Should I Go to the Emergency Department?

Most of us have had an injury or an illness that makes us stop and wonder: Is it time to go to the Emergency Department? If an urgent situation involves children, most of us tend to err on the side of caution…but what about ourselves? The guidelines are not as clear for adults as they are for children, and often we feel we should “tough it out” instead of getting immediate medical care.

An emergency department physician has some common-sense advice for us. “Certainly, things such as chest pain, severe abdominal pain, large cuts, and broken bones are emergencies,” says Daniel DeBehnke, MD, Medical College of Wisconsin Professor of Emergency Medicine. “Beyond that, an emergency may be in the eye of the beholder. We generally tell people that if they feel it is an emergency then they should come to the emergency room.”

A call to your doctor can sometimes be appropriate, too. Although physicians generally don’t give medical advice over the phone for liability reasons, Dr. DeBehnke says, “Certainly a call to your own doctor could be helpful if you are unsure” whether or not your situation warrants an emergency department (ED) visit. Typically your own physician will be aware of your medical history, your current medications and your individual health issues and may be able to advise you what to do in a given situation.

Most Common Reasons for ED Visits
Nationwide, the most commonly recorded symptoms for ED visits are abdominal pain, chest pain and fever. The most frequent diagnoses are contusions (bruising), acute upper respiratory infections, and open wounds.

Injury, poisoning and adverse effects of medical care account (such as an allergic drug reaction or complication of surgery) count for more than a third of all visits, with falls the leading injury. About 6% of injuries are intentional – either self-inflicted or the result of an assault.

About three-quarters of emergency department patients receive medications during the visit, with pain relief medications being the most frequently prescribed. Antibiotics are the second most frequent, followed by medications designed to treat respiratory illnesses.

As far as visits to the Froedtert & Medical College Emergency Department, Dr. DeBehnke reports, “The three most frequent reasons people visit our center are chest pain, back pain and abdominal pain. We also see all sorts of problems from major trauma to small lacerations and twisted ankles.”

Froedtert & Medical College ED Covers It All
Even though Froedtert & Medical College is the only Level 1 Trauma Center in Southeast Wisconsin, “Our emergency department is not just a trauma center,” Dr. DeBehnke notes. “We are part of a trauma center but we are also a community ED that takes care of everyday emergencies.”

“Our Emergency Department is really a comprehensive facility for all types of care,” explains Holly Hepp, RN, BSN, Trauma Program Manager. “We have several treatment areas within the ED, and people who come to us for any reason will be cared for in the area that’s appropriate for their symptoms.” For example, the ED includes specific areas for minor care, critical care and cardiac observation.

Visits Increase While Number of EDs Declines
Visits to America’s emergency departments are up 20% over the past decade, says the Centers for Disease Control and Prevention (CDC) in its National Hospital Ambulatory Medical Care Survey. Continuing a growing trend, there were more than 107 million visits to hospital emergency departments in 2001, compared to 90 million in 1992. This increase is partly due to overall population growth in the United States, and also to increase in older adults, who tend to visit hospital emergency departments more often than younger people. (Older Americans have the highest rate of visits to the emergency department.)

During this same time period, the number of emergency departments in the United States decreased by about 15%.

Prevention
Prevention is undoubtedly the best way to avoid a trip to the emergency department. Over 2,700 Wisconsin residents die of injuries each year, and Dr. DeBehnke advocates keeping the following injury prevention measures in mind at all times:

• Simple precautions such as wearing helmets and other protective gear, driving safely and wearing safety belts will prevent a lot of damage.
• Use extreme caution when working with flammable materials such as gasoline or cleaning solvents, poisonous substances such as lawn chemicals and of course, hunting rifles or other firearms.
• Be especially watchful when you’re at backyard barbeques, fireworks, campfires and other fire-related activities.
• Use extra caution when swimming, and avoid diving into shallow water.
• Keep hot foods hot and cold foods cold. Even a simple picnic can be a recipe for disaster when food-borne microorganisms are present.
• Use alcohol in moderation and not at all if you’re the one responsible for any driving. The CDC reports that up to 25% of injuries treated in US emergency departments are alcohol related.

Maintaining a healthy lifestyle also help you avoid illnesses and injuries. Eating properly, getting enough exercise and sleep, and keeping stress levels low help keep us healthy and well adjusted. “Certainly, accidents happen,” says Dr. DeBehnke, “and we will be there in the ER when they do. But people taking responsibility for their own health is the best prevention.”

Lastly, make sure you schedule routine health maintenance procedures such as cholesterol checks, mammograms and prostate exams. Include any testing recommended by your physician, and don’t forget regular dental and eye exams. For those with chronic illnesses such as diabetes or high blood pressure, regular check-ups and evaluations are a must.

Plan Ahead
If you decide that a trip to the emergency department is in order, Dr. DeBehnke asks that you keep in mind the following:

1. Choose your primary health care providers before any emergency occurs. “Having a physician of your own gives us a doctor to call and discuss your care with, and someone who can follow up with you after your ED visit,” Dr. DeBehnke notes.

2. Though it can be difficult to think straight during an emergency situation, try to remember to bring identification and insurance cards with you, as well as any medical information you might need, such as names of medications you are taking. The best way to do this is to plan ahead: have the information ready and available for yourself and anyone else whose care you may be involved in. Keep a list of these facts in an accessible place so everyone in your home knows where it is. If you don’t have a list, at least grab all the patient’s medications and bring them with you to the ED. This will help the health care team can save time in making an accurate evaluation.

3. “Regardless of your emergency,” says Dr. DeBehnke, “we'll do our best to get you treated expeditiously. But it's not first come, first served. People are seen in the Emergency Department in order of the severity of their injuries, not the time of arrival. If you are in an ED waiting room and someone comes in and receives immediate treatment, it just means they have a more urgent need for medical care.”

Dr. DeBehnke encourages people to pay a visit to the ED if they think it could be warranted. “Don't wait at home thinking your problem might get better. We are open 24 hours a day.”

P.J. Early
HealthLink Contributing Writer

This article includes information from the US Centers for Disease Control and Prevention (CDC).

For more information on this topic, see the HealthLink article How Do You Know When a Child Needs the ER?

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.