When to Go to the Emergency Room
By Mitchel L. Zoler
When should you go to an emergency department? Simple, say medical experts: when you think you have to.Emergency physicians encourage patients and their families to be liberal in deciding when a situation calls for immediate medical care. "People should follow their instincts. We want patients to err on the side of ensuring that there's nothing seriously wrong," says John McCabe, chairman of emergency medicine at the State University of New York Health Sciences Center at Syracuse.
Some situations, such as a painful broken bone or a heavily bleeding wound, are easy to recognize as emergencies, but other situations are not so clear. To keep the number of unnecessary emergency department visits to a minimum, the American College of Emergency Physicians (ACEP), the major professional association of emergency doctors, has issued a comprehensive list for deciding when to go to an emergency department. Their guidelines include acting on sudden severe pain; breathing difficulty; sudden dizziness, weakness, or confusion; and severe or persistent vomiting.
The ACEP stresses the need for flexibility in deciding when a patient needs emergency care. "Many factors, including the time of day, other medical problems, or state of mind, can make an otherwise minor medical problem an emergency," the ACEP says.
Evaluating risk. People with certain chronic illnesses such as diabetes or heart disease should seek expert care in the face of a new medical problem more quickly than should other people, even if the problem does not seem to be serious, says John C. Johnson, director of emergency medicine at Porter Memorial Hospital in Valparaiso, Ind., and former president of the ACEP. "These patients must be very careful about waiting too long to have an acute illness treated, because their situations can deteriorate rapidly," he says.
Johnson adds that all these guidelines apply to children, except toddlers and infants. In those cases, the rule is that the younger the patient, the sooner he or she should be examined.
People who are not in immediate danger and are in doubt over what to do should call their family physician. And patients with injuries or symptoms that fall outside emergency guidelines may want to see if the problem improves before they seek medical care or call their regular doctors to see if they should come into the office. On the other hand, patients who do not have a personal physician and who are unsure about their condition should not expect to get telephone advice from an emergency department. "Emergency physicians can't diagnose unfamiliar patients by telephone," explains McCabe. "If you're calling an emergency department to ask whether to come in, it's probably best to just come in."
Prepare for emergencies. To help speed your way to expert medical treatment, the American Medical Association (AMA) suggests preparations you should make before an emergency arises. First, post near your telephone the numbers of the nearest hospital emergency rooms and your family doctors, as well as the numbers of neighbors or relatives who can come to your residence quickly if you need aid or need to be driven to the hospital. Also post local police and fire department numbers, and know which department handles emergency medical calls. Most ambulance services are operated by communities, not by individual hospitals.
Medical emergencies cannot be anticipated. But careful planning, combined with a clear head, can help ensure that a severe injury or illness is promptly and properly treated.