More than 1 billion people visit a doctor's office, hospital outpatient care department or an emergency department in the U.S. every year, and about 136 million of those visits are to the 5,004 emergency departments across the country [sources: CDC, CDC, Emergency Medicine Network]. If that sounds like a lot of chest pains and broken bones, you're right. Sort of.
It turns out that as many as half to three-quarters of all emergency department visits in the U.S. aren't actually life-threatening situations [source: Robert Wood Johnson Foundation]. While some think the ER is a convenient solution for people without other care options, only about 3 percent of those emergency department visits are people who don't have a primary care doctor to call or any other place to go when they're sick. The majority of those emergency complaints could have been treated either at an urgent care center, by a primary care physician or, perhaps surprisingly, at home [sources: Robert Wood Johnson Foundation, CDC].
So what are people going to the ER for, if not emergencies? To know that, we need to know what emergency department physicians consider life threatening; pretty much everything else falls into the "not an emergency" category.
First things first about emergencies: Calling 911 is the best thing to do in the most life-threatening health emergencies, and it's appropriate for the most critical conditions such as when someone is choking, isn't breathing or is severely burned. Yes, in these situations, please, go to the ER where they can and will help. The emergency team that arrives in an ambulance is able to begin lifesaving care on the way to the hospital, and that timely treatment during transit may be the difference between life and death when it comes to a true health emergency. Problems such as uncontrolled bleeding, sudden and severe pain, difficulty breathing, and symptoms of a heart attack or stroke should also be considered an emergency [source: NIH].
But that minor scrape that's stopped bleeding, the achy ear you woke up with this morning or that urge to get your annual flu shot today during your lunch break? None of those is life-threatening, yet people visit hospital emergency departments every day for those very reasons. And while that bad bruise may seem like a high priority to you — we get that; it hurts — the no-appointment-needed convenience of the ER is also not a good reason to use emergency resources. Consider an urgent care facility or call your doctor before rushing to the hospital. Not only will emergency care cost you more than urgent or general care, an emergency department is designed to treat (surprise!) emergencies, and can't help you with the same general care a family physician provides.
Most dental care in the U.S. is handled by dentists in private practices, but certainly not all. In 2009, for instance, more than 800,000 visits to the emergency department were for toothaches and other non-emergency dental complaints. Hospital emergency departments in Tennessee alone saw five times more dental-related visits that year than they had visits for burns [source: Tanner]. And here's the problem with that: Emergency departments don't staff dentists, nor are emergency medical teams trained in dental care. If you accidentally lose a tooth, time is crucial to preserve and re-implant it. You only have about 30 minutes, tops. But often at the ER you'll spend more time than that just sitting in the waiting room, typically more than 55 minutes. And once you're seen, the best you can expect from emergency treatment is pain medication, antibiotics and a referral to a dentist or endodontist — where you should have gone in the first place. The best thing for your tooth is to keep it in your mouth or soaking in milk (or, if you happen to have one, a tooth preservation kit), and see a dentist ASAP.
There's a second problem with visiting the ER for dental complaints. In addition to the fact that emergency physicians aren't schooled in dentistry, patients complaining of a toothache or other dental pain are typically considered risky. Emergency department teams red-flag such complaints as potential drug-seeking behavior, so not only is it unlikely your tooth will be fixed or saved, you might be suspected (or outed) as an opiate addict [source: Saint Louis].
Pain is one of the most common reasons why any of us visit the ER. As many as 20 percent of people report living with chronic pain, and some estimates suggest that our chronic pain complaints account for a just shy of half of all visits to the emergency department overall [sources: Knox et al., Grover].
There are many types of chronic pain, and all are best managed by a health care provider whose job it is to get to know us and our chronic issues by building a doctor-patient relationship over time. Primary care health care providers are able to establish a history and relationship with patients because they care for their patients over several years. Emergency and urgent care providers, on the other hand, are better equipped to handle acute pain; think one-time instances such as a headache that appears suddenly and is the worst you've ever had in your life, or the pain of a broken arm.
For many of us who show up at the ER complaining of chronic back pain, the odds of being given a few days' supply of pain medication and an order to follow up with a primary care doctor for long-term treatment are good. However, in addition to potentially taking time and resources away from true emergencies, some patients complaining of chronic pain may also be what emergency department teams call "repeat customers." Those are patients who visit the emergency department with pain complaints continuously over several months or even several years. Emergency health care providers may be suspicious of patients who complain of chronic pain; it's one of the red flags that a patient is a narcotics seeker who might be lying to get pain pills.
A Second (or Third) Opinion
Let's say your primary care doctor diagnoses you with a rare form of cancer, stages it and sets up an aggressive treatment plan, including a few major surgeries in addition to chemotherapy. You're hesitant: Are things really this far along, and is this the only treatment option you have? Maybe, but maybe not. And to find out — or maybe it's just to give yourself (or your insurance company) peace of mind — you seek out a second (or third; we're not judging) opinion.
Second opinions can be valuable. It turns out that as many as 30 percent of patients who have gotten a second opinion about an elective surgery found the two doctors didn't agree with each other [source: Patient Advocate Foundation]. But ER doctors aren't the right choice for that second opinion. Emergency department teams aren't equipped with the time and resources to re-diagnose you — they're there for immediate treatment of life-threatening symptoms, not to ease your mind about a surgery that won't take place for several weeks (or months, or maybe never). Specialists, such as oncologists or surgeons, or another primary care doctor are better able to perform a thorough work up, including all the necessary lab work and tests to complete the puzzle and either agree or disagree with the other diagnosis.
Hives are often caused by an allergic reaction — those red, itchy welts may emerge within just a few minutes or within a few hours of coming in contact with a trigger such as pets, pollen, certain foods, latex or medications. They may sometimes also appear for reasons you might not guess, such as from stress, exercise, pressure on the skin, too much sun or cold exposure, a bacterial infection or common cold, or from certain illnesses [source: American Academy of Dermatology].
Anyone at any age can get hives, and luckily most cases don't need treatment — at least aside from a cool oatmeal bath and maybe an over-the-counter antihistamine.
If, however, in addition to hives, you also experience trouble breathing, wheezing, dizziness, or a swollen throat or tongue, you may be having a severe allergic reaction called anaphylaxis. Anaphylaxis is life-threatening; go to the ER.
The odds are pretty good that if you have cough, a sore throat and a stuffy nose, you have a viral infection. Both the common cold and influenza are caused by viruses, although these tiny organisms also cause everything from herpes and HIV to measles and Ebola. Obviously, some of these viruses do cause medical emergencies; Ebola, while rare, is deadly. However, the common cold isn't rare or deadly, and despite how sick you feel, there are no cures for a cold. It'll be over in about a week.
Unlike bacteria, which are single-celled microorganisms that are able to replicate on their own (the microorganism divides itself into two through a process known as binary fission), viruses bum what they need to reproduce from you or else they die. And, at the very basics of things, this difference is why antibiotics are effective against bacterial infections yet not against viruses. Viruses can be difficult to treat because, unlike bacteria, viruses actually live inside the cells of your body. The best that can be done against a viral infection is to ease the symptoms, usually with fluids and over-the-counter pain relievers. Unless symptoms are severe, such as a high fever or difficulty breathing, this is a treatment plan your primary care doctor can make. (And, if it turns out to be a bacterial infection, your primary care doctor can also help treat that, usually with antibiotics.)
Vaccinations protect against some viruses, such as measles or smallpox. Some viruses, such as HIV and herpes, can be treated with a prescription from your primary care doctor for antiviral medications, which work by interrupting the reproductive ability of a virus.
Rash and Skin Irritation
Emergency departments are required by the Emergency Medicine Treatment and Labor Act to care for any patient, even if that means just an exam to screen for whether the condition is actually a life-threatening emergency. You know what's not a life-threatening emergency? Accidentally coming in contact with poison ivy. Sure, that itch may be driving you mad, but it's not going to be your end. In fact, many rashes and skin irritations such as those caused by stress, environment or minor allergic reaction to common things —a new soap or that poison ivy — can be treated at home, with the advice of a primary care physician or nurse hotline if needed.
Some rashes, though, ARE emergency situations. Indicators of potentially life-threatening rashes that need emergency attention include:
- Large amounts of blistering and peeling skin
- Rashes accompanied by fainting or dizziness
- Rashes that emerge soon after you take a new medication
- Mouth sores so painful you can't sip water
If you're experiencing any of these rash symptoms, don't be shy about heading to the ER.
Many of our earaches are caused by middle-ear infections, inner-ear infections or by swimmer's ear. Sometimes, earaches hitch a ride with the common cold. Ear infections are either going to be bacterial or viral. Although earaches with an accompanying high fever usually indicate a bacterial infection, that's not a hard-and-fast rule. That means that it can be tricky to tell the viral and bacterial infections apart. While bacterial infections can be treated with antibiotics, viral infections can't. And to further complicate things, not all earaches are infections — some are related to other issues such as those that coincide with a toothache.
The good news is that most ear infections will clear up on their own with at-home treatment and a few days of patience (and usually before antibiotics even begin to do their work).
Earaches caused by a foreign object in the ear, though? The ER can absolutely help you with that. Attempting to remove the object on your own could cause serious permanent damage.
Minor Cuts and Scrapes
More than 7 million people will visit an ER seeking treatment for a cut this year [source: Hines et al.]. But most cuts and scrapes are considered minor — minor enough not to need lifesaving help. Small lacerations like the ones we've all gotten after a kitchen knife mishap or a tool slips while we're using it, for example, can be treated at home without any cause for alarm and without a trip to the hospital. At-home care for minor cuts includes just three basic first aid steps: Wash the wound to prevent infection, apply pressure to control the bleeding and then protect the injury by covering it with a bandage.
Any cut that won't stop bleeding after about 10 minutes, or any puncture wound more than a quarter of an inch deep, is no longer considered minor and should be treated by a health care professional — although probably still not in the ER. Urgent care centers are equipped to handle treatment for lacerations and scrapes that are more serious. Treatment may include a thorough cleaning of the area and local anesthetic to numb the area and block the pain, in addition to stitches or medical-grade glue to help stop bleeding and close the wound. In some cases, you may need a tetanus shot or antibiotics to avoid infection.
Flu Shots and Other Vaccinations
The National Foundation for Infectious Diseases (NFID), the Centers for Disease Control and Prevention (CDC), and pretty much any health care provider or expert all recommend that anyone over the age of 6 months get an annual vaccination against influenza. And most people really don't listen. Only about 46 percent of Americans got a flu shot during the 2013-2014 flu season — and of that vaccinated group, only 34 percent of people ages 18 to 64 were vaccinated [source: Levy]. It's not the numbers that we're here to look at though; it's the where.
Seasonal flu shots are available from your primary care provider's office. They're also available at various types of healthcare facilities, including community health clinics and pharmacies, and they may also be available at your workplace or at a local school, supermarket or another community location (find a flu vaccine location near you). Yet despite so many options, some people head to their local ER for their yearly influenza vaccine — and may be surprised to find out that the ER doesn't provide immunization, and they don't have any on hand.
Emergency departments aren't in the immunization business, and they usually immunize patients only when it's part of a bigger emergency treatment plan, such as giving a tetanus shot to a patient who's been injured by a rusty piece of metal or a rabies vaccine to a patient who's been bitten by an animal. Those two things, by the way, could be treated faster and cheaper at an urgent care center.
Let's say you're out of town for a holiday weekend and you realize you forgot to pack your medications. What do you do? You call your doctor, that's what you do. Even if your doctor has the night off, there will be an associated doctor on call who will contact a pharmacy near you to help you get the medicine you need. And the same is true for when you need a refill at home. Believe it or not, some people have used emergency department resources to request prescription refills. And there's even one anecdote about a patient who used ambulance services to the ER to make the refill request [source: Wahlgren]. You know he's not the only one out there.
It isn't that the emergency medical team doesn't want to help; it's that emergency departments aren't staffed to handle your ongoing prescription refills. In some instances, such as if you're trying to refill certain medications (opiates and other controlled substances), health care workers may suspect you're trying to game the system to feed an addition. They will contact the doctor who originally prescribed the medication to you.
ERs are equipped and authorized to dispense medications, including controlled substances, in an emergency, but the amount will be limited to the course of the emergency itself.
How are ambulances dispatched and why do they cost so much? HowStuffWorks takes a close look at the world of ambulances.
Author's Note: 10 Conditions the ER Can't Help You With
I'll admit that I've visited the ER for one of these conditions: hives. Those maddeningly itchy bumps came along with wheezing, and I was trying to be cautious. With a prior history of hives and allergies, I felt the potential for things to go wrong, and quickly, was pretty good. But, apparently, it could have waited until the morning. It wasn't that they didn't screen me (they did), but they sent me home with instructions to take antihistamines, and to call my doctor in the morning. Embarrassing? A little. But at least I didn't call 911 for a prescription refill. Or earwax impaction (that came up during the discovery phase of research). Or a paper cut (they sting way more than they should).
More Great Links
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