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Avoidable dangers that remain without effective remediation

During travel to other parts of the world, people who have lived and worked in Australia will almost inevitably encounter well-meaning colleagues who delight in making jokes (sometimes ‘half-jokes’ or even serious comments) about the many dreadful dangers that exist in this country. We are constantly reminded about animals and insects apparently waiting patiently and quietly for the opportunity to deliver a toxic or toothy coup de grâce that will send the unwary to a premature death. Intellectual counterarguments point out that Australia of course lacks the entourage of large carnivorous mammals that exist elsewhere, and that although venomous and other dangerous animals do indeed exist in Australia, their ingress into urban areas occupied by much of the population is actually far less than is the case in other parts of the world (think alligator on a golf course, or deadly vipers under the bed in dense suburbia). There is little doubt that Australian snakes and spiders are indeed potentially deadly, as regularly highlighted by catchy headlines that are redistributed with glee around the world. Estimates do suggest that there may be as many as 5.5 million snakebites around the world each year, resulting in as many as 94 000 deaths per annum, albeit public records suggest that the number of fatal bites from snakes in Australia over the past 5 years is 15 (https://en.wikipedia.org/wiki/List_ of_fatal_snake_bites_in_Australia, accessed 19 October 2018). In discussions with international colleagues about the relative dangers of living in Australia, it would also be reasonable to point out that there is no known instance whereby a snake has caused death (in Australia or elsewhere) by discharging a firearm, whereas by comparison firearm-related deaths inflicted by a species walking erect on two legs exceeded 37 000 in 2016 in the US alone. Perhaps to be safe it would be best to move to New Zealand, where the rate of firearm-related death is low and fatal snakebites are unheard of. The point of all this discussion is to highlight the notions of relative risk and proportionality. Imagine the scenario that may unfold if a staff member reported to the management of a small Australian rural hospital that they had sighted a snake on the premises. At this initial stage, we do not know what kind of snake is involved or whether it may have actually slithered out the door and be on its way back to its preferred surroundings in the bucolic Australian bush. Chaos would almost certainly ensue. Clinical areas may well be isolated, or even evacuated if feasible. If, indeed, the serpent did remain in situ, whether venomous or harmless, it would (at best) be reasonably expected to be despatched to a calico bag by an enthusiastic local snake catcher for the purposes of transportation to a far distant, innocuous place of relocation. Almost certainly there would follow a process of risk assessment and remediation to decrease the likelihood of potentially deadly reptilian appearance in the human domain (which, in this case, happened to be built, after all, in the middle of the poor animal’s native habitat). Eventually the world would be put to right again. Interestingly enough, while all of this transpired, lurking around in shadowy corners of the hospital would be a cast of dangerous characters that are, statistically speaking, much more likely to kill one or more of the inpatients than an inland taipan. The culprits referred to here are residing right now in almost every hospital around the world; we know them by names such as insulin, warfarin and oxycodone. Why are we so able to tolerate significant risk associated with some things but not others? Given that clinical pharmacy services are known to definitively reduce the risk of medication-related deaths in hospitals, it seems incongruous that there remains a struggle to convince administrators to provide adequate staffing levels for hospital pharmacy departments. Iatrogenic issues are commonly related to suboptimal prescribing by doctors, but large sectors of the medical community rail against the possibility of exploring what may happen if some aspects of prescribing were put in the hands of extensively trained, carefully supervised and highly experienced pharmacists. Hospital emergency departments (EDs) are still filled with elderly people who are, by definition, at the highest risk of medication-related harm, but healthcare administrators insist on aggregating this patient population with other people attending the ED (instead of routinely providing an alternative destination for the acute assessment of older people requiring medical attention). For that matter, why do most people attending a hospital ED around the world never get to see a pharmacist there? These and many other puzzling issues remain unanswered. It seems amazing to think that what can be done to reduce the risk of serious problems is clearly known, but hospitals, nursing homes