The calm before the storm

8.20pm, Cardiff

Facebook Twitter Pinterest Police officers at Cardiff Central police station listen to the Cardiff After Dark briefing before heading out into the city. Photograph: Gareth Phillips/The Guardian

We’re at the Cardiff ATC – alcohol treatment centre; a collaboration between Cardiff and Vale University health board, local councils, South Wales police, the Welsh ambulance service and Cardiff Street Pastors. Right now, the police are preparing for the evening with a “Cardiff After Dark” meeting in the Welsh capital’s main police station.

Sgt Gavin Howard briefs his team on what they’re doing tonight, with a slideshow with some interesting facts and figures. Last month, there were 145 people treated at the ATC, which is designed to ease pressure on hospital A&E staff by treating people with minor injuries and people suffering from too much drink.

Howard reminds officers to look out for revellers who “pre-load” – drink heavily and cheaply at home before heading into the city centre. Pre-loading is seen as a particular problem for the emergency services – the kids call it “prinking” – pre-drinking. Steve Morris

9.09pm, Southampton

Facebook Twitter Pinterest Consultant Dr Diana Hulbert, working in University hospital, Southampton, in the accident and emergency. Photograph: Antonio Olmos/The Guardian

Emergency consultant Diana Hulbert, who is in charge tonight, explains that not all alcohol-related attendances happen after a night on the town. “A classic one is people waking up the next day and finding their wrist turned the wrong way,” says Hulbert. So people are just as likely to present on the morning after.

She doesn’t judge people who turn up in the department because of alcohol-related injuries or accidents, but says over the past 20 years she had noticed changes that are concerning.

“People drink differently. Spirits is more a young person’s drink and they can make people profoundly drunk very quickly. A beer is two units and you can’t drink that many, maybe 10 pints. But if you’re drinking shots, you can down five in five minutes. That’s what young people do.” Lisa O’Carroll

Keeping people out of A&E



Across the country, teams of people tour the streets treating relatively minor injuries suffered by people out on the town. In Manchester, they are called the Street Angels; Cardiff and other cities have their Street Pastors and, in Leicester, they are the Polamb.

Facebook Twitter Pinterest Members of the Manchester Street Angels call a young woman’s father in order to help her get home. Photograph: Gary Calton/The Guardian

9.15pm, Leicester

On some nights the Polamb – police-ambulance alcohol treatment vehicle in Leicester – is a hub for treating people with alcohol-related injuries, attending up to 15 incidents in a night. It gets to the point that some of the local people recognise the Polamb and the paramedics who drive it. Jane Squire, East Midlands ambulance service paramedic, says one man she used to see regularly in the streets, a heavy drinker who would often call the ambulance for help, called her his “green angel”, for the dark green of the ambulance service uniform.



“Sometimes they’ll come up have a conversation with you and say: ‘I’ve cut my finger, can I have a plaster?’” says Squire. “Other times they’ll come up and say: ‘I’ve hurt my hand, can you take me to hospital?’ and I’ll say: ‘It says ambulance, not taxi.’”

Facebook Twitter Pinterest Emergency services in Leicester city centre. Photograph: Kate Lyons/The Guardian

But the first call-out the Polamb has received now that the policeman for the evening, Const Joe Couchman, is on board is more serious – treating a man in his 40s who suffered a cardiac arrest on the street. This isn’t a typical call-out for the Polamb, not being alcohol-related, though it is believed the man was a heavy drinker, but they go where the need arises. Kate Lyons

11.13pm, Edinburgh

Facebook Twitter Pinterest Tony Clapham (left) with his team of Edinburgh Street Pastors out on the streets. Photograph: Murdo Macleod/The Guardian

At Greenside parish church on Royal Terrace, in the centre of Edinburgh, the city’s Street Pastors are preparing for the night with tea, home baking and a rousing hymn or two.

Street Pastors is an initiative of the Ascension Trust and was pioneered in London in 2013. It is now active in 270 towns and cities across the UK.

Street Pastors are volunteers from local churches who patrol in teams of men and women, usually from 10pm to 4am on a Friday and Saturday night, to care for, listen to and help people who out on the streets, whether celebrating on a hen night or homeless.

Two teams are going out tonight, one to the Grassmarket and another to George Street, with backpacks containing flasks of hot drinks and biscuits.

As team leader Tony Clapham explains, some of these volunteers have been working on the night time streets and have built up strong relationships with homeless people, as well as police and paramedics and other concerned with health and safety of the night time economy. Libby Brooks

Midnight, Stoke

Facebook Twitter Pinterest Senior sister Nicola Beckett tries to wake a man who has come into A&E with suspected alcohol abuse issues at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter/The Guardian

One man, a regular alcohol abuser, has run off from hospital, and senior sister Nicola Beckett has to send police to find him, because he is now deemed a vulnerable adult as he has not had full medical checkups.

The hospital now has so many regular attendees they have a special group for them all, which flags up if someone has been in more than three times a month. Sometimes Beckett sees someone twice a day.

Facebook Twitter Pinterest Paramedic Tracy Proud (2nd left, purple hair) along with paramedic colleagues care for an unconscious man who is admitted to A&E with suspected alcohol abuse issues at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter/The Guardian

“You do get friendly with them, they are as nice to you as you are to them. You do see them decline, the physical decline. You admit them to rehab but you just know you’ll see them again. It’s an addiction, an illness. So many, you are discharging them and they say: ‘I’ve got no home to go to.’ You sometimes do get a sense they are here for a hot meal and a bed and a kind face.”

Beckett has seen some terrifying moments too. “I don’t want to make it too dramatic. But yes, I have feared for my life. You are trained in conflict management, self-defence. But if someone is drunk and aggressive, I can’t handle that myself.”

Elsewhere, she reported, patients were queuing on beds in the corridor at the ambulance triage. Paramedic Tracy Proud was liaising with A&E staff to speed up the transfer of people.

Facebook Twitter Pinterest Paramedic Tracy Proud. Photograph: Alicia Canter/The Guardian

“It’s ridiculous,” she said, looking over her shoulder at the queue of beds behind her. One patient has a can of Skol under the trolley.

“I think if you went through most of the patients, 85% shouldn’t be here. People have a different view about what an emergency is. If I’m called to look after a teenager or young person who is drunk, I call their parents straight away. Parents don’t realise it, but it’s not our job to just be watching a drunk person who has passed out.”

Agitated patients have lashed out in the back of moving ambulance. “I had one patient who I thought was asleep and he came to, and he turned on me. I had to jump out the side door of the van.” Jessica Elgot

Facebook Twitter Pinterest A nurse attends to a young female student from Keele University who has been taken to A&E with suspected alochol abuse issues and is treated in resus at Royal Stoke University hospital in Stoke-on-Trent Photograph: Alicia Canter/The Guardian

12.17am, Manchester

Josh Halliday speaks with chief Angel, Rachel Goddard.

12.58am, Southampton

Facebook Twitter Pinterest Nurse Katherine Chipande working in A&E at University hospital, Southampton. Photograph: Antonio Olmos/The Guardian

A night out in Southampton has turned into a night in A&E for one young woman who has just been admitted with a head injury. “She had been at a party and fell and hit her head. There was alcohol and drugs,” said nurse Catherine Chipande.



There are about 20 other patients in the “majors” area with two sleeping off the alcohol and a third about to be assessed.

Trouble

1.17am, Liverpool

Two Mikes, 23 and 32, a Carl, 18 and a Tom, 23, are sitting in a pub in the small hours. None has ever ended up in A&E, though Tom’s “ended up in the drunk and disorderly, you know, the police”. He got tangled up in the theft of a plastic ornament and jostled a plain clothes police officer leaping from a Vauxhall Corsa, five years ago. “This is my time,” he says triumphantly, “to get my story out. If I’d known he were a copper, things would have gone very differently. I was at my auntie’s 40th.”

Mike the younger said: “Things happen when you’re drunk. I hit my cousin in the face on my 20th birthday.”

“The bottom line,” said Mike the older, “is that if you’re trouble, trouble will find you.” “Yes,” said the younger Mike resoundingly. “My cousin went to Krazy House ... ” “Is that with a C or a K?” “How can you ask that?” (they all shake their heads). “And the next thing you know, he’s had his nose broken.” “Is this the same cousin you punched in the face?” “I gave him a black eye. Someone else broke his nose. There’s levels. I know this, I studied law at A level.”

The older Mike takes control. “This is a beautiful place. This isn’t a degenerate place. Independent bars, independent clubs, independent eateries. The transformation of Liverpool, the systemic regeneration of every part of this city, is almost beyond compare. I love this city and the people of this city.” Zoe Williams

The view from the professionals

1.26am, Southampton

All has been calm in the assessment area in Southampton until now when a very aggressive drunk man is admitted with a cut to his face, swearing at anyone in sight. He is being held down by two policemen. We are advised not to go near him. “Fuck off,” he shouts to a female ambulance crew member accompanying him.



The man is refusing to cooperate as he is placed in a bay next to an elderly lady, beaming with a grateful smile towards the two nurses attending to her.

It takes a while for experienced staff to calm down the 29-year-old. Then it’s all sweetness and light, with a friendly hello for staff as he is wheeled in to “majors” for further assessment.

“Sometimes it’s like that but sometimes they don’t calm down at all and they get carried out in handcuffs. If it gets too bad and they have been assessed and they are not too bad they are just taken away by police,” said receptionist Sarah Jones. Lisa O’Carroll

1.46am, Manchester

Outside Deansgate Locks, a popular party spot with several bars and clubs, it’s not quite kicking out time but we’re already seeing a couple of early casualties. A drunk girl has fallen and cut her knee badly. She’s crying on the phone to her parents while being treated by the Street Angels. Another job saved from paramedics. Josh Halliday

1.51am, Stoke

Facebook Twitter Pinterest Dr Ben Arnold in A&E at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter/The Guardian

Dr Ben Arnold, a senior house office in emergency medicine, loves a Friday night in the minor injuries section.



“I like drunk people when they are not so unwell, you can joke with them. Their friends have brought them in because they’re worried about them, but from a medical point of view, they’re healthy, you can have a chat. There’s a common theme which colours the excuses made by revellers as they come round in A&E.

“They say their drink has been spiked, their friends say: ‘They always drink this much, it must be something in the drink.’ But it obviously is because they have had more than usual or haven’t eaten enough.

“It’s younger ones, 18-year-olds, who are more honest about it. They do get very embarrassed especially if they have had a loss of continence. And they have to go home in a hospital gown.”

Sometimes, it’s not just the patients causing Arnold all the bother. “It’s friends and relatives who might be a bit drunk. They get bored, they dress up in the gloves and gowns, mucking about and you have to go and remind them that a hospital is a serious place.” Jessica Elgot

1.55am, Cardiff

Facebook Twitter Pinterest A nurse helps a very drunk teenager at the ATC in Bridge Street, Cardiff. Photograph: Gareth Phillips/The Guardian

An 18-year-old student is found lying alone, clearly drunk, on the pavement close to the university. There were a series of sexual assaults on women in this area last year so passersby are worried and dial 999.



She has not been assaulted but has simply drunk too much at a house party. An ambulance crew arrives and takes her to the alcohol treatment centre – ATC. She is sick on the way and sick several times at the ATC.

At the ATC she is assessed and given water. Ceri Martin, a sister, and Charlotte Pritchard, a healthcare support worker tend to her. She is joined by a friend at the ATC and they sit together, slumped in a corner, waiting for her to recover.

“She’ll be here for two or three hours while she gets herself together,” said Martin. “We’ll get her to drink water, observe her and keep her warm. Then we’ll make sure she gets home safely.

“I’m just glad that there’s a place like this for young women like that. She’s in a safe place and we’re helping keep pressure off A&E.”

A street pastor radios in to say she is bringing someone in to the ATC. “So it begins,” says Pritchard. It still could be a long night/morning here.

But it’s not always a thankless task, as this note at the ATC indicates:

steven morris (@stevenmorris20) A grateful patient cared for at the alcohol treatment centre in Cardiff. pic.twitter.com/CiLLATTFIV

2am, Manchester

Facebook Twitter Pinterest Josh Halliday talks to Street Angel volunteer Paul Jones

2.01am, Southampton

Facebook Twitter Pinterest Suspected drunk male brought into the assessment area of A&E in University hospital, Southampton. Photograph: Antonio Olmos/The Guardian

Two more alcohol admissions in Southampton in the space of 10 minutes, one so inebriated he is semi-conscious.



“The worry here is that the alcohol might mask a head injury,” says nurse Sam Carter. “So we do a set of neuro obs [observations] and lactate assessment to see if he is dehydrated. We might also resort to pain stimuli, squeeze his trapezium really hard to check his responses,” she adds. Ouch. Lisa O’Carroll

2.10am, Stoke

Back in Stoke, there are 99 patients in A&E at 2am, which is an achievement for the staff, the first time numbers have dropped below 100 since 4.30pm yesterday. Patients are being discharged, or waiting to be admitted to other departments as beds there become available. Though some staff are beginning to end their shifts, many others are here until the morning. More than 100 people have come through the doors already since midnight; some who have overindulged tonight are on trollies in the corridor making emotional phone calls. There is more work to do before the night is over for A&E staff – five more ambulances are on their way. Jessica Elgot