Working in a hospital emergency department must be messy and unpleasant many a time victims of accidents and crime are carried in. But how much worse it must be when the patient is the architect of her or her own misfortune by drinking to excess.

And if that is not despicable enough, the drunk and his or her inebriated companions are often abusive and violent to emergency room staff trying to deal with them. "Absolutely diabolical," our heading on this story yesterday, was the gentlest description doctors could have given.

They said it wasn't uncommon for to be vomited on, spat at, verbally abused, threatened, pushed and wrestled with as they were trying to help these people. Others were semi-comatose, unable to speak and lying in pools of their own vomit. As one doctor put it, they are "over" dealing with these people.

They have been complaining about this, and asking for better controls on alcohol, for many years and they know it is about to get worse this weekend and next as the festive season peaks. Something must be done about it.

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The immediately obvious response is to equip emergency departments with better security, which would deal with troublesome companions but the patients will often need expert physical handling, not simply restraint. In any case, the problem is not confined to hospitals: ambulance staff and others obliged to help these people are also exposed to violence and abuse.

Health professionals are right that the only proper solution is a change to New Zealand's drinking culture, particular that of young people who "pre-load" on alcohol bought from off-licensed outlets, then go out late to bars and clubs and continue drinking well into the early hours. They are liable to drive. Emergency departments are accustomed to a rush around 2am as the crashed cases come in.

Alcohol accounts for about twice the proportion of cases treated in New Zealand than it does in Australia according to a survey by the Australasian College of Emergency Medicine. Clearly something is wrong here. One obvious difference, which every New Zealander noticed in Australia, is the price of beer and wine. Taxes make drinking significantly more expensive over there.

The New Zealand Law Commission recommended taxing alcohol much more heavily here among its recommendations to Parliament before the last review of our liquor laws. The present Government did not act on that suggestion and Parliament, on a free vote, made no change to the minimum purchasing age.

One of the options discussed at that time was a variable age, 20 for off-licence sales while retaining 18 for bars and restaurants. There was a logic in that, the same legislation was placing much more stringent obligations on bar managers to monitor and control their customers' drinking and it became an offence to serve someone who is exhibiting the usual signs of excess.

The problem in New Zealand clearly occurs long before young people go to a bar or club, if they even do. They get drunk on cheap beer and RTDs consumed unsupervised. Hours later, doctors in emergency rooms see the damage. It has to stop.