Do I Go To The ER?

Early one morning I shifted my weight to one foot, my ankle rolled and I heard a sound, a “snap,” followed by an excruciating pain that shot up my leg. I had broken a bone in my foot; no, not a toe, a bone in the middle of my foot. I might even need surgery.

I did not want to go to the ER. My foot was too painful to consider driving, I was concerned about exposure to COVID-19 and other bugs and I definitely did not need an ambulance. So I made a decision about my care using a method I have developed over many years.

It got me to my doctor’s office several hours later, an X-ray right after that and a visit to a specialist the next day. I wore my large boot out of his office and for the next 10 weeks while my foot healed. No surgery.

My method, which I call Stairsteps as one level builds upon the previous level, helped me get the level of care I needed. Yes, it was slower than I wanted. However, the benefits to me of not going to the ER?

I didn't have to drive right away

I didn't worry about being in the wrong place for the care I needed

I didn't expose myself to the potential bugs in the ER

I didn't wonder about the size of the bill

In emergency situations you may be able to avoid the ER by applying the Stairsteps method but it will also help you decide when it really is time to go to the ER.

Decisions, Decisions

Does this describe you in an emergency?

Sometimes it is impossible to predict how you will react in an urgent or emergency situation until you face that situation. One choice you can make ahead of time to help you make better decisions in the moment???

Choose to prepare in advance. As the blackboard below indicates, planning for the actions you may need to take will make it much easier to act in the moment.

In this section we will focus on the general levels of care available to you in an emergency situation and who they are intended to serve. This table is an overview of what options may be out there for you.

Levels of Healthcare for Adults or Emergency Situations

Care Option	Intended For	Benefits	Disadvantages
Primary Care Physician (PCP)	Coordinating ongoing medical care, assessing minor health issues, annual wellness physicals, referring to specialists for certain conditions, recommendations for where to get more immediate care, etc.	Knows the patient and their medical history, is familiar with resources available in the community, can assess health issues, and coordinate care.	May not be able to get an appointment when needed. May need to refer to a specialist if needed for diagnosis and treatment.
>> Same-Day Appointments	For more urgent issues that need assessment.	Can be seen by a doctor who has your medical history.	The issue may require additional time and testing beyond what can be done at the appointment.
>> After Hours Appointments	For more urgent issues that need assessment.	Can be seen by a doctor who has your medical history.	The issue may require additional time and testing beyond what can be done at the appointment.
>> On-Call Doctor	For issues that come up during evenings or weekends and need assessing.	Able to advise what to do in a situation, recommend actions to take and level of care required, prescribe.	Has limited knowledge of the patient and may not have adequate information to treat over the phone.
Care Option	Intended For	Benefits	Disadvantages
Telehealth visit	Identifying level of care needed and when appropriate treating minor complaints.	May be available 24-7. Can be seen very rapidly. May be able to make treatment recommendations and send prescriptions to local pharmacies.	May be very limited in health issues that can be addressed during appointment. For more specialized health issues may need to refer you to the ER.
Care Option	Intended For	Benefits	Disadvantages
Walk-In Clinics	Very minor complaints, vaccinations, sports physicals, drug testing.	May be more cost-effective way of getting such minor activities addressed.	Will not be able to help with anything that requires more attention.
Care Option	Intended For	Benefits	Disadvantages
Urgent Care Centers	When symptoms need more immediate attention but are not life-threatening or major. Some may have X-ray or other equipment to help assess an issue.	More cost-effective than the ER for urgent issues, able to stitch wounds and run some tests. Patients will be seen. Able to assess whether a higher level of care is needed.	May not have the necessary testing equipment for the particular health issue. May need to check with a specialist on call if available to help evaluate a situation or refer the patient on if needed.
Care Option	Intended For	Benefits	Disadvantages
Closest ER (also known as ED) Note: Advanced Urgent Care Centers or "freestanding ER Care Centers" may be helpful where available. They can also be very expensive.	Life-threatening or major illnesses and injuries.	Time-critical emergencies can be treated rapidly, will have specialty services and testing available, provides the highest level of care.	Very expensive, triage patients so that those whose issues are less urgent may wait a very long time to be seen.

To help you in making decisions, get familiar with what facilities are available to you in each of these categories. It might surprise you to discover the resources your community offers!

Thimk

Did you think this section title is correct? No? But it unfortunately describes all too many of us when we are in need of urgent or emergency healthcare. Let’s guess what many people do when in the situation itself.

In the urgency of the situation, you may find yourself blanking out on options. Doing an internet search to help you choose is quite understandable. 

But there is a better way. Let’s explore.

Prepare In Advance

You can put together a workable plan for yourself or your loved ones by using the following steps. 

• Step 1: Assess Your Situation

This can take only a few minutes to do and will be essential to your decision. Here is a way to approach it.

• First answer the following two questions:
  1. Are you ill, OR
  2. Are you injured?

• If you are ill, do the following:

• If you are injured, do the following:

Now you have put together enough information to give you help in deciding what to do. You can also describe your situation to someone else with the details they need to make recommendations.

• Step 2: Your first priority? Decide whether to go to the ER or rule it out.

The first thing to do in deciding where to get your urgent or emergency care is to figure out whether you need to go to the ER. Always, always.

Some reasons for this:

• A true emergency can be time-critical and the faster you get help, the better your outcome can be.
• Some situations can deteriorate very quickly. For example, a person with trouble breathing and a high temperature could be at risk for pneumonia and complications such as sepsis. To reduce this risk, the person needs to be assessed immediately.
• You may need an ambulance depending on your situation.They can assess you at home, start treatment in the ambulance as you are transported to hospital and let the hospital know you are coming.
• You don’t waste time with the “shoulds,” you know, the “should I or shouldn’t I?” I have certainly been caught in this limbo and I can say from experience it does not improve my pneumonia to wait because I am not sure I am sick enough.

Above all, trust your gut. If you think you need to go to the ER, go. In the era of COVID-19, first call 9-1-1 or the ER itself to let them know you are coming. Follow their recommendations. And if at all possible, DO NOT DRIVE YOURSELF TO THE ER. Call an ambulance so treatment can be started.

Here are some of the other symptoms that should guide you to the ER.

1. Chest pain or difficulty breathing
2. Weakness/numbness on one side
3. Slurred speech
4. Fainting/change in mental state
5. Serious burns
6. Head or eye injury
7. Concussion/confusion
8. Broken bones and dislocated joints
9. Mental health issues that make you very agitated, confused or suicidal
10. Fever with a rash
11. Seizures
12. Severe cuts that may require stitches
13. Facial lacerations
14. Severe cold or flu symptoms
15. Vaginal bleeding with pregnancy

• Step 3: Choose the level of non-ER care that works for you.

Not experiencing these above symptoms? Then you probably don’t need to go to the ER. But what can you do to get help? Two factors will help you to decide your options.

1. The timing of care. Do you need help right away or can it wait?
2. The type of care. If you need stitches for example, they must be placed within a certain time period, generally 6 to 8 hours. After that, other methods of closing a wound must be used.

Ask yourself the following questions, keeping timing and type of care needed in mind.

• What time of day is it?
• Do I need immediate care (as in the case of smaller wounds that are bleeding and can’t be stopped)?
• How long can I wait before receiving care?
• What do I do if my doctor’s office is closed?
• Do I need to talk to a healthcare professional to find out where I should be seen?
• Am I comfortable with or willing to try telehealth visits?
• Will I need specialist care (if you feel comfortable answering this question)?
• Can I pay Urgent Care fees at the time I am seen?

Sometimes your choice is limited to Urgent Care or ER. That’s one of the reasons I waited several hours in pain to see a doctor at my doctor’s practice. 

Other Reasons:

• The Urgent Care Centers in my area opened at the same time my doctor’s office opened. 
• And I considered the level of care I needed: an X-ray and referral to an orthopedic surgeon specializing in feet and ankles. 
• The X-ray I could definitely get at Urgent Care though it was unlikely to be of great resolution.
• The referral I would still need to get through my doctor. 
• The Urgent Care referrals were all to departments in the medical clinic within which the Urgent Care operated.

Remember the table of Levels of Care For Adults In Urgent Or Emergency Situations earlier in this blog post? Review it now and think over your own preferences about where to get care.

From a very practical view, sometimes your doctor will not have any time to see you and you will be referred to Urgent Care. When the timing of your urgent situation is after Urgent Care Centers have closed, you are likely to have to go to the ER. 

Tip: You have a great way to push your way through the level of care question: telehealth visits. The healthcare professionals are often available 24/7 and can be extremely helpful in getting you access to the care you need and where you need to get it. Keep this tip handy so that you can benefit from an outside perspective and professional assessment.

And Last But Not Least:

You have a good idea about the options for care available to you in urgent or emergency situations from the table at the beginning of this blog post.

Remember these three steps when deciding what care you need for yourself or a loved one. 

Step 1: Figure out what your urgent or emergency situation is.

Step 2: Your first priority? Decide whether to go to the ER or rule it out.

Step 3: Choose the level of non-ER care that works for you.

Handy Tip: use a telehealth appointment when you really need some professional input.

Click HERE for 5 Ways to Have A Great Telehealth Appointment.

As always, stay healthy!