The results of our study showed that the number of emergency transportations due to acute alcoholic intoxication decreased in March and April of 2020, compared with the same period in other years (2016–2019).
In Japan, spring is the second most common season for alcohol intoxication emergencies, after the New Year holidays. No existing research has addressed the correlation between this excessive alcohol consumption and the need for emergency transportation due to alcoholic intoxication. Moreover, no graduation and entrance ceremonies or parties took place in 2020 and most of the usual spring events were scaled down or postponed due to COVID-19. We believe that these changes led to a decrease in alcohol-related emergencies. The decline in these numbers during the lockdown period is considered to be because of fewer outings. With fewer people going out and more people staying at home, the number of emergency transportations due to acute alcohol intoxication has decreased. March and April represent the end (or start) of the fiscal year in Japan, a time of joining, leaving, and transferring in schools and workplaces. During this time, parties are held, usually with alcohol, to welcome and send off people. At these parties, individuals are more likely to consume large amounts of alcohol and are often forced to drink, even non-drinkers and those who rarely drink consume alcoholic beverages. Early spring in Japan also brings cherry blossom viewing, which also contributes to the number of acute alcoholic intoxication cases.
The results show a clear decrease in the number of people who were transported by ambulance due to acute alcoholic intoxication in March and April of 2020, compared with other years. This may be because people were encouraged to stay home, to maintain social distancing, and not to visit restaurants that serve alcoholic beverages. During this extraordinary time, the transportation data gathered was unlike ever before. Since there were fewer transportations due to acute alcoholic intoxication in March and April of 2020—when people had less contact with each other—we believe that the risk of needing emergency transportation is larger at drinking parties in Kochi because people sometimes get overwhelmed in the moment and consume excessive amounts of alcohol, especially due to forced drinking and binge drinking [17, 18], rather than drinking by themselves.
The Kochi Prefecture Alcohol and Health Impairment Prevention addresses the environment and conditions surrounding alcohol use. The plan includes strategies for the prevention of alcohol-related health problems, early detection and treatment, and prevention of recurrence. In particular, to prevent alcohol abuse among juveniles and emergency transportation due to acute alcohol intoxication, it is necessary to provide education on alcohol-related health problems from childhood. Kochi Prefecture is promoting school education and awareness at home [19, 20]. To prevent the inducement of inappropriate drinking, it is also necessary to promote cooperation with alcoholic beverage vendors and to address the issue on a society-wide basis.
As soon as the period of self-isolation was relaxed, the suppressed movement of people seems to have bounced back and the number of alcohol-related incidents increased. The problem of acute alcoholic intoxication among young people is global and there are also reports of young people increasing the amount of alcohol they consumed during lockdowns . This indicates the possibility that the decrease in emergency incidents due to alcohol intoxication is because of heavy drinking at home [21, 22]. Countermeasures need to be implemented to help people who are alcohol dependent due to unstable lifestyles or who are drinking more due to telecommuting.
The main strength of this study is its use of a large dataset from Kochi-Iryo-Net that contains more than 190,000 emergency transportation records from October 2015 to date. This system is designed to enter data when emergency transportation is dispatched, and it covers all emergency transportation data in Kochi Prefecture. The study also has several limitations. First, it is possible that there were patients with acute alcoholic intoxication who were not transported by ambulance; therefore, the data in this study do not represent all acute alcoholic intoxication cases in Kochi Prefecture. However, as fire stations throughout the target area were included, acute alcohol intoxication that requires urgent attention may have been identified. Second, transportation information was provided by ambulance crews, meaning that there was room for errors. There was a wide range of possible descriptions; for example, “acute alcoholic intoxication” and “neurological intoxication due to acute alcoholism.” However, the date, time, and other information were quite accurate because the paramedics used a bulletin board with their own system installed to enter this data. This unique system, which was mainly developed by Kochi Prefecture, uses tablets to collect information so that emergency transportation information can be captured and stored in real time. Third, this study used transportation records only in Kochi Prefecture; therefore, the results may not be generalizable to other prefectures. However, the fact that we were able to evaluate data from Kochi Prefecture, which has its own culture regarding alcohol consumption, is of some value.
Alcohol consumption by minors who are still growing up poses a number of physical and mental risks. To prevent underage drinking, it is necessary for the entire community, especially in Kochi Prefecture where drinking is tolerated, to ensure that minors understand the risks of drinking and to explain the risks to them at school and at home. In addition, during the New Year holidays, spring, and other times of the year when alcohol consumption increases, it is necessary to work together with businesses who serve alcoholic beverages to conduct campaigns to prevent excessive consumption and emergency transportation due to acute alcohol intoxication. In particular, young people need to be educated on how to avoid drinking in a way that can lead to acute alcohol intoxication, how to refuse alcohol if they are constitutionally incapable of drinking, and that they should never be forced to drink alcohol.