   ED   attendances   came   from  Halton   Lea   (n=1,031),   Norton  

South  (n=991),  Grange  (n=949),  Castlefields  (n=842)  and  Halton  Brook  (n=837;  Map  4).    

Map  4:  Number  of  ED  attendances  by  ward  of  residency,  Halton  local  authority  residents  (winter  months  2011/12  to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

Over   half   (52%)   of   attendees   from  Halton   local   authority  were  male   (n=7,030)   and   one-­‐third   (33%)   of   attendees  were   aged  

between  30  and  59  (n=4,503).    

 

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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WARRINGTON  

The  number  of  winter   injury  attendances  made  by  Warrington   local  authority  residents  to  a  Merseyside  and  Cheshire  ED  was  

13,549,  representing  6%  of  all  winter  injuries  made  by  Merseyside  and  Cheshire  residents.  In  2011/12  there  were  4,603  winter  

injury  attendances  and  in  2013/14  this  had  increased  slightly  by  1%  to  4,665.  

Warrington   had   the   fewest   number   of   attendances   across   all   Cheshire   local   authorities   and   the   second   lowest   crude   rate  

(6,605.8   per   100,000   resident   population;   Figure   11).   Across   Merseyside   and   Cheshire,   Warrington   had   the   second   lowest  

number  of  attendances  and  second  lowest  crude  rate.      

Figure  11:  Crude  rate  of  ED  attendances  by   local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

TIIG Merseyside and Cheshire Themed Report Page 28

 

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Within   Warrington   local   authority,   the   highest   number   of   winter   injury   ED   attendances   came   from   Bewsey   and   Whitecross  

(n=1,216),  Fairfield  and  Howley  (n=1,113),  Poplars  and  Hulme  (n=984),  Orford  (n=916)  and  Whittle  Hall  (n=759;  Map  5).    

Map  5:  Number   of   ED   attendances   by  ward  of   residency,  Warrington   local   authority   residents   (winter  months   2011/12   to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

Males  made  up  53%  of  attendances  (n=7,168)  and  one-­‐third  (33%)  of  all  attendees  from  Warrington  local  authority  were  aged  

between  30  and  59  years  (n=4,404).      

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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KNOWSLEY  

The   number   of  winter   injury   attendances  made   by   Knowsley   local   authority   residents   to   a  Merseyside   and   Cheshire   ED  was  

22,290,   representing   10%   of   all   winter   injuries  made   by  Merseyside   and   Cheshire   residents.   There  were   7,979  winter   injury  

attendances  in  2011/12  which  decreased  by  20%  in  2013/14  (n=6,411).    

Knowsley   had   the   second   lowest   number   of   attendances   across   all   Merseyside   local   authorities,   but   the   highest   crude   rate  

(15,258.1  per  100,000  resident  population;  Figure  12).  Across  Merseyside  and  Cheshire,  Knowsley  had  the  fifth  highest  number  

of  attendances  and  highest  crude  rate.      

Figure  12:  Crude  rate  of  ED  attendances  by   local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

TIIG Merseyside and Cheshire Themed Report Page 30

 

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Within  Knowsley  local  authority,  the  highest  number  of  winter  injury  ED  attendances  came  from  Tower  Hill  (n=2,065),  Whitefield  

(n=1,742),  Park  (n=1,586),  Cherryfield  (n=1,418)  and  Kirkby  Central  (n=1,412;  Map  6).    

Map   6:   Number   of   ED   attendances   by   ward   of   residency,   Knowsley   local   authority   residents   (winter   months   2011/12   to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

 

There  was  an  equal  proportion  of  males  and  females  (50%  each)  from  Knowsley  local  authority  and  those  aged  between  30  and  

59  years  accounted  for  the  largest  proportion  of  attendances  (n=7,638;  34%).    

 

 

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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LIVERPOOL  

The   number   of  winter   injury   attendances  made   by   Liverpool   local   authority   residents   to   a  Merseyside   and   Cheshire   ED  was  

52,917,   representing   24%   of   all   winter   injuries   made   by   Merseyside   and   Cheshire   residents.   In   2013/14   there   were   17,054  

winter  injury  attendances  which  had  decreased  by  3%  compared  to  2011/12  (n=17,614).    

Liverpool   local  authority  had   the  highest  number  of  attendances  and   third  highest   crude   rate   (11,240.3  per  100,000   resident  

population)  across  the  whole  of  Merseyside  and  Cheshire  (Figure  13).    

Figure  13:  Crude  rate  of  ED  attendances  by   local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

TIIG Merseyside and Cheshire Themed Report Page 32

 

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Within  Liverpool  local  authority,  the  highest  number  of  winter  injury  ED  attendances  came  from  Warbreck  (n=4,118),  Gillmoss  

(n=3,973),  Fazakerley  (n=3,468),  County  (n=2,949)  and  Pirrie  (n=2,916;  Map  7).    

Map   7:   Number   of   ED   attendances   by   ward   of   residency,   Liverpool   local   authority   residents   (winter   months   2011/12   to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

 

Males  made  up  51%  of  attendances  (n=27,206)  and  those  aged  between  30  and  59  years  accounted  for  the  highest  proportion  

from  Liverpool  local  authority  (n=18,377;  35%).  

 

 

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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SEFTON  

The  number  of  winter  injury  attendances  made  by  Sefton  local  authority  residents  to  a  Merseyside  and  Cheshire  ED  was  34,581,  

representing  16%  of  all  winter  injuries  made  by  Merseyside  and  Cheshire  residents.  In  2011/12  there  were  12,004  winter  injury  

attendances  and  in  2013/14  there  were  10,749;  a  10%  decrease.    

Sefton   local   authority   had   the   second   highest   number   of   attendances   and   second   highest   crude   rate   (12,657.4   per   100,000  

population)  across  the  whole  of  Merseyside  and  Cheshire  (Figure  14).    

Figure  14:  Crude  rate  of  ED  attendances  by   local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

TIIG Merseyside and Cheshire Themed Report Page 34

 

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Within   Sefton   local   authority,   the   highest   number   of   winter   injury   ED   attendances   came   from   St   Oswald   (n=2,894),   Linacre  

(n=2,864),  Netherton  and  Orrell  (n=2,580),  Derby  (n=2,535)  and  Ford  (n=2,279;  Map  8).    

Map  8:  Number  of  ED  attendances  by  ward  of  residency,  Sefton  local  authority  residents  (winter  months  2011/12  to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

 

Just  over  half  (51%)  of  winter  injury  attendees  from  Sefton  local  authority  were  female  (n=17,475)  and  just  over  one-­‐third  (34%)  

were  aged  between  30  and  59  years  (n=11,670).    

 

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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ST  HELENS  

The   number   of  winter   injury   attendances  made   by   St  Helens   local   authority   residents   to   a  Merseyside   and   Cheshire   ED  was  

12,864,  representing  6%  of  all  winter  injuries  made  by  Merseyside  and  Cheshire  residents.  In  2011/12  there  were  4,826  winter  

injury  attendances  and  in  2013/14  this  had  decreased  by  31%  to  3,324.  

St   Helens   local   authority   had   the   fewest   number   of   attendances   across   the   whole   of   Merseyside   and   Cheshire.   Within  

Merseyside,   St   Helens   had   the   second   lowest   crude   rate   and   across  Merseyside   and   Cheshire   as   a  whole,   the   fourth   lowest  

(7,300.0  per  100,000  population;  Figure  15).    

Figure  15:  Crude  rate  of  ED  attendances  by   local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

TIIG Merseyside and Cheshire Themed Report Page 36

 

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Within   St   Helens   local   authority,   the   highest   number   of   winter   injury   ED   attendances   came   from   Rainhill   (n=1,133),   Thatto  

Health  (n=1,081),  Grange  Park  (n=903),  Parr  and  Hardshaw  (n=781),  Haydock  (n=767)  and  West  Sutton  (n=765;  Map  9).    

Map   9:   Number   of   ED   attendances   by   ward   of   residency,   St   Helens   local   authority   residents   (winter   months   2011/12   to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

 

Males  from  St  Helens  local  authority  made  up  51%  of  attendances  (n=6,555)  and  just  under  one-­‐third  (32%)  were  aged  between  

30  and  59  years  (n=4,125).  

 

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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WIRRAL  

The  number  of  winter  injury  attendances  made  by  Wirral  local  authority  residents  to  a  Merseyside  and  Cheshire  ED  was  22,476,  

representing  10%  of  all  winter  injuries  made  by  Merseyside  and  Cheshire  residents.  There  were  7,419  winter  injury  attendances  

in  2011/12  which  increased  slightly  by  3%  in  2013/14  (n=7,631).    

Wirral  had  the  third  highest  number  of  attendances  across  all  Merseyside  local  authorities,  but  the  lowest  crude  rate  (7,017.3  

per   100,000   resident   population;   Figure   16).   Across   Merseyside   and   Cheshire,   Wirral   had   the   fourth   highest   number   of  

attendances,  but  the  third  lowest  crude  rate.      

Figure  16:  Crude  rate  of  ED  attendances  by   local  authority  of  residency,  Merseyside  and  Cheshire  residents  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

 

15258.1  

12657.4  

11240.3  

7300.0  

7017.3  

10831.2  

7726.2  

6605.8  

4797.2  

0   2000   4000   6000   8000   10000   12000   14000   16000   18000  

Knowsley  

Seqon    

Liverpool  

St  Helens  

Wirral  

Halton  

Cheshire  East  

Warrington  

Cheshire  West  and  Chester  

Mer

seys

ide  

Ches

hire

 

Crude  rate  (per  100,000)  

Loca

l  aut

horit

y  

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Within   Wirral   local   authority,   the   highest   number   of   winter   injury   ED   attendances   came   from   Upton   (n=1,404),   Claughton  

(n=1,332),  Birkenhead  (n=1,296),  Egerton  (n=1,294)  and  Tranmere  (n=1,279;  Map  10).    

Map  10:  Number  of  ED  attendances  by  ward  of  residency,  Wirral  local  authority  residents  (winter  months  2011/12  to  2013/14)    

 

 

 

 

 

 

 

 

 

 

 

 

Over   half   (52%)   of   attendees   from  Wirral   local   authority  were  male   (n=11,670)   and   just   over   three   in   ten   (31%)  were   aged  

between  30  and  59  years  (n=7,004).    

 

 

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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AMBULANCE  CALL  OUTS  ACROSS  MERSEYSIDE  AND  CHESHIRE  

NUMBER  OF  CALL  OUTS  AND  TRENDS  

There  were  a  total  of  53,131  ambulance  call  outs  due  to  injury  across  Merseyside  and  Cheshire  during  winter  between  2011/12  

and   2013/14.   The   number   of   call   outs   reduced   year   on   year   (Table   15);   with   an   overall   reduction   of   10%   from   2011/12   to  

2013/14.    

Table  15:  Number  of  ambulance  call  outs  due  to  injury  by  year  (winter  months  2011/12  to  2013/14)  

Year   December   January   February   Total  

2011/12   6061   6380   6187   18628  

2012/13   6523   5935   5308   17766  

2013/14   6142   5543   5052   16737  

Total   18726   17858   16547   53131  

LOCATION  OF  CALL  OUT  

Table  16  illustrates  the  local  authority  of  ambulance  call  out  location  over  the  past  three  wintersR.  Almost  one-­‐quarter  (23%)  of  

all  call  outs  were  made  to  Liverpool  local  authority  (n=12,061),  followed  by  14%  to  Wirral  (n=7,635)  and  12%  to  Sefton  (n=6,163)  

local  authorities.    

Table  16:  Number  and  percentage  of  ambulance  call  outs  by   local  authority  of  call  out   location  (winter  months  2011/12  to  2013/14)  

Local  authority   n   %  

Liverpool   12061   23%  

Wirral   7635   14%  

Sefton   6163   12%  

Warrington   4050   8%  

St.  Helens   3707   7%  

Knowsley   3065   6%  

Halton   2516   5%  

Cheshire  East   2391   5%  

Cheshire  West  and  Chester   2074   4%  

Macclesfield   2059   4%  

Chester   1790   3%  

Crewe  and  Nantwich   1638   3%  

Vale  Royal   1570   3%  

Congleton   1272   2%  

Ellesmere  Port  &  Neston   1140   2%  

Total   53131   100%  

                                                                                                                                       R  The  North  West  Ambulance  Service  reports  on  the  location  where  the  ambulance  was  requested  to;  it  should  be  noted  that  this  may  not  be  the  same  location  at  which  the  incident  occurred  or  where  the  patient  resides.    

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The  20  wards  which  received  the  highest  number  of  ambulance  call  outs  are  presented  in  Table  17.  A  large  proportion  of  these  

wards  where  in  Liverpool  local  authority.  

Table  17:  Number  of  ambulance  call  outs  by  ward  of  call  out  location  (winter  months  2011/12  to  2013/14)  

Ward  name   Ward  code   Local  authority   Number  of  call  outs  Abercromby   00BYFA   Liverpool   1004  Everton   00BYFQ   Liverpool   947  Birkenhead   00CBFC   Wirral   816  Dukes   00CAGG   Sefton   670  Bewsey  and  Whitecross   00EUNC   Warrington   512  Cambridge   00CAGD   Sefton   498  Kensington   00BYFW   Liverpool   494  Broadgreen   00BYFG   Liverpool   478  Tuebrook   00BYGF   Liverpool   461  Linacre   00CAGL   Sefton   450  Anfield   00BYFD   Liverpool   445  Melrose   00BYFX   Liverpool   440  Tranmere   00CBFW   Wirral   440  City  &  St  Anne's   13UBGL   Cheshire  West  and  Chester   440  Seacombe   00CBFT   Wirral   430  Gillmoss   00BYFS   Liverpool   427  Granby   00BYFT   Liverpool   423  Fairfield  and  Howley   00EUNG   Warrington   416  New  Brighton   00CBFP   Wirral   412  Warbreck   00BYGJ   Liverpool   410  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Map  11  illustrates  the  number  of  ambulance  call  outs  by  ward  of  call  out  location,  overlaid  by  local  authority  boundaries.    

Map  11:  Number  of  ambulance  call  outs  by  ward  of  call  out  location,  overlaid  by  local  authority  boundaries  (winter  months  2011/12  to  2013/14)  

 

 

 

 

 

 

 

Key  (number  of  attendances):  

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PATIENT  DEMOGRAPHICS  

The   patient   demographics,   where   providedS,   of   ambulance   call   outs   across  Merseyside   and   Cheshire   are   shown   in   Figure   8.    

There  were  more  females  than  males  (females=26,746;  53%;  Figure  8a)  and  over  half  (51%)  of  ambulance  call  outs  during  winter  

were  made  to  those  aged  60  years  and  above  (n=24,627),   followed  by   just  under  three   in  ten  (28%)  aged  between  30  and  59  

years  (n=13,373;  Figure  8b).    

Figure  8:  Number  of  ambulance  call  outs  by  gender  and  age  group  (winter  months  2011/12  to  2013/14)  

a) GenderT                    b)  Age  groupU  

   

 

 

 

 

 

 

 

 

 

 

                                                                                                                                       S  Please  note  that  the  completion  of  patient  sex  and  age  is  poor.  T  There  were  2,041  records  with  the  gender  recorded  as  ‘unknown’  and  574  records  without  the  gender  recorded;  these  have  been  omitted  from  the  chart.  U  There  were  4,695  records  without  the  age  recorded;  these  have  been  omitted  from  the  chart.  

26746  23770  

Female  

Male  

1562   1254  

7620  

13373  

24627  

0  

5000  

10000  

15000  

20000  

25000  

30000  

0-­‐4   5-­‐14   15-­‐29   30-­‐59   60+  

Num

ber  o

f  am

bual

nce  

 cal

l  out

s  

Age  group  

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INCIDENT  TYPE  

Over   half   (55%)  of   all   ambulance   call   outs  were  due   to   injuries   sustained  by   a   fall   (n=29,219;   Table   17).  Overdose/poisoning  

(ingestion;   n=5,574)   and   psychiatric/suicide   attempt   (n=5,112)   each   accounted   for   10%   of   call   outs,   followed   by   9%   due   to  

traffic/transportation  accidents  (n=4,746).  

Table  17:  Number  and  percentage  of  ambulance  call  outs  by  incident  type  (winter  months  2011/12  to  2013/14)  

Incident  type   n   %  

Falls   29219   55%  

Overdose/poisoning  (ingestion)   5574   10%  

Psychiatric/suicide  attempt   5112   10%  

Traffic/transportation  accidents   4746   9%  

Traumatic  injuries  (specific)   3974   7%  

Assault/sexual  assault   2379   4%  

Burns  (scolds)/explosion   686   1%  

Choking   585   1%  

Stab/gunshot/penetrating  trauma   512   1%  

Animal  bites/attacks   172   0%  

Eye  problems/injuries   76   0%  

Drowning  (near)/diving  accident   51   0%  

Electrocution/lightning   45   0%  

Total   53131   100%  

 

 

 

 

 

 

 

 

 

 

 

 

 

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REFERENCES  

Association  of  Public  Health  Observatories  (2008)  Commonly  used  public  health  statistics  and  their  confidence  intervals  [online].  

Available  at:  http://www.apho.org.uk/resource/item.aspx?RID=48457  [Accessed  12th  December,  2013].  

British  Broadcasting  Corporation  (2014)  NHS  Drafts  in  extra  A&E  doctors  to  ‘bolster  units’  [online].  Available  at:  

http://www.bbc.co.uk/news/health-­‐29704925  [Accessed  21st  October,  2014].  

Dean,  M.  (1997)  The  NHS’s  comfortable  escape  from  “winter  chaos”.  The  Lancet  [online],  349  (9047),  pp.  261.  Available  at:  

http://www.thelancet.com/journals/lancet/article/PIIS0140-­‐6736(05)64877-­‐5/fulltext?version=printerFriendly  [Accessed  29th  

September,  2014].  

Doctors.net.uk  Limited  (2013)  Doctors.net.uk  [online].  Available  at:  http://www.doctors.net.uk/  [Accessed  28th  September,  

2014].  

Health  and  Social  Care  Information  Centre  (2009)  Trends  in  Consultation  Rates  in  General  Practice:  1995-­‐2009  [online].  Available  

at:  http://www.hscic.gov.uk/catalogue/PUB01077  [Accessed  30th  September,  2014].  

Liverpool  Commissioning  Group  (2013)  Do  you  know  what  your  options  are  this  winter?  [online].  Available  at:  

http://www.liverpoolccg.nhs.uk/News/2013/november/examine_your_options.aspx  [Accessed  6th  November,  2014].    

McNulty.  C.A.M.,  et  al  (2013)  Expectations  for  consultations  and  antibiotics  for  respiratory  tract  infection  in  primary  care:  the  RTI  

clinical  iceberg.  British  Journal  of  General  Practice  [online],  63  (612)  pp.429-­‐436.  Available  at:  

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693799/  [Accessed  11th  November,  2014].    

England  (2013a)  Senior  clinicians  urge  people  to  take  advice  early  on  health  problems  this  winter  [online].  Available  at:  

http://www.england.nhs.uk/2013/11/15/wint-­‐ad  [Accessed  28th  September,  2014].  

NHS  England  (2013b)  The  NHS  belongs  to  the  people:  a  call  to  action  [online].  Available  at:  http://www.england.nhs.uk/wp-­‐

content/uploads/2013/07/nhs_belongs.pdf.  24  October  2013    [Accessed  28th  September,  2014].  

Proprietary  Association  of  Great  Britain  and  Pharmacy  Voice  (2013)  Treat  yourself  better  with  pharmacist  advice  [online].  

Available  at:  http://www.treatyourselfbetter.co.uk  [Accessed  30th  September,  2014].  

Proprietary  Association  of  Great  Britain  and  Pharmacy  Voice  (2014)  Press  release:  NHS  facing  winter  pressures  as  millions  of  Brits  

visit  their  GP  or  A&E  as  first  port  of  call  for  winter  sniffles  [online].  Available  at:  

http://www.treatyourselfbetter.co.uk/pdf/140908_Treat_Yourself_Better_with_Pharmacist_Advice_launch_release_FINAL.pdf  

[Accessed  30th  September,  2014].  

The  British  Medical  Association   (2013)  The  British  Medical  Association  Briefing  Paper:  Beating   the   effects   of  winter   pressures  

[online].  Available  at:  http://bma.org.uk/winter-­‐pressures  [Accessed  7th  October,  2014].    

 

Jennifer Brizell, Stuart Cole, Karen A Critchley and Mark WhitfieldCentre for Public Health Research Directorate Faculty of Education, Health and Community Liverpool John Moores University 2nd Floor, Henry Cotton Building 15-21 Webster Street Liverpool L3 2ET

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ISBN: 978-1-908929-85-3 (web)