How to Survive a Trip to the Emergency Room

To experience true chaos, just visit an emergency room. Through those metal doors is a busy, often disorganized place that can be hazardous to your health.

ERs are overcrowded and understaffed. You may be treated by an overworked medical student, an exhausted intern or a doctor trained in a field unrelated to your problem.

Obtaining high-quality emergency care fast can be vital after an accident or when a chronic illness, such as heart disease or asthma, suddenly becomes life threatening. But in a surprising number of situations, you'll have enough leeway to choose your ER.

Key: Know how to go to the right place at the right time for the right reasons-and be treated by the right caregiver. Here's how...

Preparation is important

Get ready for the ER visit that you hope you'll never need. Do your homework...

Visit all ERs within 3O minutes of your home. If your condition demands exceptional treatment, arriving in a half hour may be better than being transferred from another hospital later. Look around. 'Would you feel well cared for?

Snowbird Alert: If you have multiple homes or travel to the same places frequently, also do this exercise in these locations.

Identify facilities geared to your health problems

Example: If you have a heart condition, locate the ER with the best cardiac service. Your ultimate plan will be to ask an ambulance driver to take you there if your condition, such as symptoms of a mild heart attack, permits. It surprises many people to learn that you often can get an ambulance crew to take you to the hospital of your choice. If the ambulance must go elsewhere or your condition demands faster treatment, the paramedic will say so.

Find the best ERs: Ask your primary care doctor pulmonologist, cardiologist or other specialist where to find local high-level trauma or teaching hospitals. Ask the public relations departments at nearby hospitals for brochures promoting the hospitals' areas of expertise. Read hospital websites. Consult Castle Connolly Medical Ltd., a guide to top doctors and hospitals (212-367 -8400, ext. 16, www.castleconnolly.com).

Cost: $24.95 for a one-year membership.

Wear a tag, necklace or bracelet identifying your medical status

Examples: Diabetes, medication allergies, need for dialysis. Wearing this information on a medical alert tag will help ensure that you receive appropriate care. Also, medical personnel will be able to retrieve your health information by calling the tag sponsor.

Information: MedicAlert (888- 633-4298 www.medicalert.org)... Bodyguard Medical I.D. Tags (800-383 -7790, www.bodyguardidtags.com).

Keep These Essential ER Aids In Your Wallet

Regularly update information that could be lifesaving in the ER. Don't leave home without a…

List of your drug allergies (or the statement "no known drug allergies')

List of all current medications, prescription, and nonprescription (herbs, vitamins, antacids), including dose and reason.
Health insurance and/or Medicare card.
Miniature copy of your baseline electrocardiogram (ECG), laminated. Take your ECG readout to a copy place, reduce it to wallet size and cover it with self-stick clear plastic sheets, sold at stationery and office supply stores.

Why: Comparing a new ECG with an old one can increase accuracy in diagnosing heart problems.

Research your health insurance plan's emergency coverage. Must you report an ER visit within 24hours? What if you're out of town or taken to an out-of-plan hospital? Having this information on hand will save precious time when admitted to an ER.
Maintain a relationship with a trusted physician. In an emergency, your doctor may help you decide whether an ER visit is warranted...meet you there or consult by phone...recommend a specialist if you need one...find you a local doctor if you're out of town.

Know When to Go

For flu, a twisted ankle, longtime bad back or repeat kidney stone pain, call your doctor for an appointment. Consider going to a good walk-in urgent-care center (their quality varies tremendously) if your doctor isn't available and your insurance covers it. If you can, avoid ERs on Mondays and on Friday and Saturday nights, the busiest times.

Do head for the ER if you're experiencing unbearable or worst-ever pain.. .profuse bleeding… unfamiliar or severe chest pain, shortness of breath or abdominal pain...sudden arm or leg numbness or weakness...any other signs of a stroke or heart attack (see below).

Stealth Symptoms

If you are having a stroke or heart attack, the sooner you reach an ER that has the appropriate technology and expertise, the better. When given within about three hours for stroke, six hours for a heart attack, clot-busting drugs may save your life or reduce disability. Optimal stroke treatment can make the difference between paralysis and a little weakness.

Little-known symptom: In older women, shortness of breath is a more common primary heart attack symptom than chest pain.

Other subtle heart symptoms: Weakness...fatigue...unfamiliar indigestion...jaw or upper back pain.

Information: American Heart Association (800-242-8721 www.americanheart.org)...National Heart, Lung, and Blood Institute (301-592- 8573, www.nblbi.nib,gov/actintime).

Subtle stroke symptoms: Severe headache...facial tingling...drooping mouth...unexplained dizziness.

Information: American Stroke Association (888-478-7653, www.strokeassociation.org).

How to get the best care once there

At the ER, contribute to the quality of your care. Be sure to…

Enter riding. Patients arriving by ambulance get much faster attention than walk-ins. Don't let a friend drive you unless waiting for an ambulance would take too long.
Focus on one or two chief complaints. The more vague you are, the less seriously your problems will be taken.

Example: Mention the new sharp pain in your side, not your arthritic hip.

Help the staff to help you. Don't accept every test or treatment suggested without a discussion. Ask the doctor treating you in the ER to help you decide whether the potential gains of any proposed intervention justify possible risks.
Identify yourself and your circumstances often. Ask what you're being given and why. To a nurse adding medication to your IV line, say, "Do you know about my drug allergies?" Don't assume that everyone has read your chart.
Be wary. Reject medications and prescriptions proposed without logical, compelling reasons. Refuse any risky or unnecessary test or treatment.
Reasons: Older people are especially vulnerable to complications from invasive procedures... standard adult drug dosages can be too strong for older people.

If you are sensitive to drugs or you have kidney or liver problems, tell every ER staff member who treats you.

Don't leave too soon. An ER staff eager to "clear the board" may want to send you home although you feel the same as or worse than when you arrived. Explain that you still feel bad. Ask the person discharging you, 'Are you an attending physician here? Will you discuss my case with my family doctor?" You can also ask to speak to the attending physician yourself, but he/she may not be available.