10 Injury Treatment Priorities at the Emergency Room

Patients with life-threatening injuries receive first priority by the emergency staff.
Patients with life-threatening injuries receive first priority by the emergency staff.
Photodisc/Thinkstock

In 2007, roughly 117 million Americans went to the emergency room [source: Niska, Bhuija and Xu]. What's sending them there? The top 10 reasons why we visit the ER may surprise you. Accidents and critical injuries aren't the main drivers. Instead we seek help for everything from abdominal and chest pain to fever, cough and sore throat [source: McCaig and Burt].

But the way emergency departments work is not first come, first serve. While your back pain may feel like a critical injury to you, the emergency team may have a different set of priorities. How quickly you are seen depends on how severe your condition is.

Patient priority is determined by a triage staff once the patient arrives at the ER. Symptoms are assessed and the triage staff takes a medical history. Those with the most critical injuries or symptoms, such as patients with multiple traumas or those unconscious or not breathing, are first priority. These patients are seen immediately.

Patients with urgent symptoms that could deteriorate quickly into an emergency are typically seen in 15 minutes to one hour, while patients with semi-urgent symptoms are generally seen by a physician in one to two hours. Non-urgent patients are given the lowest priority, and could wait as long as two hours or more in a crowded ER [source: McCaig and Burt].

"High-acuity patients are taken straight to the ER," explains Dr. Tarlan Hedayati, a physician in the department of emergency medicine at John H. Stroger Hospital of Cook County in Chicago. "Others will wait in the waiting room where they will be reassessed during that time. It's a very dynamic process, and patients might increase or decrease in priority while they wait."

Additionally, the entire patient, not just the immediate complaint, is taken into account during the triage process. Other conditions, such as cancer or HIV, are considered in the assessment, as well as how long the patient's symptoms have been going on. For example, explains Hedayati, a patient who has experienced stomach pain for six months may be less of a priority than a patient who has complained of severe stomach pain for a few days.

So what types of symptoms or injuries are at the top of the emergency department's priorities? Let's look at the reasons why people visit the emergency room and prioritize them through the eyes of the triage staff, starting with the least urgent and working our way to the most critical.

10
Pain

Patients who come to the emergency department complaining of non-specific pain can be tricky to triage. This type of pain is different from that caused by an identifiable source, such as a patient complaining of chest pain, back pain, stomach pain or a headache. Non-specific pain could be caused by any number of reasons related to the body's 10 main organ systems, from the skeletal system, the nervous system or the muscular system. It could also be psychosomatic in some instances. Identifying its cause can be a complex puzzle.

This is one instance where getting an accurate medical history, either from the patient, through patient medical files or from the patient's primary care physician, can help determine if the pain has been a chronic problem or is acute. A solid understanding of the patient's medical history will also help emergency room staff understand if the patient has another illness that may contribute to this pain or if the pain has been previously treated and how. It also helps doctors and nurses flag patients who may have previously visited the ER in an effort to solicit pain-relieving medications for an addiction rather than for pain treatment.

9
Sore Throat

Patients who complain of a sore throat should expect to get comfortable in the waiting room during their ER visits. Two of the more common diagnoses made in the ER are acute upper respiratory infections and acute pharyngitis, but neither are life-threatening conditions. While a sore throat is uncomfortable, it's often caused by a viral or bacterial infection and treated either by antibiotics -- if it's bacterial -- or with time and rest if it's viral.

"A sore throat is typically not urgent or an emergency, but occasionally it can be. For example, there could be an abscess in the throat," explains Dr. Niels Rathlev, chair of the department of emergency medicine at Baystate Medical Center in Springfield, Mass.

8
Cough

When it's cold and flu season, it might feel like you can't escape from people coughing around you. Coughs from colds and flu are caused by bacterial or viral infections and generally clear up on their own in a few days or weeks. Some coughs, though, may be symptoms of more serious problems.

But a cough alone is not a serious medical emergency. While most patients with coughs who visit the emergency department are diagnosed with acute upper respiratory infections, coughs that are raspy or sound a bit like a barking seal could be indicative of croup, and patients with shortness of breath and wheezing in addition to a cough may be having an asthma attack. Whooping cough, an illness with severe coughing is a high-contagious condition that requires medical attention. Coughs that are accompanied by blood or bloody, frothy or thick mucus are not normal and could be signs of a medical emergency, such as pulmonary edema or lung cancer. Furthermore, coughs with severe chest pain could be a symptom of a pulmonary embolism, tuberculosis or congestive heart failure.

7
Back Pain

Symptoms associated with back pain, not including lower back pain symptoms (those are considered separate and rank low both in reasons why people visit the ER and in priority during the triage process), may be caused by injury to or inflammation of soft tissue, tendons, muscles, ligaments, bones, joints, nerves or discs. Back pain and is commonly caused by a sprain or strain, unintentional injury, fall or accident, or even aging or a degenerative health condition. Most often, patients who visit the ER with back symptoms are diagnosed as a sprain or a strain, but depending on if there are other symptoms (fever and burning during urination combined with back pain could indicate a kidney infection, for example) back pain is a minor priority in the emergency room.

6
Fever
When a patient has a fever above 103 degrees Fahrenheit (39.4 degrees Celsius), it could be a medical emergency.
When a patient has a fever above 103 degrees Fahrenheit (39.4 degrees Celsius), it could be a medical emergency.
Juanmonino/Getty Images

The mean temperature of patients who visit the emergency room complaining of a fever is 100.6 degrees Fahrenheit (38.1 degrees Celsius) [source: McCaig and Burt]. Fevers that are below 102 degrees Fahrenheit (38.8 degrees Celsius) are usually considered to be a mild symptom, often caused by an infection that the body is trying to fight off, such as a cold or flu.

But when a patient has a fever, plus additional symptoms that include a stiff neck or confusion, which could indicate encephalitis or meningitis, or the fever climbs above 103 degrees Fahrenheit (39.4 degrees Celsius) or lasts for more than two days it, could be a medical emergency. The chances of most fevers climbing over 105 degrees Fahrenheit (40.5 degrees Celsius) is low, but if a fever goes as high as 107.6 degrees Fahrenheit (42 degrees Celsius) it puts the patient at risk for brain damage and should be treated immediately [sources: Cleveland Clinic; MedlinePlus].

5
Vomiting

The cause of a patient's vomiting, much like many of the other reasons for ER visits, can be complicated to diagnose. Reasons range from mild, such as a viral infection, a migraine headache or motion sickness, to serious, like food poisoning or food allergies, to life-threatening, such as when it's a symptom of a brain tumor. Doctors will look closely at any co-existing conditions and symptoms, as well as conduct diagnostic tests like blood work, urinalysis and X-rays to help determine the cause of the problem. Because of the potential for vomiting to be a serious condition, it is given mid-level priority in the emergency department.

4
Severe Headache

Most people will have a headache from time to time. Others may suffer from tension, cluster or migraine headaches. But a headache that happens suddenly, causes visual disturbances, confusion or seizures is considered high-risk, as is a headache that is more intense than any the patient has previously experienced. If it's the worst headache of your life, you'll have priority over a patient who is known to have, for example, migraine headaches.

Severe headaches can be caused by serious, sometimes life-threatening, reasons. For example a subarachnoid hemorrhage -- bleeding between the brain and its surrounding tissue -- is sometimes caused by a head injury or a ruptured cerebral aneurysm and is a critical condition. Severe headaches may also be indicative of a stroke or meningitis, two serious conditions that are given priority in the emergency room.

3
Abdominal Pain

Abdominal pain is the over-arching term for symptoms that include stomach pain, cramps and spasms, and according to the Centers for Disease Control and Prevention about 17 percent of patients who visit the ER with these complaints are diagnosed with a serious condition [source: Meisel].

The cause of abdominal pain can be caused by something as mild as indigestion and menstrual cramps or as urgent as appendicitis and angina. Some life-threatening conditions like a heart attack, aneurysm or ectopic pregnancy may also feel like stomach pains. Because the condition could be life-threatening, patients with these complaints are given high priority. Diagnosing the cause of abdominal pain is often a puzzle that can require multiple diagnostic tests, such as blood work and CT scans. In the end, the three most common causes of abdominal pain are no acute condition, followed by renal colic (pain usually associated with kidney stones) and intestinal obstruction.

2
Chest Pain and Shortness of Breath

Chest pain and shortness of breath are high priorities in the ER, and often it's the patient's co-complaints that will determine if chest pain trumps shortness of breath or vice versa when determining patient priority.

Both conditions can be caused by severe or minor problems. Chest pain can be a sign you're having a heart attack or have a pulmonary embolism (a blood clot in the lung). But it could also be a symptom of heartburn or gallbladder inflammation, as well as injured ribs, cancer or a panic attack. Similarly shortness of breath can be caused by several medical conditions, including life threatening emergencies like a heart attack, pneumonia, severe asthma attack or allergic reaction to less urgent problems like a panic attack.

When it comes to chest pain and shortness of breath, the priority is going to depend on any other complaints, as well as the age and sex of the patient, explains Dr. Hedayati. "A 60-year-old man suffering from shortness of breath takes priority over a 20-year-old woman complaining of shortness of breath."

1
Life-threatening Injuries

Although life-threatening injuries aren't the No. 1 reason patients find themselves in the emergency room, or even in the top 10, these are the patients who will receive first priority by the emergency staff.

"The obvious first-priority patients are those with multiple trauma, gunshot or stab wounds, those who've been in motor vehicle accidents, those with obvious stroke or who are having a heart attack with a specific pattern on EKG," explains Dr. Rathlev. Patients in shock or who have unstable vital signs -- extremely low blood pressure, extremely high pulse -- or who have a change in their mental status or have sudden confusion are also given first priority.

UP NEXT

How Ambulances Work

How Ambulances Work

How are ambulances dispatched and why do they cost so much? HowStuffWorks takes a close look at the world of ambulances.


Related Articles

More Great Links

Sources

  • Agency for Healthcare Research and Quality. "Emergency Severity Index, Version 4." (July 1, 2011) http://www.ahrq.gov/research/esi/esi1.htm#Contents
  • American Academy of Family Physicians. "Cough." 1996. (July 1, 2011) http://familydoctor.org/online/famdocen/home/tools/symptom/516.html
  • American College of Emergency Physicians. "A Typical Shift for an Emergency Physician." 2011. (July 1, 2011) http://www.acep.org/Content.aspx?id=75947
  • American College of Emergency Physicians. "CDC: Two-Thirds of Emergency Visits Occur During Non-Business Hours; Percentage of non-urgent Emergency Patients Drops To Less than 8 Percent." 2010. (July 1, 2011) http://www.acep.org/Content.aspx?id=49128
  • American College of Emergency Physicians. "One in Five People in the U.S. Visited the Emergency Department in 2007, New Report Finds." 2010. (July 1, 2011) http://www.acep.org/Content.aspx?id=48554
  • American College of Emergency Physicians. "Statistics and Data." (July 1, 2011) http://www.acep.org/Content.aspx?id=25214
  • Bhuiya, Farida A.; Pitts, Stephen R.; and Linda F. McCaig. "Emergency Department Visits for Chest Pain and Abdominal Pain: United States, 1999-2008." National Center for Health Statistics. NCHS Data Brief No. 42. 2010. (July 1, 2011) http://www.cdc.gov/nchs/data/databriefs/db43.htm
  • Cleveland Clinic. "Fever." (July 1, 2011) http://my.clevelandclinic.org/symptoms/fever/hic_fever.aspx
  • Cox, Lauren. "Computers Can Send You to the ER, Study Shows." ABC News. 2009. (July 1, 2011) http://abcnews.go.com/Health/PainNews/story?id=7788538&page=1
  • Cutrer, F. Michael. "Evaluation of the adult with headache in the emergency department." 2011. (July 1, 2011) http://www.uptodate.com/contents/evaluation-of-the-adult-with-headache-in-the-emergency-department
  • Gorfine, Lawrence; Douglas MacLear. "Eliminating the Emergency Room Wait – Effective Out of Hospital Treatment for Pain." Palm Beach Spine Pain Institute. (July 1, 2011) http://www.helpain.com/pdf/Eliminating%20the%20Emergency%20Room%20Wait.pdf
  • Hedayati, Tarlan. Assistant Professor, Department of Emergency Medicine. John H. Stroger Hospital of Cook County and Rush University Medical Center. Personal Interview. June 29, 2011. (July 1, 2011)
  • MayoClinic. "Chest pain - Causes." 2011. (July 1, 2011) http://www.mayoclinic.com/health/chest-pain/DS00016/DSECTION=causes
  • McCaig, Linda F.; and Catharine Burt. "National Hospital Ambulatory Medical Care Survey: 2002 Emergency Department Summary." Centers of Disease Control and Prevention. 2004. (July 1, 2011) http://www.cdc.gov/nchs/data/ad/ad340.pdf
  • MedlinePlus. "Breathing difficulty." 2009. (July 1, 2011) http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm
  • MedlinePlus. "Fever." 2010. (July 1, 2011) http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm
  • MedlinePlus. "Nausea and vomiting." 2009. (July 1, 2011) http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm
  • Meisel, Zachary F. "Why Belly Pain Is Such a Headache for ER Doctors." TIME. 2011. (July 1, 2011) http://www.time.com/time/nation/article/0,8599,2045685,00.html
  • Merrill, Chaya T.; Owens, Pamela L.; Carol Stocks. "Pediatric Emergency Department Visits in Community Hospitals from Selected States, 2005." Healthcare Cost and Utilization Project. 2008. (July 1, 2011) http://www.hcup-us.ahrq.gov/reports/statbriefs/sb52.jsp
  • National Center for Biotechnology Information. "Subarachnoid hemorrhage." 2011. (July 1, 2011) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001720/
  • Neale, Todd. "CT Helps Emergency Docs Treat Abdominal Pain." Medpage Today. 2011. (July 1, 2011) http://www.medpagetoday.com/Radiology/DiagnosticRadiology/24480
  • Niska, Richard; Bhuiya, Farida; Jianmin Xu. "National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary." National Health Statistics Reports. No. 26. Centers for Disease Control and Prevention. August 2010. (July 1, 2011) http://www.cdc.gov/nchs/data/nhsr/nhsr026.pdf
  • Rathlev, Niels. Chair, Department of Emergency Medicine. Baystate Medical Practices and Professor of Emergency Medicine at Tufts University School of Medicine. Personal Interview. June 29, 2011. (July 1, 2011)