The dos and don'ts of going to the ER

ERs across the country are filling up in a return to the pre-pandemic norm. Before you see a doctor at the emergency room or call 911, read these tips from Dr. Michael Daignault,.

During this past winter's COVID-19 surge, fueled by the highly transmissible omicron variant, a lot of front-line and customer-facing industries were impacted by widespread infections. 

Local emergency medical service systems were hit especially hard. Communities were told to call 911 only for “true-life- or limb-threatening emergencies.” But this gave those of us who work in the EMS and the emergency room a pause. We thought: “Isn’t this the way the 911 system is supposed to be used?”

ERs across the country are seeing a rapid return to pre-pandemic volume. My ER in Burbank, California, has had some 200-plus patient days recently.

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As we head deeper into spring and then summer – traditionally the busiest time for ERs – and in the context of reiterating the importance of using your local ER appropriately, I wanted to present some practical "dos and don'ts."

Do not "wait it out." If you have dangerous cardiac symptoms like chest pain or stroke-like symptoms including severe headache, dizziness, weakness to one side of your body, facial droop, or slurred speech. These symptoms could signify a heart attack or stroke – life-threatening conditions that are time-dependent. If not identified and treated within a matter of hours, the damaged part of your heart or brain could be unsalvageable

A study from spring 2020 surveyed nine major hospital systems and found the number of severe heart attacks being treated in the U.S. had plummeted by approximately 40%. Patients were either afraid of going to the ER because of fear of COVID-19 or were unable to access their primary care doctors or specialists. Early treatment with clot-buster medications or a trip to the catheterization laboratory is critical. As we say in the ER, “Time is heart (and brain).”

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Do bring a list of your doctors, known medical problems and prescriptions, including your dosage and any recent changes. Do not assume such critical information is “in the computer.” Even though all hospitals use electronic medical records, they’re often not integrated. It’s extremely difficult and time-consuming for us to call other hospitals or pharmacies for this information. Time that would be better served attending to your emergency!

Also, if you were referred by a doctor’s office or urgent care center for an “abnormal” lab value or image, please bring the report and CD of the image with you. 

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Do not assume you’ll be able to jump the line if you come by ambulance. It won’t work. And it’s a misuse of the EMS system. As with all visitors to the ER – whether you walk in or come by ambulance – you’ll be quickly evaluated by a triage nurse who will determine whether you need to be seen immediately by a doctor based on an assessment of your “chief complaint” and vital signs. If you’re assessed to be “stable” and asked to wait in the waiting room, this is a good thing! It means you likely do not have a life- or limb-threatening emergency. Please be patient.

Do focus on the reason that brings you to the ER. As much as we’d love to help you out with multiple concerns, we simply don’t have the time, staff, or resources. Please don’t be upset if your doctor asks you “What's the main reason you came to the ER today?” Or “What’s bothering you the most?” We can always refer you back to your primary doctor or a clinic to assess most chronic medical concerns.

Do not call and ask “What’s the wait time in the ER right now?” We are not a restaurant. We have a rule: If you have to ask the wait time, you probably don’t have an emergency. Post-pandemic wait times are up to multiple hours at ERs across the country. Your time may be better spent at urgent care or use the telehealth function most insurance companies offer now. You can speak to a nurse about your medical complaint, and they can direct you appropriately.

Do bring your own charger for your phone/tablet/laptop. We don’t have extras. Also, most places do have free Wi-Fi but it can be spotty. Better yet, bring a book or magazine.

And finally, please do ask your doctor to go over your discharge plan. This is perhaps the most crucial aspect of the entire ER visit. Ask for a copy and review your lab and imaging results. And please follow up with your primary doctor or specialist. If the doctor recommends you follow up, there’s probably a really good reason.

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