A larged medical insurance company received criticism for its handling of some emergency room (ER) claims recently. If, after review of an ER visit the company determines the condition was not a true emergency, it will deny payment for the visit, making the patient responsible for the full amount.

Critics, including patients, doctors, and hospital administrators fear this endangers patients , who may be harmed by avoiding  emergency room care for financial reasons.

You may consider an  emergency to be any medical condition which 

• is new , sudden, and/or unexpected,
• worse than usual or uncontrolled,
• of unknown origin,
• not responding to treatment,
• not improving or resolving,
• interrupts normal life.

However, to physicians and other health care personnel, the definition of an emergency is more specific.

An emergent medical condition is one that, if not treated promptly 

• Threatens life
• Threatens one or more limbs
• Threatens vision/hearing/speech/mental function/ function of any major internal organ or organ system
• Threatens long term and/or permanent bodily harm

In the United States, a federal law known as EMTALA defines a medical emergency as

“a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”

Examples of emergent conditions include 

• Sudden or new  changes in heart function, like a myocardial infarction (heart attack), arrhythmia (abnormal heart rate or rhythm) or congestive failure (poor pumping capacity)
• Brain conditions including stroke, head trauma, seizure, psychosis
• Pulmonary (breathing) dysfunction including pulmonary embolus (blood clot), severe pneumonia, asthma or COPD
• Multiple trauma, including extensive burns , multiple fractures, or trauma to any major organ like the liver or kidneys
• Chemical changes in the blood; for example high /low blood sugar, low blood potassium, low platelets,
• Severe depression and/or anxiety
• Drug and alcohol overdoses

SYMPTOMS of an emergency  include

• Shortness of breath, or difficulty breathing, especially if not associated with exertion
• Uncontrollable bleeding
• A seizure, especially in a person with no previous diagnosis of seizures
• Sudden or severe loss or difficulty with vision, hearing , speech, or other functions such as swallowing, thinking, walking, passing urine or stool
• Fainting, passing out, loss of consciousness, severe dizziness
• Hallucinations, confusion, thoughts or threats of harm to self or others
• In a pregnant woman- any of the above plus loss of fetal movement
• Persistent/severe nausea/vomiting/diarrhea
• Severe pain, especially if it prevents or inhibits body function

Certain groups of people are more at risk of significant illness with any of these symptoms, so emergency care should be sought sooner than later. They include

• infants up to age 2
• elderly-most medical references still call this over age 65
• pregnant women
• people with suppressed immune systems as from cancer chemotherapy, HIV, malnutrition, other drugs

Chest pain must always be taken seriously, even if mild.

Although in persons under 40 years old it is less likely due to a heart attack, there are other life threatening conditions that can occur in this age group. Again, especially if it is associated with any of the other symptoms, it is emergent.

Learn more about common heart diseases at this previous post

Exploring -when HEARTS break

IN AN EMERGENCY  CALL 911!

You should not call your doctor’s office or answering service, your mother, your best friend, or post a question on social media (which I have seen done!)

If it’s not an emergency but is urgent, then the next best options are calling your doctor’s office or going to an urgent care clinic. Posting on social media is still a bad choice. Do you really want your “friends” giving you medical advice about something they know nothing about?

We doctors don’t expect you to diagnose your condition before coming to the ER or the office, and insurance companies either. With using the above guidelines, if you even suspect your problem is an emergency, you are wise to seek help.

Dr. Esther Choo, an emergency physician shares

6 Tips for Getting the Most Out of Your Emergency Room Visit

Dr. Deborah Burton, pediatric ear, nose, and throat physician gives

5 Top Tips to Best Use Urgent Care Centers

Your definition of an emergency and your insurance company’s definition may differ-and that difference may cost you money. Read why here.

Is it an emergency? Insurer makes patients question ER visit

exploring the HEART of emergencies

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

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                              Dr. Aletha