Due to the COVID-19 pandemic, hospitals risk being overrun with more patients than they can adequately care for. Plus, the more people who go to a hospital or clinic, the more opportunities for the virus to spread.

So, many hospitals are urging the public not to come in an ER unless they truly have an an emergency need. But what is an emergency?

You may assume an emergency is 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

While on a mission trip to Panama, my husband had a near emergency when a board flew into his leg causing a deep gash; our medical team members took care of the injury right on the clinic site, and he recovered without permanent damage — While on a mission trip to Panama, my husband had a near emergency when a board flew into his leg causing a deep gash; a local surgeon was working with our medical team , and with their help he sutured the wound at the small rural church where we were holding clinic; his leg has healed well, just a scar to remind us of the adventure.

IN AN EMERGENCY CALL 911!

Helicopters transport of emergency patients can make the difference between life and death.

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 shouldn’t 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

a speed limit sign with an H for hospital , 5 miles — A hospital will have a full service emergency room, although the level of services differs based on the size of the hospital.

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

5 Top Tips to Best Use Urgent Care Centers

a sign on a building -"express-urgent care" — Don’t expect an urgent care clinic to offer all the services of an emergency room.

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

Helicopter landing at a hospital to deliver a critically ill person.

To patients, an emergency is any medical condition which

is new, unexpected, worse than usual, uncontrolled, of unknown origin, not responding to treatment, not going away and interrupts normal life.

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

An emergent medical condition is one that

Threatens life
Threatens one or more limbs
Threatens vision/hearing/speech/mental function/ function of any major internal organ or organ system
Has the potential, if not treated promptly, to cause death or long term and/or permanent harm.

Some examples of conditions that meet this definition are

Acute changes in heart function, like a myocardial infarction (heart attack), arrhythmia (abnormal heart rate or rhythm) or congestive failure (poor pumping capacity)
Acute brain conditions including stroke, head trauma, seizure, psychosis
Pulmonary (lung) dysfunction including pulmonary embolus (blood clot), severe pneumonia, asthma or COPD
Multiple trauma , including large burns or trauma to any major organ
Significant changes in components of the blood; for example high blood sugar, low blood potassium, low platelets
Severe depression

When should you suspect any of these conditions?

The 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
Hallucinations, confusion, thoughts or threats of harm to self or others
In a pregnant woman- any of the above plus loss of fetal movement

You notice that I did not list PAIN and FEVER. Even though these are symptoms that concern patients the most, BY THEMSELVES they do not define an emergent condition. However, if they occur with any of the other symptoms, or are severe, then it is reasonable to call it an emergency.

The COVID-19 pandemic presented some unique challenges in emergency room use, I discuss those in this article.

Reliable keys to identify a medical emergency during COVID-19

How to know when an ER visit is needed for a medical problem

Keep reading

November 20, 2017March 23, 2020

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

So assuming it is an emergency, what do you do now? You do 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!)

IN AN EMERGENCY CALL 911!

Now, some doctors may disagree with this- but I think it is acceptable to go to an emergency room for problems that are serious but not emergencies. Since an emergency center is staffed 24/7, it should be utilized; there’s no reason to waste our health care resources. And sometimes it may be your only choice- if your doctor’s office is closed or the schedule full, if you are away from home, or you don’t have a primary care physician.

Just be aware if you go to an emergency room instead of an office, clinic or urgent care facility you may

Wait longer to be treated
Pay more for that treatment

That brings me to my final point. There are

10 Things to Know Before Your Next Visit to the Emergency Department

that Dr. Kristin Prentiss Ott and I want you to know. She is an emergency physician who knows exactly what an emergency is . In my career I have worked in ERs so I can attest to the accuracy of what she writes. I hope you never need to go to an emergency room, but if you do, keep her advice in mind.