Monday, December 12, 2011

Who You Gonna Call?

Admit it. You said "ghostbusters," at least in your head. :-)

A couple of years back, I wrote a short piece for our local town newsletter-thing, about how to know when to call an ambulance. I was hoping, of course, that everyone would read it, and become educated, and then they would never call when it wasn't necessary, but always call early on when it was.

Did that happen?
Not so much. :-0

Some of it is because there is a serious lack of understanding and knowledge of medical issues out there in the real world. It stuns me, on a daily basis, that people can grow to adulthood and not know any first aid. Not know how to take care of themselves. Why would anyone do that? Seems to me they'd have enough of a vested interest to go out and find out, if someone didn't teach them already.

I know someone who called an ambulance because she cut her hand opening a package. Was it a deep cut with serious bleeding? No. But she didn't know how to make the bleeding stop, or how to know whether or not she should get stitches. I recommended taking a First Aid class and even sent the textbook from the current Red Cross class at the time.

I have never been one to call a doctor unless it was really necessary. I'm not interested in antibiotics for a cold, for example.
Not one to run off to the ER.
For the most part, I know enough about how to tell if someone really needs a doctor.

And that's the key, right there.
Knowing how to tell.

A LARGE part of that is knowing what the doctor can do for you when you get there, and that varies, depending on where you go.

In a recent online discussion, someone mentioned that her mother thought it was perfectly okay to go to the ER for minor things, because it would give the people there something to do when they weren't otherwise busy. I don't know what image of an ER she has in HER head, but it doesn't match my experience, at all.

But for the sake of discussion, let's imagine that it's true, there are times when the ER is empty, and those folks are just itching for something to pass the time.

The problem in that case is that the ER is only designed to do what it is designed to do. You know, handle emergencies. Or evaluate someone to see if what is happening IS an emergency or not.

If it is, then it is likely that the ER will be staffed and equipped to do whatever it is that needs to be done, or to package the patient and get them to somewhere that can.

But if it ISN'T, sometimes, there simply isn't anything they can do. They can have the patient wait until a doctor can come in and tell them to go see their regular doctor the next day, or whenever they can get an appointment. Contrary to popular belief, ER docs can't magically make things get better, or go away, or whatever. If you go in there puking from a stomach bug, you're going to go right back home in pretty much the same condition. Problem not solved.

So the first step in deciding whether to call an ambulance, or to go to the hospital, or any doctor at all, is to consider what they can actually DO for you, and decide whether that will solve your problem or not.

Do you need a test they can do that you can't? I can't do my own bloodwork or x-rays, for example, so if that's what I need, I have to go somewhere that can.
Do you need medication that only a doctor can prescribe, or is over the counter appropriate?
If you don't go right now, what will happen? Will it matter, other than your own level of discomfort, if you wait until morning, or the next day? Is this something that needs to be fixed as soon as possible because it will get worse otherwise?

If what I need is to ice and wrap something, I can do that all on my own, and take a couple of ibuprofen. But if a bone is broken... I need help with that.
If I'm vomiting, I can be miserable until it stops, and focus on keeping up my fluids. Pepto works fairly well.  But if I'm vomiting BLOOD... different story.

Personally, my decisions point on calling an ambulance has two parts.
First, I have a pretty good idea of what they can do, and what they can't. And some things that they can do are pretty important at times.
If syncope is likely, the back of a rig is a better place than behind the wheel of a car, for example. If I can get someone to drive me who would have a clue what to do if I passed out, I'll do that.
If I'm trying to catch that occasional arrhythmia, and the medic can get me on a monitor about half an hour quicker than getting to the ER, that's something to consider.
If I'm having chest pain and difficulty breathing, no question. Starting treatment HERE is much better than delaying it. The ambulance can get to me a lot faster than someone can get me to the hospital. If I lived closer to the hospital, things might change a little, but I don't.

What I'm looking at in deciding, is whether I am able to get to the ER any other way, and whether it would increase the danger to me to do that, remembering that in some ways, the back of an ambulance around here may be better care than in the ER. If that 30-40 minute delay is not an issue, I'll drive (if I can) or get a ride. If time is critical, especially if I'm not just talking about transport time, but starting treatment on scene, then I'd call.

I am amazed by how often people will call an ambulance, and then follow the ambulance to the hospital. Um... if you were going ANYWAY, why didn't you just DO THAT?  Sometimes, it's the right choice because the medics can "bring the ER to you" in a sense. Other times, it's just silly.

Just the other day, I heard a medic say that they were heading to the ER with a voluntary mental health transport, and both parents would be following in their personal vehicles. A voluntary transport? Stable patient? What on earth would the medics be able to do en route that is important enough to do? Sit and talk, and fill out paperwork? This was an underage patient who couldn't sign any paperwork anyway.

Waste of resources.
I don't mind talking with a patient all the way to the ER, but really, there's no medical need at all in cases like that.

Hmmm. I digressed a bit.

Back to the topic at hand.

List your resources.
The list may go something like this:

Primary care doctor
Specialist of some kind
Physical Therapist
Urgent Care
Free Clinic (limited hours)
Emergency Room

Take some time to find out what kinds of care each of those offers- and what they DON'T offer.
For example, the free clinic here can't do x-rays.
Primary care doc doesn't offer any alternative therapies of any kind, and can only do "sick" appointments if you call early in the day.
Urgent care has specific hours, but otherwise can do almost everything the ER can do- if in doubt, call and ask. They'll refer you to the ER if necessary.

Consider, if necessary, what your insurance will cover. Mine, for instance, is not accepted by the closest hospital, but IS accepted by my primary care doc, and by the next nearest hospital. In an emergency, it doesn't matter, but if it isn't a true emergency, it matters a lot.

Everyone needs to compile their own list, and know their own options.
You can't make a choice you don't know about.

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