Christmas is a time for families and friends to come together, relax and enjoy themselves. It’s a time of giving and receiving and of feasting – and perhaps, for some, a celebratory tipple. But sometimes, yuletide plans can go awry. And some of these purported pleasures might lead to a visit to the local emergency department.
The holiday season is often one of the busiest times in A&E departments in the UK and around the world. But Christmas day itself is actually the least busy day of the bunch. In my A&E department, attendances temporarily fall by up to a third on Christmas day.
This is perhaps unsurprising, as people will want to be with their families on December 25th. So those who might have otherwise visited the emergency department with less urgent reasons for attending may prioritise their family time on that day instead.
Unfortunately, the remainder of the Christmas season sees a surge in attendances – *and the number of these Christmas attendances in the UK is rising by around 4% each year.
The reasons for this surge are quite complex. One explanation is that primary care is less available over the holidays. We actually see the same sort of surge in A&E attendances around Easter too.
Another reason is that patients are unable to visit their general practitioners, so they go elsewhere, often to the emergency department.
This time of year is particularly stressful for staff, so many apply for annual leave over that time as a consequence. Senior staff are also often unavailable because staffing is reduced and many want to be with their families.
All of these factors combined explain why A&E is often uniquely packed around the holidays. Some of the problems that land people in A&E at this time of year are also unique to the Christmas period.
Overindulgence
Food, alcohol and drugs are often taken to excess at Christmas.
Alcohol is a common reason for attendances during public holidays worldwide. Even on regular weekends, up to 70% of A&E attendances in the UK are alcohol related.
Alcohol intoxication is a significant burden on emergency departments. Unruly drunken patients may cause disruption. Patients who are rendered unconscious by alcohol require careful monitoring to ensure they don’t fill their airways with vomit.
Gluttony can also bring someone to the emergency department. Eating and drinking too much can cause acid reflux, which in severe cases can mimic the symptoms of a heart attack. However, the number of these attendances are dwarfed by the number of those related to alcohol misuse.
Accidents
Christmas presents can sometimes be a significant threat to safety.
Over 40 years ago, poisoning and burns related to chemistry sets were quite common and sometimes fatal. In more recent times, it’s electric scooters which have become a significant threat due to collisions and lithium battery-related fires.
Christmas trees – particularly artificial ones – can also cause injuries. In fact, artificial Christmas trees carry a sixfold higher risk of injury over real ones. Fires, electrical injuries and blunt injuries have all been reported.
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Some of those glass baubles can be quite nasty too. The glass is sharp, thin and in my experience, sometimes quite difficult to locate and extract from a wound.
Violence
Christmas is said to be the season of good will. Sadly, this is not always the case. The Christmas period sees an increase in the incidence of assaults. These are commonly alcohol related, and may occur within families or even outside in the community.
There’s also an increase in sexual assault and domestic violence at Christmas. Much of this comes to the emergency department.
Poor mental health
Loneliness is rife in old and young alike. Christmas sees an increase in those feeling desperate – and in some cases, harming themselves.
Psychiatric services come under particular pressure at this time. The number of these attendances at Christmas are no higher compared to the rest of the year but services are less well staffed so patients may be waiting longer for support.
Elder abuse
One of the most egregious things we see in emergency departments is the abandonment of elderly relatives by families wishing to rid themselves of them for a quieter time at home or perhaps make their holiday celebrations easier.Known as “granny dumping, this involves people bringing a relative to A&E in the days before Christmas, claiming they require care and need to be admitted to hospital for monitoring. Figures on this are hard to come by, but it’s seen widely in emergency departments.
Emergency departments continue to function over the festive season. Patients present with all manner of emergencies that require immediate treatment, and by no means are they all due to human folly. In fact, such presentations are a minority.
