Sometimes it can be difficult to say. And “going to the ER can be time-consuming and stressful,” says Kevin Bissey, M.D., director of the Division of Geriatric Emergency Medicine at the North Carolina School of Medicine in Chapel Hill. But it’s always better to be safe than sorry, he says. The expert advice here can guide you on the steps to take in some key situations.
Call 911 immediately. For some problems, you want to get to the ER as soon as possible and by ambulance, Biese says.
“If you call an ambulance, they can start life-saving care while you’re on your way to the emergency room,” he says. Additionally, emergency medical technicians in the ambulance can communicate with the hospital so the staff will be ready when you arrive. In some cases, EMTs can help decide where to take you for further care.
For example, if you suspect a stroke, you will be referred to a specialist stroke center near you. That’s because it’s important to take anticoagulants within one to three hours after a clot develops, according to the Centers for Disease Control and Prevention. (In some cases, it can be up to 4½ hours.) Below are some examples of when you should call 911 right away.
- Chest pain.
- Shortness of breath (feeling short of breath, wheezing or, in severe cases, feeling like you’re suffocating).
- Frontal drooping on one side. This means that if you try to smile, it will be lopsided, says Bisse.
- Arm weakness on one side. If you lift both hands, one will drop down.
- Speech problem. You can’t speak, or speech is slurred and unclear.
- A head injury caused by confusion, fainting, or a fall.
- Suffocation or cessation of breathing.
- Spine or neck injury.
- Severe burns.
- Epilepsy.
- Electric shock or lightning strike.
Go to the ER. In the cases below, going to the emergency room is usually the right course of action. “Someone drives a car or calls 911,” says Saket Saxena, MD, associate director of the geriatric emergency department at the Cleveland Clinic. You may also want to let your doctor’s office know. If so, take action:
- You have respiratory symptoms (such as cough, runny nose or sore throat) and shortness of breath. This is a sign that you’re suffering from a lack of oxygen or problems such as pneumonia, says Cameron Gettel, M.D., an assistant professor of emergency medicine at Yale School of Medicine in New Haven, Conn.
- You fall and hit your head, but you’re awake and/or think you may have broken a bone. (If you use blood thinners, consider going to the ER after you faint.) You need to be evaluated for stress and internal bleeding, says Biese. If an X-ray shows a broken bone, timely care can relieve pain and prevent complications such as permanent muscle damage.
- After 10 minutes you will have a deep cut that will not stop bleeding. While a minor cut can be treated at an urgent care clinic, a deep gash that may require stitches is best done in the ER, Gettel says.
- You experience sudden, violent vomiting that lasts more than an hour or two. IV fluids may be required. In addition, such vomiting may indicate a life-threatening condition, such as intestinal obstruction.
Call your regular doctor. For most other less obvious acute — but uncomfortable — conditions, such as a painful pulled muscle, call your doctor’s office first. Many primary care practices schedule appointments for people who need to be seen the same day, Saxena says.
If your regular doctor or another physician in your care isn’t available, ask to see an advanced practice provider, such as a nurse practitioner or physician assistant, says Terry Fulmer, a registered nurse and director of the John A. Hartford Foundation in New York, which is committed to improving health care for older adults. They will have quick access to your medical records and may already know you.
If your provider’s practice is fully booked but affiliated with a nearby medical center, check the center’s website to see if it offers it. Same day appointments with other doctors in his system. Or consider searching for an opening with another local doctor on Zocdoc, Fulmer says. The online service searches for appointment slots by medical specialty, location and insurance plan. “A lot of doctor’s practices use it because it’s a way to fill last-minute cancellations,” she says.
On evenings and weekends, Saxena suggests calling your doctor’s practice. There is often a provider on the phone who can advise you whether you can wait to see the practice reopen or if you should go to an urgent care clinic or emergency room.
Consider urgent care. For non-life-threatening illnesses and injuries, urgent care clinics — often open evenings and weekends — may be an option.
“If you stumble and think you sprained your ankle, and it’s after normal business hours, it’s best to go to an urgent care clinic and get an X-ray and a bandage to make sure,” Gettel says. The clinic will, for example, check for the flu and Covid-19, check your heart rate and blood pressure, listen to your lungs, and if you’re having painful urination, look at your urine and prescribe antibiotics if needed. Urinary tract infection.
Urgent care facilities are often staffed by doctors, nurse practitioners, or physician assistants. “This is different from an emergency room staffed by board-certified emergency medicine physicians,” says Biese. “As a result, there can be a difference in experience and skill sets.”
Your signs are best if they are direct. “Most urgent care centers don’t have a wide variety of tests to diagnose a more complicated condition,” says Bisse. And people with serious medical conditions, such as heart failure, probably need to go to the ER outside of their doctor’s office hours.
Another quick opportunity for simple problems: Pharmacy walk-in clinics at major retailers, such as CVS, Target, Walgreens and Walmart, may be open evenings and weekends. These are a good option for ailments like throat, ear infections and urinary tract infections, Fulmer says. They can also treat minor lacerations, cuts that don’t require stitches, and rashes caused by poison ivy.
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