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History records that in December 1642, a Dutch seaman called Abel Tasman led his two ships, the Heemskerck and the Zeehaen, into Golden Bay, New Zealand, thinking he had found the western edge of Terra Australis Incognita. Back in Europe, people were over the fear they would drop off the edge of the earth if they sailed too far, but still believed there must be a great southern continent to balance the northern Eurasian continent, thereby stopping the otherwise unbalanced world from toppling over and rolling into space. The Dutch were just the people to find it, being the great explorers of the time, but finding it was not without risk their boats were small, the seas were big, their rations were scorbutic and there were sea monsters depicted on their maps. However, after a skirmish with the locals, Tasman decided the risk was too great and he sailed away without stepping on land. Exactly what happened is a little unclear, as there is only a cursory account, and only from Tasmans perspective. The local folk, Ngti T\u016bmatak\u014dkiri, might have written a different account were they able (rather than Abel). Suffice it to say, there was an altercation and some of Tasmans crew were lost. He labelled the place Murderers Bay as a concluding expression of his version of events. More recently, the bay was re-named Golden Bay by local real estate agents.More than a century later, an Englishman called James Cook came to New Zealand, fed his sailors oranges, used maps without sea monsters on them, and made landfall. The Dutch had missed their chance. Eager French sailors made an impression, but generally were too late. The English had set the scene for a persisting period of British colonisation and all the things that came with it not the least of which was rugby.History records that in October 2011, New Zealand won the Rugby World Cup. The English invented it, the French tried to ruin it and a Dutch brewery was sponsoring it, but it was the local emergency department left to resuscitate some of the consequences.In this edition of the Journal, Gardener and colleagues describe the experience of Auckland City Hospital Adult Emergency Department (ED) during the tournament.1 Eden Park, in Auckland, hosted the opening ceremony, the first game, both semi-finals and the final. The ED was the receiving hospital for medical events from Eden Park and from the central city Fan Zone. The ED planned for more than a year: planned again when games were redistributed from an earthquake-damaged Christchurch; spent approximately $50,000 on extra medical staffing; doubled the number of beds available in its Short Stay Unit; ran a publicity campaign; and established agreements with the three other emergency departments in greater Auckland to assist, if required. They saw 8% more patients overall, but with a number of surges of demand which overwhelmed capacity. Alcohol was a significant contributor to the increased demand.The paper is succinct, well written and is a useful example for other centres which might host similar events most significantly, of course, London for the 2015 Rugby World Cup. However, their paper raises an important question:While many probably including the major sponsor profited from this event, why did the health system incur a cost?In addition to the quantified money for extra medical staff, there are unquantified dollar costs associated with planning and with treating more patients. Furthermore, there are unknown opportunity costs missed or delayed opportunities for care. Auckland Hospital ED was overwhelmed on at least two occasions due to World Cup activities, such that ambulances had to queue to offload new patients and patients had to be diverted to other EDs in Auckland. During these occasions, the ED would have been significantly overcrowded with patients in corridors and the waiting areas, suffering delays for all phases of care, and with nurses, doctors and others able to spend less time with each patient.There is overwhelming evidence that this state of affairs is associated with worse patient experiences and outcomes, including higher mortality rates for the population of patients treated in overcrowded emergency departments.2Are we happy with this? Are we happy that an elderly lady with pneumonia might have received antibiotics later than she should have; that a child with asthma might have remained in a corridor sitting on his mothers lap inhaling the stale fumes of the sponsors product; that a girl with abdominal pain might have gone home unseen, disillusioned by the delay and frightened by the raucous clientele in the waiting room? Are we happy that, while the health system pays and its customers suffer, others are profiting from the Rugby World Cup?Statistics New Zealand notes financial gains, including an increase in New Zealands Gross Domestic Product, from increased international visitor arrivals, transport demands, international visitor spending, and increased activity in the retail, accommodation, and restaurant industries.3 Of course, the purveyors of alcohol are likely to have made a killing.What might have been done? It would seem that reduction and mitigation of the health harms of events such as the Rugby World Cup should have been part of the preparation. In this regard, harms might have been reduced by interventions primarily associated with alcohol use. During the London Olympics, alcohol-related harm was reduced and the likely effective interventions were the restricted advertising, appropriate service planning, and pricing strategies that were in place for the Games .4 The Rugby World Cup was sponsored by a brewery, the sponsors product was promoted heavily, and the party nature of the tournament (party central) was emphasised. It would seem the New Zealand Rugby World Cup approach was something opposite to the discouragement associated with the London Olympics.In addition to reducing the harms, there was further capacity to intervene prior to the harms overwhelming the local hospital. Swain and colleagues described their efforts to reduce the impact on Wellington Hospital due to the Wellington Rugby Sevens tournaments and the Wellington Rugby World Cup games. They worked successfully with their local council and ambulance service to provide more cost effective medical care for intoxicated people closer to the scene.5Our public hospitals sail close to the supply and demand wind. They cannot be expected to soak up the predictable health side-effects of events such as the Rugby World Cup. Efforts should be made to prevent harm and to mitigate the effects of the remaining harm on the hospital. Beyond this, the demand which cannot be prevented nor mitigated should be paid for.History records that the 2011 Rugby World Cup had many winners, but the public health system was a loser. History should not repeat.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Michael Ardagh, Professor of Emergency Medicine, University of Otago, Christchurch

Acknowledgements

Correspondence

Michael Ardagh, Professor of Emergency Medicine, University of Otago, Christchurch

Correspondence Email

Michael.ardagh@cdhb.health.nz

Competing Interests

- - Gardener M, Tim Parke T, Peter Jones P. Impact of the New Zealand 2011 Rugby World Cup on an Urban Emergency Department. New Zealand Medical Journal. 2015 July; 128 (1418) Ardagh M. How to achieve New Zealands shorter stay in emergency departments health target. New Zealand Medical Journal. 2010; 123 (1316) Statistics New Zealand. Impact of the Rugby World Cup in New Zealands macro-economic statistics http://www.stats.govt.nz/browse_for_stats/economic_indicators/NationalAccounts/impact-of-rugby-world-cup.aspx (accessed 12 July, 2015) Morleo M, Jones A, OKeefe M, et al. (Centre for Public Health). The Impact of the London 2012 Olympic and Paralympic Games on Alcohol-Related Ilness and Injury. July 2013. www.cph.org.uk (accessed 12 July, 2015). Swain A, Weaver A, Gray A et al. Ambulance Triage and Treatment at Major Rugby Events in Wellington, New Zealand: A Sobering Experience. New Zealand Medical Journal 2013 Apr; 126(1372)- -

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

History records that in December 1642, a Dutch seaman called Abel Tasman led his two ships, the Heemskerck and the Zeehaen, into Golden Bay, New Zealand, thinking he had found the western edge of Terra Australis Incognita. Back in Europe, people were over the fear they would drop off the edge of the earth if they sailed too far, but still believed there must be a great southern continent to balance the northern Eurasian continent, thereby stopping the otherwise unbalanced world from toppling over and rolling into space. The Dutch were just the people to find it, being the great explorers of the time, but finding it was not without risk their boats were small, the seas were big, their rations were scorbutic and there were sea monsters depicted on their maps. However, after a skirmish with the locals, Tasman decided the risk was too great and he sailed away without stepping on land. Exactly what happened is a little unclear, as there is only a cursory account, and only from Tasmans perspective. The local folk, Ngti T\u016bmatak\u014dkiri, might have written a different account were they able (rather than Abel). Suffice it to say, there was an altercation and some of Tasmans crew were lost. He labelled the place Murderers Bay as a concluding expression of his version of events. More recently, the bay was re-named Golden Bay by local real estate agents.More than a century later, an Englishman called James Cook came to New Zealand, fed his sailors oranges, used maps without sea monsters on them, and made landfall. The Dutch had missed their chance. Eager French sailors made an impression, but generally were too late. The English had set the scene for a persisting period of British colonisation and all the things that came with it not the least of which was rugby.History records that in October 2011, New Zealand won the Rugby World Cup. The English invented it, the French tried to ruin it and a Dutch brewery was sponsoring it, but it was the local emergency department left to resuscitate some of the consequences.In this edition of the Journal, Gardener and colleagues describe the experience of Auckland City Hospital Adult Emergency Department (ED) during the tournament.1 Eden Park, in Auckland, hosted the opening ceremony, the first game, both semi-finals and the final. The ED was the receiving hospital for medical events from Eden Park and from the central city Fan Zone. The ED planned for more than a year: planned again when games were redistributed from an earthquake-damaged Christchurch; spent approximately $50,000 on extra medical staffing; doubled the number of beds available in its Short Stay Unit; ran a publicity campaign; and established agreements with the three other emergency departments in greater Auckland to assist, if required. They saw 8% more patients overall, but with a number of surges of demand which overwhelmed capacity. Alcohol was a significant contributor to the increased demand.The paper is succinct, well written and is a useful example for other centres which might host similar events most significantly, of course, London for the 2015 Rugby World Cup. However, their paper raises an important question:While many probably including the major sponsor profited from this event, why did the health system incur a cost?In addition to the quantified money for extra medical staff, there are unquantified dollar costs associated with planning and with treating more patients. Furthermore, there are unknown opportunity costs missed or delayed opportunities for care. Auckland Hospital ED was overwhelmed on at least two occasions due to World Cup activities, such that ambulances had to queue to offload new patients and patients had to be diverted to other EDs in Auckland. During these occasions, the ED would have been significantly overcrowded with patients in corridors and the waiting areas, suffering delays for all phases of care, and with nurses, doctors and others able to spend less time with each patient.There is overwhelming evidence that this state of affairs is associated with worse patient experiences and outcomes, including higher mortality rates for the population of patients treated in overcrowded emergency departments.2Are we happy with this? Are we happy that an elderly lady with pneumonia might have received antibiotics later than she should have; that a child with asthma might have remained in a corridor sitting on his mothers lap inhaling the stale fumes of the sponsors product; that a girl with abdominal pain might have gone home unseen, disillusioned by the delay and frightened by the raucous clientele in the waiting room? Are we happy that, while the health system pays and its customers suffer, others are profiting from the Rugby World Cup?Statistics New Zealand notes financial gains, including an increase in New Zealands Gross Domestic Product, from increased international visitor arrivals, transport demands, international visitor spending, and increased activity in the retail, accommodation, and restaurant industries.3 Of course, the purveyors of alcohol are likely to have made a killing.What might have been done? It would seem that reduction and mitigation of the health harms of events such as the Rugby World Cup should have been part of the preparation. In this regard, harms might have been reduced by interventions primarily associated with alcohol use. During the London Olympics, alcohol-related harm was reduced and the likely effective interventions were the restricted advertising, appropriate service planning, and pricing strategies that were in place for the Games .4 The Rugby World Cup was sponsored by a brewery, the sponsors product was promoted heavily, and the party nature of the tournament (party central) was emphasised. It would seem the New Zealand Rugby World Cup approach was something opposite to the discouragement associated with the London Olympics.In addition to reducing the harms, there was further capacity to intervene prior to the harms overwhelming the local hospital. Swain and colleagues described their efforts to reduce the impact on Wellington Hospital due to the Wellington Rugby Sevens tournaments and the Wellington Rugby World Cup games. They worked successfully with their local council and ambulance service to provide more cost effective medical care for intoxicated people closer to the scene.5Our public hospitals sail close to the supply and demand wind. They cannot be expected to soak up the predictable health side-effects of events such as the Rugby World Cup. Efforts should be made to prevent harm and to mitigate the effects of the remaining harm on the hospital. Beyond this, the demand which cannot be prevented nor mitigated should be paid for.History records that the 2011 Rugby World Cup had many winners, but the public health system was a loser. History should not repeat.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Michael Ardagh, Professor of Emergency Medicine, University of Otago, Christchurch

Acknowledgements

Correspondence

Michael Ardagh, Professor of Emergency Medicine, University of Otago, Christchurch

Correspondence Email

Michael.ardagh@cdhb.health.nz

Competing Interests

- - Gardener M, Tim Parke T, Peter Jones P. Impact of the New Zealand 2011 Rugby World Cup on an Urban Emergency Department. New Zealand Medical Journal. 2015 July; 128 (1418) Ardagh M. How to achieve New Zealands shorter stay in emergency departments health target. New Zealand Medical Journal. 2010; 123 (1316) Statistics New Zealand. Impact of the Rugby World Cup in New Zealands macro-economic statistics http://www.stats.govt.nz/browse_for_stats/economic_indicators/NationalAccounts/impact-of-rugby-world-cup.aspx (accessed 12 July, 2015) Morleo M, Jones A, OKeefe M, et al. (Centre for Public Health). The Impact of the London 2012 Olympic and Paralympic Games on Alcohol-Related Ilness and Injury. July 2013. www.cph.org.uk (accessed 12 July, 2015). Swain A, Weaver A, Gray A et al. Ambulance Triage and Treatment at Major Rugby Events in Wellington, New Zealand: A Sobering Experience. New Zealand Medical Journal 2013 Apr; 126(1372)- -

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

History records that in December 1642, a Dutch seaman called Abel Tasman led his two ships, the Heemskerck and the Zeehaen, into Golden Bay, New Zealand, thinking he had found the western edge of Terra Australis Incognita. Back in Europe, people were over the fear they would drop off the edge of the earth if they sailed too far, but still believed there must be a great southern continent to balance the northern Eurasian continent, thereby stopping the otherwise unbalanced world from toppling over and rolling into space. The Dutch were just the people to find it, being the great explorers of the time, but finding it was not without risk their boats were small, the seas were big, their rations were scorbutic and there were sea monsters depicted on their maps. However, after a skirmish with the locals, Tasman decided the risk was too great and he sailed away without stepping on land. Exactly what happened is a little unclear, as there is only a cursory account, and only from Tasmans perspective. The local folk, Ngti T\u016bmatak\u014dkiri, might have written a different account were they able (rather than Abel). Suffice it to say, there was an altercation and some of Tasmans crew were lost. He labelled the place Murderers Bay as a concluding expression of his version of events. More recently, the bay was re-named Golden Bay by local real estate agents.More than a century later, an Englishman called James Cook came to New Zealand, fed his sailors oranges, used maps without sea monsters on them, and made landfall. The Dutch had missed their chance. Eager French sailors made an impression, but generally were too late. The English had set the scene for a persisting period of British colonisation and all the things that came with it not the least of which was rugby.History records that in October 2011, New Zealand won the Rugby World Cup. The English invented it, the French tried to ruin it and a Dutch brewery was sponsoring it, but it was the local emergency department left to resuscitate some of the consequences.In this edition of the Journal, Gardener and colleagues describe the experience of Auckland City Hospital Adult Emergency Department (ED) during the tournament.1 Eden Park, in Auckland, hosted the opening ceremony, the first game, both semi-finals and the final. The ED was the receiving hospital for medical events from Eden Park and from the central city Fan Zone. The ED planned for more than a year: planned again when games were redistributed from an earthquake-damaged Christchurch; spent approximately $50,000 on extra medical staffing; doubled the number of beds available in its Short Stay Unit; ran a publicity campaign; and established agreements with the three other emergency departments in greater Auckland to assist, if required. They saw 8% more patients overall, but with a number of surges of demand which overwhelmed capacity. Alcohol was a significant contributor to the increased demand.The paper is succinct, well written and is a useful example for other centres which might host similar events most significantly, of course, London for the 2015 Rugby World Cup. However, their paper raises an important question:While many probably including the major sponsor profited from this event, why did the health system incur a cost?In addition to the quantified money for extra medical staff, there are unquantified dollar costs associated with planning and with treating more patients. Furthermore, there are unknown opportunity costs missed or delayed opportunities for care. Auckland Hospital ED was overwhelmed on at least two occasions due to World Cup activities, such that ambulances had to queue to offload new patients and patients had to be diverted to other EDs in Auckland. During these occasions, the ED would have been significantly overcrowded with patients in corridors and the waiting areas, suffering delays for all phases of care, and with nurses, doctors and others able to spend less time with each patient.There is overwhelming evidence that this state of affairs is associated with worse patient experiences and outcomes, including higher mortality rates for the population of patients treated in overcrowded emergency departments.2Are we happy with this? Are we happy that an elderly lady with pneumonia might have received antibiotics later than she should have; that a child with asthma might have remained in a corridor sitting on his mothers lap inhaling the stale fumes of the sponsors product; that a girl with abdominal pain might have gone home unseen, disillusioned by the delay and frightened by the raucous clientele in the waiting room? Are we happy that, while the health system pays and its customers suffer, others are profiting from the Rugby World Cup?Statistics New Zealand notes financial gains, including an increase in New Zealands Gross Domestic Product, from increased international visitor arrivals, transport demands, international visitor spending, and increased activity in the retail, accommodation, and restaurant industries.3 Of course, the purveyors of alcohol are likely to have made a killing.What might have been done? It would seem that reduction and mitigation of the health harms of events such as the Rugby World Cup should have been part of the preparation. In this regard, harms might have been reduced by interventions primarily associated with alcohol use. During the London Olympics, alcohol-related harm was reduced and the likely effective interventions were the restricted advertising, appropriate service planning, and pricing strategies that were in place for the Games .4 The Rugby World Cup was sponsored by a brewery, the sponsors product was promoted heavily, and the party nature of the tournament (party central) was emphasised. It would seem the New Zealand Rugby World Cup approach was something opposite to the discouragement associated with the London Olympics.In addition to reducing the harms, there was further capacity to intervene prior to the harms overwhelming the local hospital. Swain and colleagues described their efforts to reduce the impact on Wellington Hospital due to the Wellington Rugby Sevens tournaments and the Wellington Rugby World Cup games. They worked successfully with their local council and ambulance service to provide more cost effective medical care for intoxicated people closer to the scene.5Our public hospitals sail close to the supply and demand wind. They cannot be expected to soak up the predictable health side-effects of events such as the Rugby World Cup. Efforts should be made to prevent harm and to mitigate the effects of the remaining harm on the hospital. Beyond this, the demand which cannot be prevented nor mitigated should be paid for.History records that the 2011 Rugby World Cup had many winners, but the public health system was a loser. History should not repeat.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Michael Ardagh, Professor of Emergency Medicine, University of Otago, Christchurch

Acknowledgements

Correspondence

Michael Ardagh, Professor of Emergency Medicine, University of Otago, Christchurch

Correspondence Email

Michael.ardagh@cdhb.health.nz

Competing Interests

- - Gardener M, Tim Parke T, Peter Jones P. Impact of the New Zealand 2011 Rugby World Cup on an Urban Emergency Department. New Zealand Medical Journal. 2015 July; 128 (1418) Ardagh M. How to achieve New Zealands shorter stay in emergency departments health target. New Zealand Medical Journal. 2010; 123 (1316) Statistics New Zealand. Impact of the Rugby World Cup in New Zealands macro-economic statistics http://www.stats.govt.nz/browse_for_stats/economic_indicators/NationalAccounts/impact-of-rugby-world-cup.aspx (accessed 12 July, 2015) Morleo M, Jones A, OKeefe M, et al. (Centre for Public Health). The Impact of the London 2012 Olympic and Paralympic Games on Alcohol-Related Ilness and Injury. July 2013. www.cph.org.uk (accessed 12 July, 2015). Swain A, Weaver A, Gray A et al. Ambulance Triage and Treatment at Major Rugby Events in Wellington, New Zealand: A Sobering Experience. New Zealand Medical Journal 2013 Apr; 126(1372)- -

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