Chapter 43: The Importance of Emergency Care
|Sickness comes on horseback, but goes away on foot.
- W. C. Hazlitt
With rapid technological advances making the aggressive treatment of emergency conditions possible, a new medical specialty called emergency medicine has come into existence. Almost every large hospital has an emergency room (known formerly as the casualty ward). The emergency room can prove to be an invaluable resource if properly used, as round-the-clock availability of trained staff, backed by state-of-the-art equipment, could mean the difference between life and death. However, many patients still misuse the emergency room; they land up there for the treatment of minor ailments in the middle of the night. One would be amazed to know that serious medical problems such as heart attacks, gunshot wounds, accidental poisonings, automobile accidents and other serious trauma account for only 10 per cent of the cases treated at emergency rooms; the other 90 per cent pertain to minor problems such as sore throats, cat scratches and diarrhea.
Though emergency rooms serve as excellent places to receive care for real medical emergencies, they are unsuitable for individuals with non-emergency problems. First of all, they are expensive. Secondly, other than serious trauma, most medical problems are more easily diagnosed and treated when a close relationship between the patient and the physician exists. Lastly, if you visit the emergency room with a minor complaint you may be in for a long and frustrating wait -- after all, patients with more serious problems will need to be attended to first !
Emergencies require prompt, calm action. It would be helpful if one were to learn basic first aid and CPR (cardiopulmonary resuscitation) skills, which can be life-saving in a crisis. Whatever be the urgency, dont lose your head ! Prepare yourself in advance by researching the emergency medical facilities available in your area. There is really very little a layperson can do once an emergency actually occurs, but you can do your homework conscientiously and identify which ER is the nearest to you (usually in a large hospital).
A major problem in India stems from the fact that some hospitals refuse to admit or treat emergencies because of the potential medico-legal complications associated with such patients. Because of antiquated laws, police formalities can be very time consuming, and most doctors would rather avoid them. That is why some of them may refuse to treat victims of, say, car accidents. Also, it is often not sensible to simply rush the patient to the nearest hospital or nursing home; some of them may simply not be equipped to cope with medical emergencies!
Avoid using an ambulance except when absolutely necessary. If you can move (or be moved) by a car, use it. Usually, an ambulance is the slowest ( and the most expensive!) means of reaching an emergency room since it takes time to get to you before it can transport you to the ER .
If the injury involves the neck, head or back, or if the illness is obviously grave, an ambulance is the best choice, particularly if it can offer paramedical services and has in-built life-saving equipment. While some ambulances are extremely well equipped, others are little better than large vans. When in doubt call your doctor or the emergency room to get the relevant details.
If time permits, call your private physician before heading for the ER. If your situation is not life threatening, often, you can consult your private physician in his clinic; alternatively he can make more efficient and less expensive arrangements for you. If your physician advises you to proceed to the ER, he can call ahead and perhaps expedite matters relating to your admittance and subsequent treatment. If your condition requires a specialists care such as a surgeon or orthopaedist, your private physician may be able to arrange for a doctor of your choice, rather than the one who happens to be on call.
It is very useful to arrange for an emergency advocate; in other words, take a relative or friend along. When afflicted by the trauma of emergency illness or accident you may be too overwhelmed to keep track of what type of care you are receiving. Consequently, assign a friend or relative to be your advocate and monitor your care. This person can serve as a clear head for you. He or she can monitor what procedures are being undertaken, keep track of what kind of service youre getting and speak up on your behalf if the treatment is too slow in coming or if it is not up to the mark. Such an individuals timely assistance can help you manage your stress levels while being confined in an emergency room. Dont forget to carry important documents such as: your medical records and your insurance papers. Also, take along enough money ! Most hospitals will demand a large deposit ( usually in cash !) upfront before admitting you.
If you are on medications, take them along with you to the emergency encounter ( if circumstances allow you to do so). Such a step will not only give a hard-pressed ER physician an idea of the extent of your other problems, but could also prevent dangerous drug interactions. If it becomes apparent to you that hospitalisation is likely, request the ER personnel to notify your physician as soon as possible, but definitely before an extensive work-up is begun.
Write down the name of the emergency physician who has treated you. If things do not go as expected with respect to your treatment, it is helpful to be able to talk to this physician later if headed. Before you leave the ER, ask what follow-up care, if any, you will require. Ask what problems you can expect and what additional treatment will be necessary.
Remember that not all conditions are really medical emergencies or matters of life and death. Therefore, dont blindly rush to the nearest hospital ! Doctors find that patients will often misuse emergency care facilities, simply because they are open and easily available. For example, it is common to see a patient who has ignored an injury for three days walk into an ER at 1 a.m., because the wound has started "paining a lot".
For serious trauma, hemorrhage, chest pain and conditions that might require hospitalization, the hospital-based emergency room is the best bet. However, for minor trauma broken bones (without serious trauma), and minor medical emergencies (such as sore throat or bladder infections) the best place for getting treatment would be your doctors clinic. Here, the care would be more personalized, less expensive, and follow-up would be straightforward. After-hour emergencies can be best handled by calling your doctor and requesting him to see you at the clinic or hospital.
While a medical emergency can be a scary situation, which can tax your resources to the utmost, the guidance of a family doctor can help you obtain timely, beneficial and quality medical care!