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Healthy Aging

When to Go to the Emergency Room

By Sheryl Kraft

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Have you ever been to an emergency room? Chances are you have. And if you have, you know how absolutely awful they can be. To me, they're like a microcosm of life itself. Drunk, bruised teenagers with police escorts (a bar brawl?); a pregnant, very worried woman and her husband (a miscarriage?); an elderly man, alone and disoriented (picked up while wandering away from his home?)

Just this week, a few of my colleagues visited ERs for various reasons, and their stories about the long waits, sick crowds and general poor conditions took me back to my time spent in ERs. Like the time my son, as a toddler, cut his head, which bled profusely all the way to the hospital. Or the time my grandmother, while visiting, fell down a flight of stairs in my home at 2 AM.  Or most recently when my husband's new replacement hip dislocated and left him writhing in excruciating, uncontrollable pain.

Those visits were warranted.

But many visits can be treated outside emergency rooms, yet for various reasons - lack of health insurance, trouble getting through to your overworked doctor, convenience or ignorance – people are overusing them. And that leads to even more problems, since waits can extend into several hours and treatment by the overworked staff can be less than acceptable. 

And while it's true that many lives have been saved in emergency rooms, unfortunately, the opposite is true, too. People do die – sometimes because they simply had to wait too long.

Knowing when to visit an ER can be a thorny issue at times…especially if your mind is muddled with anxiety, fear or pain.

Jane Brody, the health writer for the New York Times, wrote a very helpful column about this last month. She included tips for when an emergency room visit is warranted from author Patrick Conlon (he wrote "The Essential Hospital Handbook"), based on recommendations from the American College of Emergency Physicians. I personally think it's worthwhile to print these out and tape them to the inside of a cabinet or closet door.

  • Difficulty breathing
  • Chest or upper abdominal pain or pressure
  • Fainting, sudden dizziness, weakness
  • Changes in vision
  • Confusion or changes in mental state
  • Any sudden or severe pain
  • Uncontrolled bleeding
  • Severe or persistent vomiting or diarrhea
  • Coughing or vomiting blood
  • Suicidal feelings
  • Difficulty speaking
  • Shortness of breath
  • Unusual abdominal pain

I was unusually calm when I had to call 911 to take my husband to the ER. I think it might have been – thank goodness - because it was not life-threatening. So, while I waited for the ambulance, I packed a goody bag full of snacks, reading material and even my I-Pod, since I knew from experience that we'd be in for a pretty long wait.

But all is not always so calm…maybe you want to think in advance of other things you’ll need to bring – just in case:

  • Any medications the person takes (prescription and over-the-counter)
  • Name and phone number of the family doctor
  • Insurance card
  • Picture ID (this is something new I encountered: people are actually stealing other people’s insurance cards; some hospitals ask for photo ID. I know, it’s a sad commentary)
  • Brief health history
  • Cash
  • Cell phone – and charger

I'm hopeful that fewer of us will have to visit an ER. Ms. Brody states in her article that the new federal health care legislation includes a generous fund for setting up community health centers to provide treatment to low-income people who have nowhere else to turn but to emergency rooms for their health needs.

And of course, being proactive with your health in the first place to prevent the need for emergency care is always the best medicine, isn't it?

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Excellent advice on when to go to the emergency room and how to prepare for it. I would add a small bottle of bacterial hand wash. Many emergency rooms are dirty and full of germs.

Good suggestion, Donna. But I must say that I've seen hand wash in every visible area of the hospital. It seems to be everywhere. But no harm in bringing your own, in case you can't get out of bed.

Urgent care centers are a great alternative to ERs for many things that are not life-threatening. This is a great list to have available to consult. The problem people often get into is they get really sick after their doctor's office closes for the night or the entire weekend and have nowhere else to turn.

Wow, wish I'd had all these tips & that handy list when I showed up in the ER last month. Can I add another I think is absolutely critical?

You need an advocate. So don't go there alone, if you can possibly help it. A good friend accompanied me and aside from offering tremendous emotional support, she was on top of things in a way that you can't always be when you're the one experiencing the emergency.

Everything from -- no, she's allergic to that drug, when is she going to be admitted?, what does she need to make her more comfortable?, why are you doing that? -- my friend had it covered.

She stayed until 4 am (poor thing) and went home with a list of people to call, supplies to grab, and stuff to take care of in my absence. And, bless her, she showed up at 8 with my much-needed heating pad, something the hospital couldn't seem to get together for several more hours, despite the ER doc's order for such a simple comfort aid.

My doctor, called the night before, didn't roll in until 11.
She had quite the audience by then -- a posse of my extremely pissed-off friends -- and she apologized profusely (to them) for my hideous post-op infection.

Bottomline: Bring an advocate to the ER. S/he may just save your life.

What a great suggestion, Sarah. That is SO important. And you are so fortunate to have all the support you needed!

Interesting, I also get very calm during emergency situations. Thankfully, I've never had to go to the ER for myself or my kids, but my husband has had to take a couple trips because of kidney stones. You've given some great tips, I would also say, not that there's much of a way to avoid it, but we found through unfortunate experience that you get better service at the ER during the weekdays than on the weekends.

What a helpful post! Thanks. My pregnant daughter-in-law had the difficulty breathing one last week due to asthma and was rushed to the ER. She was put in ICU but fortunately is better now.

oh, that must have been quite scary, Alexandra. Glad she's better now.

What a thoughtful, practical list. Thanks for posting, Sheryl.

Very helpful list! Perhaps it's worth it to have a small bag near the door with the necessary things (and a list of other things you can't store there all the time), just in case.

That's a great suggestion, Christine...kind of like when you're pregnant and can be surprised at any time and need to make a quick getaway.

Great advice. I'm terrible about knowing when to go to a doctor or emergency room. I tend to "wait it out" until it becomes very clear that something needs to be done.

Great tips! The one time I went to the ER was when I sliced my finger open while cooking and it wouldn't stop bleeding. Obviously, that was a necessary visit, because it was Saturday and I needed stitches, but I wish I'd thought to get some pain killer before I left my apartment, because it was several hours before I was admtited and they won't give you pain killer until you're admitted.

Ironically, I have a friend who actually severed her finger slicing butternut squash (same starch as my incident) and she didn't go to the doctor for a few days. Big mistake! She's OK now, but it was a hairy recovery process.


That's a terrific suggestion, Susan. Makes sense. You're sitting there in pain, waiting to be seen, with no pain relief. Easy solution - must add this one to the list.

It is a good idea to be wary though of what medications you take before going in, especially if the injury is something more serious then a cut finger. The staff may be withholding them for a reason! Ie some drugs interact with anesthetics. This is the same with eating and drinking, none of that until you've seen someone.

Great post; in my work at Caring.com I hear the worst stories about emergency rooms; it seems they are particularly dangerous for older folks and Alzheimer's patients. One woman brought her mom in with a hairline crack in her anklet; she was left unattended, fell off the gurney, and ended up with a broken leg and arm and lengthy hospitalization. I treat emergency rooms as last-ditch options.

That IS a scary and unfortunate story...which leads me to think that I need to do a post on how to get the attention you need once you get to an emergency room!

especially for older folks and those with Alzheimer's. In my work at Caring.com I hear lots of scary emergency room stories; one woman brought her mom in after a fall with a hairline ankle fracture; she was left unattended, fell off a gurney, and ended up with a broken leg and arm and a lengthy hospitalization! I always ask myself on Fridays whether any symptoms I'm having need looking into, so I can go to the clinic rather than getting stuck with the emergency room over the weekend.

In addition to the community health centers, we also need weekend and after care for people who have serious health issues that need medical attention--but that are not necessarily life threatening--when their doctor's office is closed. I think ERs probably get flooded at night and on weekends because of that. I see more and more hotels now offer doctors on call, which is great. Because traveling can end you up on the ER too because most doctors will only treat their regular patients and not a random out of towner.

This is a good and practical list to share for another excellent reason: many people who really do need to go to the ER won't for fear they are not really that ill.

I'm terrified of hospitals, and emergency rooms. But I think ER doctors are American medicine at its very best and I am so grateful for them.

The last time I was in the hospital, they wouldn't let me use my cell phone for fear it would interfere with their instruments, much like flying in an airplane. But I did anyway....

I work in an assisted living and sending patients out is quite routine. NEVER forget to tell the paramedics and ER staff that the patient has Alzheimer's - it can be terrifying for the patient to not know where they are. Always have a packet ready of past exams, records, and warnings.
Don't be afraid to ask which hospitals work best with Alzheimer's patients, it is worth the trouble.

awesome and Very helpful list! Perhaps it's worth it to have a small bag near the door with the necessary things, etc, thanks

Kate, the founder of non-profit Plan To Get Pregnant


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