Should I Gut It Out at Home, or Do I Need an Ambulance?

Simple guidelines to help when you suddenly suffer an injury or illness

Posted Mar 25, 2016

As a physician, I am routinely approached by family, friends, and friends of friends with medical questions.  I am not complaining.  Far from it.  I am more than happy to help out anyone I know (or anyone they know) if I can.  And the favor is returned, as I routinely ask for guidance from family and friends with professional expertise in areas of which I am ignorant (or just knowledgeable enough to be dangerous).  But these regular medical queries expose one reality, that most people struggle at time in deciding if they should seek immediate medical attention and, if so, from whom.

There are in reality three major considerations when you or a loved one suddenly grows ill.  First, is any professional medical evaluation really necessary?  Second, if medical attention is required, should it be immediate?  And third, if immediate medical attention is necessary, from whom (and where)?

Every adult has the experience of feeling well when suddenly and rapidly we develop a headache, fatigue, a fever, maybe some nausea.  Because we’ve all had the flu several times during our lives.  And who hasn’t slammed a toe on a piece of furniture.  Maybe even broken it.  Or cut our finger while preparing a meal.  And banged our head hard enough to see stars.  And yet in the vast majority of sudden injuries and illnesses, we don’t even consider (or at least not for more than a moment) running off to our doctor’s office, let alone calling an ambulance to take us to the emergency room (ER).  Because our own lifetime of experiences has taught us that these things virtually always resolve over time without professional medical intervention.  And that in the rare case that things don’t get better (or get worse), there’s not likely any major risk in the delay before seeing a physician.  Thus, if the cut on your finger begins to swell and drain pus after a couple of days, the delay before finally seeing receiving treatment from your doctor is of little truly significant health consequence.

But what if you’re a woman who suddenly develops belly pain and nausea?  Is it the start of the flu?  Or is it symptoms of a heart attack in women?  What if when dicing onions you cut your finger and you think it’s really deep?  What if after banging your head the stars don’t clear that quickly, or perhaps you think you were briefly knocked out?  What if your little boy or girl has a really high fever and a very bad headache?

If you clearly have a life-threatening event, or if you clearly don’t, then your decision is simple.  But it is the large gray area where you’re just not sure whether you or a loved one needs to immediately seek medical attentions.  So here are a few simple guidelines to help you out.

Guideline #1:  WHEN IN DOUBT ABOUT WHETHER YOU NEED IMMEDIATE MEDICAL ATTENTION, ALWAYS ERR ON THE “YES” SIDE.  Being conservative, deciding that you do need to see a physician right away, has no medical downside if it ultimately turns out that such emergent evaluation was not needed.  No one ever died because they ran to a physician when in the end they were not having a heart attack.  Notice I said that there was no medical downside of being wrong.  That doesn’t mean that racing off to see a physician doesn’t disrupt your life and cost you money.  But balance these inconveniences (even if significant) with not seeking medical help when it turns out you needed to…  I suggest to you that the personal, professional, and financial losses when you fail to seek needed emergency care are significant.  And when it comes to your children, lean even further to the side of seeking immediate medical attention.  Meningitis and other pediatric infections not only arise quickly, they can be rapidly destructive, even fatal.

Guideline #2:  IF UNSURE OF THE NEED FOR IMMEDIATE MEDICAL ATTENTION, CALL AND SPEAK TO A PHYSICIAN OR NURSE.  Tell them everything you can about the new condition (when it came on, all of the symptoms, etc.).  Recognize that healthcare providers routinely err on the conservative side, often recommending that you come in for immediate evaluation, so if so recommended, do it.  If, however, the doctor or nurse reassures you that immediate medical attention is not needed, understand that if things get worse (or even don’t improve soon), call them back or simply go in and be seen.  Situations change, and thus what didn’t need to be evaluated initially may require immediate medical attention over time.  And if you’re wrong, so what (see Guideline #1).

Guideline #3:  IF YOU BELIEVE YOU NEED TO BE SEEN IMMEDIATELY, NEXT DECIDE BY WHOM, WHICH REALLY MEANS, WHERE?  Most of us have at least once spent hours sitting in an ER waiting room with a non-life threatening problem. It’s miserable.  And understandable.  That is, it makes sense that while, yes, you may have a broken arm, the ER staff must first care for a new stroke patient, even if you arrived at the ER first.  Yet waiting is miserable.  And often unnecessary.  Today, Urgent Care Centers have sprung up all over the country.  So the key is to decide whether you need “Urgent” or “Emergent” immediate medical attention.

Think like an ER doctor.  In other words, if you believe (or if talking by phone with you, a nurse or doctor believes) you are potentially suffering from a life threatening condition, go to the ER.  Symptoms that might be (let alone clearly are) due to a heart attack?  ER.  Stroke symptoms?  ER.  Overwhelming infection?  ER.  Can’t catch your breath?  ER.

The Urgent Care is for conditions on the other end of the “needs immediate medical attention” spectrum:  cut yourself but the bleeding is controlled?  Urgent Care.  Been ill for a few days but now can no longer keep down liquids?  Urgent Care.  Maybe (or even most likely) broke your wrist?  Urgent Care.  The tremendous benefit of an Urgent Care is that the absence of true medical emergencies means less crowded waiting rooms and that you’ll be seen in the order in which you arrived.  For non-life threatening injuries and illnesses, you’ll receive the same needed care from physicians and nurses that you would receive (eventually) in the ER.  And understand this:  if the Urgent Care staff believes that you truly need ER care and hospitalization (for example, it turns out that your nausea is due to a heart attack), they not only know how to rapidly recognize this critical reality, they can still begin appropriate emergency medical treatment while arranging an emergent transfer to the Emergency Room.  Because the first thing Urgent Care doctors and nurse do when you arrive is make certain for themselves that you don’t actually need to be in an Emergency Room.

Guideline #4:  BE PREPARED.  Unlike an ER (open 24 hours a day, 7 days a week, 365 days a year), Urgent Care Centers routinely have set (albeit long) hours.  That is, some hours an Urgent Care Center might not be open.  So now, when you’re not frantic over the decision of where to go, find the website of your nearest ER and your nearest Urgent Care Center.  Write down their phone numbers, addresses, and service hours and post this important information on your refrigerator, note board, or wherever you keep such stuff.  That way, when you’re trying to figure out where to take your loved one or who to call to determine if you even need to see a physician immediately, the information is at your fingertips.