Health Watch: Save the ER for a true emergency


Your daughter's friend is stung by a bee while playing in your yard and suddenly finds it hard to breathe.

Your husband feels numb on one side of his body, is disoriented and having a hard time getting words to come out right.

In either case, your thoughts should turn immediately to the emergency room. Your daughter's friend is in all probability having a life-threatening allergic reaction to the bee sting and needs immediate medical care. Your husband in displaying classic symptoms of a stroke, and time is of the essence.

The emergency department of your local hospital - or ER as it is commonly known - is set up precisely to handle such emergencies. Open 24 hours a day, seven days a week, it has the equipment and staff to deal with the most serious and life-threatening illnesses and injuries.

It stands to reason that an emergency room is expensive to run. While you or your insurance company will probably pay at least double what you would pay for the same services in a doctor's office or urgent care center, the hospital also is likely to absorb a good portion of that cost.

The law requires that an ER deliver services regardless of whether a patient has health insurance or the money to pay. As a result, many emergency departments serve as safety nets for those who otherwise have no access to health care.

During the 1970s and 1980s, many families got into the habit of using the emergency room for relatively routine matters such as a child's earache or runny nose. Insurance plans paid for these ER visits without question, even if physician's visits were not covered under the plan. During the 1990s, the health care system tried to reverse those incentives, and today you are likely to have to get prior approval before using emergency services or face a co-payment.

With rising health care costs and an aging population, many hospitals are struggling to keep their emergency departments solvent. A concerned consumer can help by using the ER for emergencies rather than convenience.

Don't think twice

Emergency medical staff know their ABCs - airways, breathing and circulation. The logic is simple: the human body doesn't survive long without a constant supply of oxygen to every organ, and this requires unobstructed inhalation of air and circulation of blood.

A morsel of food or other objects blocking the airways is an obvious emergency. Sudden breathing difficulty also can occur as a result of an allergic reaction to peanuts, an insect sting or medications. Or, it can be a sign of a heart attack or a blood clot in the lungs.

Chest pain is a well recognized sign of a heart attack. It's a feeling of pressure, crushing, squeezing or tightness in the middle of the chest caused by inadequate blood flow through the coronary arteries. The heart muscle is crying for oxygen, and the obstructed blood vessels are unable to deliver it fast enough.

A stroke also is caused by a breakdown in circulation - in this case to the brain. Rather than pain, symptoms are likely to include confusion, disorientation, sudden memory loss, numbness, partial or complete loss of vision or an ability to handle simple tasks such as speaking or walking.

A less common type of stroke is caused by a hemorrhage or bleeding in the brain. The symptoms are similar although usually more severe.

Even a bad headache is usually not reason to head for the emergency room. But, a headache unlike one you've ever had before or one accompanied by drowsiness, confusion, loss of sensation or muscle strength, nausea, vomiting or unusual sensitivity to bright light should prompt a call to 911.

Vomitting, seldom a cause for concern, becomes an emergency if it produces blood or dark-colored material like coffee grounds - a sign of bleeding in the stomach or upper bowel. Vomiting accompanied by severe abdominal pain could be caused by appendicitis, an inflamed gall bladder or a perforated or obstructed bowel - all emergency conditions.

Purple spots on the skin along with a temperature higher than 100 degrees could be a sign of meningitis, especially if it's accompanied by a headache, sensitivity to bright light or pain when the head is leaned forward.

A blow hard enough to cause loss of consciousness or a suspected bone fracture is reason to visit the emergency room or at least an urgent care center, if one is available.

Also requiring emergency or urgent care treatment are gaping wounds or bleeding that cannot be stopped after 15 minutes of direct pressure.

Emergency burns are those that extend through all layers of skin and look white or charred or those that cover an area of the body roughly equal to four hand prints.

Non-urgent visits

Unfortunately, more than half of emergency room visits are not for life-threatening illnesses or injuries, but for minor medical problems that could be handled more cost effectively in a doctor's office or urgent care center.

These include sore throats, colds, earaches, minor cuts and burns and painful muscle strains. A child who develops a moderately high fever, but no other symptoms usually does not need an emergency room visit.

If you have questions about whether a problem requires emergency treatment, call your primary care physician, who is best able to give advice and follow-up care based on your personal health history. When there's a possibility that you may be having a stroke, heart attack or other life threatening emergency, you should, of course, never waste time pondering a decision.

Unnecessary emergency room visits add $5 billion to $7 billion to national health care costs each year, according to one study, and lead to overcrowding of facilities, creating a risk that care might be delayed for those who really need it.

You can help by making prudent use of emergency facilities.


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