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Emergency Department Presentations During Southwest Leavers Week 2022: A Retrospective Observational Study[1]

Borshoff J, McQuillan S, Jamieson E, Willix C · 2026 · Emerg Med Australas

Summary

Retrospective observational study of emergency-department presentations by school-leavers ("Leavers", the Western Australian schoolies celebration - a planned youth mass-gathering event) to the regional Busselton ED around the 2022 event, spanning the 4 event days (with an in-event health service, IEHS, operating 7pm-1am) plus 2 days before and 3 after. Of 9621 Leavers, 121 (1.26%; presentation rate 12.6/1000) presented to the ED - 12 before, 85 during, 24 after - and 85.1% (n=103) arrived from the community rather than the event site. Separately, 557 Leavers presented to the IEHS, of whom 18 were transported to hospital (transport-to-hospital rate 1.87/1000). Acuity was mostly urgent/semi-urgent (ATS 3 43.8%, ATS 4 42.1%); medical illness was the single largest category (n=59, 48.8%); and 51.2% of presentations were related to alcohol or illicit-substance use. 85.6% of Leavers were seen and given a discharge disposition within 4 hours. The authors conclude the celebration imposes a significant burden on the regional ED, that the majority need urgent/semi-urgent assessment, and that the on-site IEHS likely reduced the ED burden during its operating hours.

So what

A quantified case study of the youth-alcohol mass gathering as a distinct planning problem, and a real-world test of the on-site-service-reduces-hospital-burden thesis. Two numbers anchor it for a planner: a presentation rate of 12.6/1000 to the local ED and an IEHS transport-to-hospital rate of only 1.87/1000, with over half of all presentations alcohol/substance related and the case-mix dominated by medical illness at urgent/semi-urgent acuity. The community-origin share (85.1% of ED presentations came from the community, not the event footprint) is the subtle lesson - a youth event's medical load spills into the surrounding town and its single regional ED, so the harm-minimisation and IEHS plan has to be sized to the whole host community, not just the venue. It sits alongside the disposition-power evidence (on-site care holding people out of hospital during operating hours) and the dependent-populations frame (adolescents, alcohol-naive, away from home). Caveats: single event, single regional ED, retrospective, 2022 - and the IEHS "likely reduced" burden is an inference, not a controlled comparison (the authors call for exactly that next).

Key findings

  • Leavers/schoolies WA 2022 (youth mass gathering); Busselton regional ED; 9621 Leavers
  • 121 ED presentations (1.26%; presentation rate 12.6/1000) - 85 during the event; 85.1% arrived from the community, not the event site
  • IEHS saw 557; only 18 transported to hospital (transport-to-hospital rate 1.87/1000)
  • Acuity mostly urgent/semi-urgent (ATS 3 43.8%, ATS 4 42.1%); medical illness the largest category (48.8%); 51.2% alcohol/illicit-substance related; 85.6% dispositioned <4h
  • On-site IEHS likely reduced ED burden during operating hours (inference, not controlled) - size the plan to the whole host community

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