Logan Reid
There are many reasons why someone may need to go to the hospital. In the case of an emergency, it is usually safest to call emergency medical services (EMS) by dialing 9-1-1 in the U.S. However, there may be situations in which you decide to transport a patient to the hospital yourself, such as if you think it will be quicker or if the patient's condition is not immediately life-threatening. If you are experiencing a mental health crisis, a voluntary stay at a hospital can help stabilize you and develop a plan for ongoing treatment. In any case, it is important to assess the situation and determine the best course of action to ensure that you or the patient receives the necessary medical care.
| Characteristics | Values |
|---|---|
| Illness or injury | Determine how serious it is and how soon medical care is needed |
| Ambulance or self-transport | Call 911 or transport the patient yourself, depending on the urgency and life-threatening nature of the situation |
| Labor | Generally, it is safe to transport a woman in labor to the hospital in a personal vehicle |
| Severe bleeding | The patient's life may be in immediate danger; call 911 or transport to the hospital, applying pressure to the wound or creating a tourniquet |
| Venomous animal bite | Call 911 and transport the patient yourself, as antivenin is most effective when administered quickly |
| Mental health crisis | Suicidal thoughts, self-harm urges, inability to take care of basic needs, severe agitation, or severe and prolonged mood swings may indicate a need for hospitalization |
| Emergency medical condition | The hospital must offer treatment to stabilize the condition and prevent it from materially worsening |
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What You'll Learn
When to call an ambulance
Calling an ambulance is a crucial step in seeking emergency medical assistance. It is important to understand when to call an ambulance to ensure timely and appropriate care. Here are some detailed guidelines on when to call an ambulance:
Life-Threatening Situations:
Call an ambulance if you or someone else is experiencing a life-threatening emergency. This includes situations such as chest pains, difficulty breathing, sudden confusion, or an altered mental status, which could indicate a heart attack or stroke. Call 911 immediately and seek emergency medical attention.
Severe Allergic Reactions:
If an individual is experiencing a severe allergic reaction, administer their adrenaline auto-injector if they have one, and then call an ambulance right away.
Burns:
For children, the elderly, or adults with severe burns, call an ambulance. Treat the burn with cool running water for at least 20 minutes and continue cooling until paramedics arrive.
Spinal Injuries:
Call an ambulance if there is a possibility of a spinal injury due to a fall from height, a high-speed impact (such as a car accident), spinal manipulation, or a forceful blow during combat or contact sports.
Unconsciousness and Breathing Difficulties:
If a person is unconscious and not breathing, start CPR immediately. For a child or baby, perform CPR for one minute before calling an ambulance. For adults, phone an ambulance immediately and get an AED if available. If the person is unconscious but breathing, carefully roll them into the recovery position and then call for emergency assistance.
Severe Bleeding and Injuries:
Call an ambulance if a person is severely injured and bleeding profusely. Apply direct pressure to the wound while waiting for emergency services. Additionally, call for emergency assistance if a person has a limb injury and cannot use the affected arm or leg.
Poisoning:
If an individual has swallowed poison or a large number of tablets, call an ambulance even if they are not showing any adverse effects.
Elderly Individuals, Babies, and Young Children:
Always call an ambulance if the person in distress falls into these categories, as their condition can deteriorate quickly, and they may be unable to communicate effectively.
Geographic Considerations:
Your location plays a significant role in response times. If you live in a rural area, understand that response times may be longer, and consider the proximity to the nearest emergency facility. In urban areas, traffic congestion can also delay ambulance arrival.
Remember, when in doubt, it is always better to call for emergency help. While considering ambulance alternatives, such as taxis or ride-sharing services, keep in mind that ambulances provide emergency medical care en route to the hospital, which can be crucial in life-threatening situations. Additionally, check your health insurance coverage, as it may impact the cost of ambulance services.
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When to drive to the hospital yourself
While it is generally recommended to call an ambulance in an emergency, there are situations when driving yourself or someone else to the hospital is a better option. This could be because you think it will be quicker than waiting for an ambulance, or because the patient's condition is not immediately life-threatening.
For example, if you live far away from town and someone is showing signs of a stroke, it might be quicker to drive them to the hospital yourself rather than wait for an ambulance. Similarly, if the patient is going into labour, it is usually okay to transport them to the hospital in a personal vehicle, as labour generally takes a long time and most deliveries are not life-threatening.
In the case of severe bleeding or a venomous animal bite, you may be able to obtain treatment for the patient more quickly by driving them yourself. However, it is important to call 911 and alert the hospital and emergency medical services (EMS) that you are on your way so they can prepare for your arrival.
If the patient is experiencing a drug overdose, EMS can provide reversal drugs before you arrive at the hospital. In the case of a heart attack, it is recommended to call an ambulance as emergency responders are trained to start life-saving treatment on the way to the hospital. They can also check for dangerous heart rhythms and cardiac arrest, which require immediate treatment.
It is important to note that if the patient is unconscious, delirious, or in shock, an ambulance should be called immediately. Additionally, if you are experiencing symptoms such as severe bleeding, difficulty breathing, or a severe allergic reaction, it is safer to call an ambulance rather than drive yourself.
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How to assess the severity of an injury or illness
Assessing the severity of an injury or illness is a complex process that requires medical expertise. However, there are some established scoring systems that can provide a framework for understanding the severity of an injury. These systems are designed to help medical professionals determine the best course of treatment and predict potential outcomes. Here is an overview of how to assess the severity of an injury or illness:
Understanding Severity Scoring Systems
Several severity scoring systems are used in medical practice, each with its own advantages and limitations. Here are some of the most common ones:
- Injury Severity Score (ISS): This is a widely used and highly accurate measure of injury severity. It is based on several commonly used scales and considers factors such as age, gender, location of the injury, and level of education. The ISS score ranges from 1 to 75, with higher scores indicating more severe injuries. An ISS score greater than 15 is considered a major trauma.
- Abbreviated Injury Scale (AIS): The AIS is an anatomically based scoring system that classifies injuries in nine body regions according to their relative severity on a six-point ordinal scale. It is used in conjunction with the ISS, with the AIS codes from the three most severely injured body regions squared and summed to calculate the ISS score.
- Associated Injury Score (AIS): This scale rates the overall severity of an injury, ranging from 1 (not at all serious) to 10 (very serious), with 0 being minimal and 10 being fatal.
- Glasgow Coma Scale (GCS): This scale is often used in conjunction with the ISS, particularly for neck injuries and in pediatric patients. It assesses the level of consciousness and neurological function.
- Barrell Injury Matrix Score: This score provides a quantitative assessment of how severe an injury is, ranging from 0 (no injury) to 4 (death or substantial disability).
Factors Influencing Severity Assessment
When assessing the severity of an injury or illness, several factors come into play:
- Nature of Injury: The type and extent of the injury, including the body parts affected and the degree of damage.
- Treatment Required: The duration and nature of the treatment needed, including potential surgical interventions, medication, and rehabilitation.
- Functional Impact: The impact of the injury or illness on daily activities, including sporting and working time lost, as well as any permanent disabilities or long-term quality of life implications.
- Mortality and Morbidity: The potential impact on survival and overall health, including the risk of multiple organ failure or long-term health complications.
- Cost of Treatment: The financial implications of the injury or illness, including hospitalization costs and ongoing medical expenses.
Assessing Specific Injuries
The severity assessment may vary depending on the type of injury or illness:
- Brain Injuries: Severity is often assessed using the AIS, ISS, or Barrell Injury Matrix Score, taking into account factors such as age, gender, and location of the injury.
- Facial Fractures: Particular attention must be paid to assessing for frontal lobe contusion, CSF rhinorrhea, and pneumocephalus, as these can indicate severe trauma.
- Lung Injuries: Lung injuries often indicate ↑ overall injury severity and are associated with multisystem trauma. It is crucial to assess for other major organ injuries, as morbidity and mortality rates are high.
- Pediatric Patients: Modified scoring systems like the Modified Injury Severity Scale (MISS) and the Pediatric Trauma Score (PTS) are used to assess and monitor outcomes in children with multiple injuries.
Limitations and Considerations
It is important to recognize that severity scoring systems have limitations:
- Underestimation of Multiple Injuries: Systems like the ISS may underestimate the impact of multiple injuries to a single body region or organ, as they only consider the single most severe injury in each region.
- Subjectivity: Some scoring systems, like the AIS severity scores, are based on subjective expert opinions, which can vary.
- Data Delays: In geriatric patients, the ISS may have limited prognostic capability due to significant delays in obtaining sufficient data to calculate the score.
- Bias and Misallocation: When using administrative data sets for severity scoring, there is a risk of bias and potential misallocation of severity scores, especially with certain diagnosis codes and body regions.
In conclusion, assessing the severity of an injury or illness involves utilizing established scoring systems, considering various factors, and tailoring the assessment to the specific type of injury or illness. It is a dynamic process that guides medical decision-making and predicts potential outcomes.
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What to do in a mental health crisis
If you or someone you know is experiencing a mental health crisis, it is important to know that you have options for support and treatment. Here are some steps and considerations to help you navigate this challenging situation:
Recognize the Signs of a Mental Health Crisis
Know the signs that indicate a mental health crisis and the need for hospitalization. This includes experiencing suicidal thoughts, self-harm urges, or a sudden change in mental status. Other signs may include severe and prolonged mood swings, agitation, or a desire to hurt oneself or others.
Seek Immediate Help
If you or someone you know is in immediate danger or experiencing a mental health emergency, call emergency services or go to the nearest emergency room. This is especially important if there is a risk of self-harm or harm to others. In the United States, you can call the National Suicide Prevention Lifeline at 988 to speak with a trained counselor.
Voluntary Hospitalization
If you are experiencing a mental health crisis but are not in immediate danger, consider voluntary hospitalization. This involves checking yourself into a mental health hospital or treatment facility. You can call the facility in advance to learn about admission procedures, what to bring, and what to expect during your stay. Most mental hospitals require a referral from a mental health professional, such as a psychologist, psychiatrist, or social worker.
Involuntary Hospitalization
In some cases, a person may be hospitalized involuntarily if they are at risk of harming themselves or others and are unable to make decisions about their care. This decision is often made by a family member or a legal authority. It is important to note that the criteria and rules for involuntary hospitalization differ from those of voluntary hospitalization.
Treatment Options
During hospitalization, you will work with a team of mental health professionals, including therapists, psychiatrists, and addiction specialists if substance use is involved. Treatment typically involves individual, group, or family therapy, psychiatric medications, and stabilization of symptoms. The length of stay varies depending on the individual's needs and can range from several weeks to several months.
Remember, seeking help for a mental health crisis is a courageous step towards healing and recovery. There are professionals and resources available to support you through this challenging time.
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Knowing your rights in an emergency room
In an emergency, you have the right to receive prompt and comprehensive care. This is true regardless of your insurance status or ability to pay. This is thanks to the Emergency Medical Treatment and Labor Act, or EMTALA, which was enacted in 1986. EMTALA applies to hospitals that accept payments from Medicare or Medicaid, which includes most U.S. hospitals. Under EMTALA, hospitals must:
- Offer patients a timely and appropriate medical screening exam. This must be performed by a qualified professional, such as a doctor, advanced practice nurse, or physician assistant. It is different from triage, in which a nurse or other provider takes vital signs to decide the order in which to see patients.
- Provide treatment to stabilize your condition. This means your condition is unlikely to get materially worse. If the hospital does not have the capability to treat your condition, they must arrange an appropriate transfer to another facility.
- Keep appropriate records on patients, including a central log of who came to the ER and what happened to them.
- Post signs in the ER letting people know about these rights.
- Keep a list of on-call doctors who can see patients in case of an emergency.
If you believe your EMTALA rights have been violated, you can file a complaint. Additionally, if you feel you have been treated unfairly by the hospital or your insurance company, you can contact your state's health department.
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Frequently asked questions
First, assess the situation and decide how serious it is and how soon you need medical care. If it is an emergency, call 911 or your local emergency number. If the situation is urgent but not life-threatening, it may be best to go to an urgent care clinic or your healthcare provider's office, as treatment in an emergency department can be much more costly.
If the person is unconscious, delirious, or in shock, call an ambulance immediately. If their life is not in immediate danger, you may be able to transport them to the hospital yourself, but you should still call 911 and alert the hospital so that they can prepare for your arrival.
Some signs that indicate you may benefit from a stay at a mental health hospital include experiencing suicidal thoughts or self-harm urges, no longer being able to take care of your basic needs, and severe agitation or mood swings.
