Background Injecting drug use contributes significantly to morbidity, mortality and broader social harms globally. Supervised Injecting Facilities (SIFs) are harm reduction interventions that reduce overdose risk and facilitate access to health services for marginalised individuals. While international evidence supports the effectiveness of SIFs, Australian population-level surveillance data quantifying their impact on emergency medical service utilisation remain limited. Methods Using data from the National Ambulance Surveillance System, we conducted a retrospective, interrupted time series analysis of heroin-related ambulance attendances within the local catchment of the Medically Supervised Injecting Room (MSIR) between January 2015 and December 2023. Supplementary analysis included comparisons with central Melbourne suburbs and the broader state of Victoria. Key intervention timepoints, including the opening of the MSIR on 30 June 2018, expansion of its operating hours in July 2019, and the COVID-19 pandemic from April 2020 to October 2021, were examined to assess changes in heroin-related attendances over time. Segmented regression models were used to assess changes in heroin-related ambulance attendance trends over time. Results At the time the MSIR opened, the model-predicted heroin-related ambulance attendance rate within the MSIR catchment was 123 per 100,000 population per month, equivalent to approximately 48 heroin-related ambulance attendances per month. Prior to implementation, the attendance rate was increasing by an estimated 0.74 per 100,000 population per month. Following the opening of the MSIR, the previously increasing trajectory reversed, with ambulance attendance rates declining by approximately 2.3 per 100,000 population per month relative to the pre-intervention trend. By the end of the study period (December 2023), the predicted monthly heroin-related ambulance attendance rate had declined to 36 per 100,000 population (approximately 14 attendances per month), representing an overall reduction of 70.7% from the time of MSIR implementation. These reductions persisted throughout the COVID-19 lockdown period and were sustained after restrictions lifted. Supplementary analysis showed no comparable reductions in the central Melbourne region or the remainder of Victoria. Conclusions The introduction of the MSIR in Richmond was associated with a sustained reduction in heroin-related ambulance attendances within its catchment area. These findings provide strong population-level evidence that SIFs reduce acute heroin-related harms requiring emergency ambulance response, reinforcing their role as an effective harm reduction strategy within the Australian context.

In Australia, adolescent suicidal and non-suicidal self-injury (NSSI) behaviours have been steadily increasing over that past two decades. However, existing research on the geographic distribution of these behaviours in Australia largely focuses on adults, suicides, or uses pre-COVID-19 data. This study aimed to map and describe the geographic regions where ambulance attendances for adolescent suicidal and NSSI behaviours are occurring. Data from the National Ambulance Surveillance System were used to analyse three-year averages and per capita rates of ambulance attendances for adolescents (12-17 years) across local government areas in New South Wales (NSW), Victoria, and Tasmania from 2021 to 2023. The three-year annual average of ambulance attendances for adolescent suicidal behaviour and NSSI were 6,504 in NSW (35.94 per 10,000), 4,017 in Victoria (25.61 per 10,000), and 444 in Tasmania (44.86 per 10,000). Nearly 90% of attendances required transport to hospital, and over 50% occurred outside traditional service hours. Results identified that Major Cities and high socioeconomic status (SES) local government areas (LGAs), were significantly less likely to have higher rates of ambulance attendances for adolescent suicidal and NSSI behaviours. This study highlights substantial variability across three eastern states of Australia where adolescent suicidal and NSSI behaviours are occurring, demonstrating the need for accessible after-hours mental health support, and that regional and lower SES LGA's are disproportionately impacted. Given the concerning state of adolescent mental health in Australia, this study highlights the need for targeted, data-informed responses to reduce the current reliance on emergency care.

Background: Alcohol harms changed significantly during COVID-19, but did not affect the population equally. Vulnerable groups including people with pre-existing mental health or suicidal behaviors may be at greater risk of alcohol-related harms, yet limited public health data are able to assess these. Methods: The present study utilised a novel, statewide surveillance system to examine ambulance attendances for alcohol intoxication over a four-year period prior to, and during the strictest lockdowns in Victoria, Australia. Results: While there was an overall reduction in alcohol-related attendances during lockdown (n = 15,064) compared to the 2018-19 period (n = 16,989), alcohol- intoxication attendances involving mental health symptoms increased by 40 % in Melbourne (IRR: 1.40 [1.30-1.51], p < 0.001), and by 25 % in regional Victoria (IRR: 1.25 [1.07-1.44], p = 0.005).There was also a 7 % increase in alcohol-intoxication attendances with co- morbid suicidal behaviors in Melbourne (IRR: 1.07 95%CI [1.02-1.13], p = 0.006), and a 21 % increase in regional Victoria (IRR: 1.21 [1.08-1.35], p = 0.001). Conclusions: These findings suggest that extra services and supports for individuals with co-morbid alcohol- related harms are required to ensure their clinical care needs are being met.

Limited surveillance mechanisms have investigated the acute harms associated with intimate partner violence (IPV). This study used novel coded ambulance data to examine the socioeconomic and geographical remoteness distribution of IPV victim survivors attended to by paramedics in the context of acute alcohol and/or drug and mental health harms. Coded ambulance records involving IPV (N = 1484) from 2016 to 2018 were extracted from the Victorian arm of the National Ambulance Surveillance System. Regression models were used to examine sociodemographic characteristics associated with IPV-related ambulance attendances. These attendances were more likely to be associated with the most disadvantaged socioeconomic areas (incidence rate ratio (IRR) = 3.56, 95 % CI 2.71-4.67), and occur in outer regional and remote areas (IRR = 1.58, 95 % CI 1.07-2.35). Ambulance data offers unique potential to map and predict socioeconomic and geographical help-seeking in IPV victim survivors.

BackgroundPeople in justice settings experience higher rates of psychiatric morbidity, including alcohol and drug use disorders, compared with the general population. However, our understanding of opioid-related harms in justice settings is limited. This study used ambulance data to examine opioid-related harms and experiences of care in New South Wales (NSW), Australia, during periods of incarceration or detention.MethodsThis mixed-methods study used data from the National Ambulance Surveillance System (NASS) for patients aged 18 and older with an opioid-related ambulance attendance between December 2020 and April 2023. People in justice settings were identified using ambulance billing codes and manual review of paramedic case notes. Descriptive statistics described the patterns and modalities of opioid-related harms in justice settings, and a qualitative thematic analysis of paramedic case notes was used to contextualise findings. Results Over the study period, 328 opioid-related ambulance attendances for people in justice settings were identified (51% heroin; 41% opioid agonist therapy (OAT) medication). Symptoms of opioid withdrawal were noted in 35% of attendances, most commonly for heroin (51%) and withdrawal from OAT medications (48%). Three interconnected themes were identified using qualitative analysis: trust and mistrust in justice settings, systemic barriers to providing OAT, and other harm reduction strategies, and experiences of withdrawal in justice settings.ConclusionOur study demonstrated the utility of ambulance data in identifying opioid-related harms for people in justice settings in NSW. Qualitative findings highlight current barriers to effective opioid care in justice settings and identify opportunities for intervention, including targeted harm reduction programs, as well as policies that promote continuity of care particularly during transitions in and out of justice settings.

Purpose: This study investigated changes in suicidal ideation, attempts, and nonsuicidal self -injury (NSSI)-related ambulance attendances among adolescents during the COVID-19 pandemic. Methods: An interrupted time series analysis using data from the National Ambulance Surveillance System, a globally unique mental health and suicide surveillance system. Patients aged 12 -17 years from the state of Victoria, Australia who were attended by ambulance for suicide attempts, suicide ideation, and NSSI between January 2016 and October 2021 were included. Monthly ambulance attendances during the pre-COVID period (January 2016 -March 2020) were compared to those in the peak period of COVID-19 (April 2020 -October 2021). Results: There were 20,125 ambulance attendances for suicide ideation, suicide attempt, and NSSI in adolescents over the study period. During the pre-COVID period, the number of suicide ideation, attempts, and NSSI attendances was increasing by 1.1% per month (incidence rate ratio [IRR]:1.011; 95% confidence interval [1.009-1.013], p < .001). There was no change in the rate of all suicide ideation, attempt, and NSSI for all adolescents during the period of COVID-19. However, when disaggregated by gender, there was a 0.7% increase in the monthly rate of attendances for females (IRR: 1.007 [1.001-1.013], p 1 / 4 .029), and a 3.0% decrease for males (IRR: 0.970 [0.964-0.975], p < .001). Discussion: Adolescent female suicide ideation, attempt, and NSSI attendances increased during the COVID-19 period, compared with males in the same time period. These findings suggest tailored intervention strategies may be needed to address the increasing trends of self -harm among young people. (c) 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

OBJECTIVE:Preventable transmission of blood-borne viruses (BBV), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV), continue in at-risk populations, including people who use alcohol and drugs (AODs). To our knowledge, no studies have explored the use of ambulance data for surveillance of AOD harms in patients with BBV infections. METHODS:We used electronic patient care records from the National Ambulance Surveillance System for people who were attended by an ambulance in Victoria, Australia between July 2015 and July 2016 for AOD-related harms, and with identified history of a BBV infection. Descriptive and geospatial analyses explored the epidemiological and psychosocial characteristics of patients for these attendances. RESULTS:The present study included 1832 patients with a history of a BBV infection who required an ambulance for AOD-related harms. Amphetamines were reported in 24.7% of attendances where the patient identified HIV history, and heroin was reported more often for patients with viral hepatitis history (HCV: 19.2%; HBV: 12.7%). Higher proportions of attendances with a viral hepatitis history were observed in patients from the most socially disadvantaged areas. Geospatial analyses revealed higher concentrations of AOD attendances with a BBV history occurring in metropolitan Melbourne. CONCLUSIONS:Our study describes the utility of ambulance data to identify a sub-population of patients with a BBV history and complex medical and social characteristics. Repeat attendances of BBV history patients to paramedics could present an opportunity for ongoing surveillance using ambulance data and possible paramedic intervention, with potential linkage to appropriate BBV services.

BACKGROUND AND AIMS:Public health measures introduced to contain the spread of the SARS-CoV-2 virus likely affected opioid supply and demand, as well as the patterns and contexts of opioid use. We measured opioid-related harms during the first 2 years of COVID-19 restrictions in Victoria, Australia. DESIGN:We adopted an interrupted time series analysis design using interventional autoregressive integrated moving average (ARIMA) models. Opioid-related ambulance attendance data between January 2015 and March 2022 were extracted from the National Ambulance Surveillance System. SETTING:Victoria, Australia. PARTICIPANTS:Patients (≥15 years) attended to by an ambulance for opioid-related harms. MEASUREMENTS:Monthly opioid-related ambulance attendances for three drug types: heroin, prescription opioids and opioid agonist therapy (OAT) medications. FINDINGS:The monthly rate of heroin-related attendances fell by 26% immediately after the introduction of COVID-19 restrictions. A reduced rate of heroin-related attendances was observed during COVID-19 restrictions, resulting in 2578 averted heroin-related attendances. There was no change in the rate of attendances for extra-medical OAT medications or prescription opioids. CONCLUSIONS:Strict COVID-19 restrictions in Victoria, Australia appear to have resulted in a substantial reduction in heroin-related ambulance attendances, perhaps because of border closures and restrictions on movement affecting supply, changing patterns of drug consumption, and efforts to improve access to OAT. Despite policy changes allowing longer OAT prescriptions and an increased number of unsupervised doses, we found no evidence of increased harms related to the extra-medical use of these medications.