Emergency!

[imoldernu]

What do you know about dealing with a health emergency?
In "Other Topics" because it's not a health question but what to do in dealing with the pre-treatment actions.

Instead of giving answers, here are some questions that involve actions, and costs.. You can decide whether you need to know the answers or not.
In no particular order.
AMBULANCE

What ambulance service do you have in your area?
-- 911? or direct ambulance tel number to save time?
-- Private
-- Volunteer
--City
--County
--All responders Ambulance Fire Police
--Hospital based
--Ambulance Costs
--Insurance paid?
--Self Paid
--Paid if ambulance moves you to care provider? or, if determined to be a non critical/not transport situation... free service to home... (as in our area)
--Medicare paid?
--Supplement pay?
--Wait time if going to hospital by ambulance vs. driving yourself
--Ambulance additional costs for test equipment used
--Hospital costs for additional equipmant used
--Hospital emergency room costs
--Does your doctor take minor emergencies, cuts, broken arm etc.
--Doctors fees in hospital.. emergency room dr. , consulting doctors?
--Admission to hospital room for observation. Additional costs?

Clinics...
--When are they open? Daily, weekends?
--Who is on duty? Nurse Practitioner? Doctor?
-- Just pills or full test equipment?
--A one time clinic or as a sub for a personal doctor?
--Facilty cost?
--Clinic prepared to handle what kinds of complaints?
--Cost compared to Hospital?
--Affiliated with a Hospital?

Hundred of more questions, but good enough for starters. FWIW, about 90 percent of the public knows only "Call 911".

From personal experience, and having learned some of this up front... and doing the right thing, has saved us (two instances in the past 6 years)... in one case I calculate about $1600, and in the second case, over $5000.

As an extreme... a neighbor who feared he was having a heart attack drove himself to the hospital, where he went into the emergency room, where they found no indication of a heart attack... but kept him for observation for 5 days... total cost $14,000.
Just to put a fine point on this... DW felt chest pains at Walmart a month ago. In an abundance of caution we called the ambulance, and loaded her in. The EMT's did an EKG and some other tests in the back of the ambulance and found that except for a slighly elevated pulse, no indications of other problems. "Did we want to go to the Hospital for more tests?" No... We went home, and an AlkaSeletzer and some Miralax solved the problem.
Our total cost for the ambulance.... Zero!. Except for a voluntary donation that we made in thanksgiving.

We have a wonderful nearby clinic that is associated with our local hospital... just daily hours but every day. One price for visit $76... nurses and always a doctor in house. If you have a clinic, do you know the hours? and whether it is open weekends. Clinics definitely the coming thing... All are not created equal... especially Walmart... at least in our town.

I don't think this should be an arguable thread, as every situation is different, but I would be very interested in other observations about questions or situations that will require knowledge or decision.

Emergency healthcare is far different than it was in the 1970's or 1980's.

[MRG]

Great post, I've had some experience. I could answer part of these questions for myself. One additional question, that comes to mind which hospital?

For me I have 2 in network hospitals within 10 miles of home, both rated as level 2 trama centers. One is 6.8 miles, one 9.2. Travel time is 10 minutes to the first, probably 14 to the second. Seems obvious, go to the closest.

I've been to the closest 3 times, each time I've been admitted for 3 days. I now realize, thanks to this board, I was subjected to testing and procedures that were totaly unneeded.

I complained last time. The nice Risk Manager assured me all the tests were necessary, I had received the best possible care. Really, they didn't even notice when I removed the monitors and IV, discharging myself!

Your post reminds me to actually drive to the other ER so I know exactly how to get there.
Thank you,
MRG

[growing_older]

A friend on vacation felt chest pains and was airlifted 50 miles to a regional medical center, where he was tested extensively and pronounced in good health. Then he was discharged. Since he had been picked up wearing only a bathrobe, he had no other clothes, no shoes, no wallet, no money, no phone and was 50 miles away from his car. He laughs now and is glad there was no medical emergency, but they don't airlift you back home. He ended up asking strangers to use their phones in the waiting room, They must have thought he was nuts, barefoot guy in a bathrobe.

[aim-high]

For those of us who are younger still and haven't thought about this, I would love to see answers.

[Lsbcal]

Quote:

Originally Posted by imoldernu ... Just to put a fine point on this... DW felt chest pains at Walmart a month ago. In an abundance of caution we called the ambulance, and loaded her in. The EMT's did an EKG and some other tests in the back of the ambulance and found that except for a slighly elevated pulse, no indications of other problems. "Did we want to go to the Hospital for more tests?" No... We went home, and an AlkaSeletzer and some Miralax solved the problem. Our total cost for the ambulance.... Zero!. Except for a voluntary donation that we made in thanksgiving. ...

How did you choose the ambulance in this emergency? Was it 911 or did you have an alternate number picked out in advance?

[imoldernu]

Two common situations.
1. A cut that is bleeding extensively, and obviously needs a few simple stitches.
2. A very painful ankle sprain

What do you do?

This news item might help in making your decision.
An average ER visit costs more than an average month’s rent
Emergency Room Cost Analysis
(last two columns represent the minimum and maximum charges.)

[travelover]

I have to take Red Cross first aid training periodically to lead hikes for an organization that I am active with. I've noticed that every successive session has less actual intervention and more advice to call 911 for a given issue. I guess you have to take wilderness first aid to actually learn to do anything.

[imoldernu]

I've been poking around the subject of emergency care and Emergency Care Clinics versus emergency care in Hospitals.
Because of the typical wait time in some hospitals, I wondered whether the level of care would be significantly less in the clicnics, because of the knowledge and skill of the employees.
When I went to our nearest Clinic yesterday, to find out hours and levels of care, I was told that either a Doctor or a Nurse Practitioner would be on duty at all times when they are open.
Hmmm... a Doctor or a Nurse... At least that's what I thought. Upon looking up Nurse Practitioner in Wikipedia, I was very surprised to see just what that title means. Without getting into details, and understanding that state laws may be different, the skill and education of a Nurse Practitioner may well be very near to the equivalent of a doctor.
In our state, it means that the N.P. can not only diagnose, but treat, prescribe medications and do almost everything that a Doctor can do..

Here's an excerpt from wiki, that explains in some detail:

Quote:

To become licensed to practice, nurse practitioners must first graduate from an accredited graduate/doctoral level program. Curriculum for NP programs includes, but is not limited to, courses in epidemiology; health promotion; pathophysiology; physical assessment; pharmacology; differential diagnosis and laboratory/radiography diagnostics; statistics and research methods; health policy; role development and leadership; acute and chronic disease management (e.g., adults, children, women's health, geriatrics, etc.); and, clinical rotations, which varies depending on the program. There are a variety of paths to becoming a nurse practitioner in the United States. Typically, the process begins with obtaining a Bachelor of Science in Nursing (BSN, 4 years), followed by a Masters of Science in Nursing (MSN, usually 3 years).[12] Doctor of Nursing Practice (DNP) programs usually require an additional 2–3 years of study beyond the MSN. DNP programs require advanced coursework in biostatistics; research methods; quality improvement and outcome measures; care of special populations; evidence based practice; informatics; organizational management; and, a project/dissertation and practicum. There is currently an initiative to require the DNP as the entry level practice degree for nurse practitioners. There are programs that eliminate the need for a MSN and allow the student to progress from a BSN directly to a DNP. Some APRNs (e.g., nurse practitioners) may choose to pursue the Doctor of Philosophy (PhD) as a terminal degree. The PhD in nursing focuses more on nursing research and nursing education, while the DNP focuses more on clinical practice.

Passing it on for anyone (like me) who didn't know ...

[Amethyst]

We're within 9 miles of a hospital, and have several "Doc in a Box" places ("Urgent Care" is how they refer to themselves) nearby. I've taken family members to both ER and Doc in Box for stitches and such, and gone to both places myself for urgent issues. Our experience is that the ER wait is longer, and thus is not the preferred option. However, the Doc in Box is not open in the middle of the night.

Doc in Box bills our insurance for emergency services, which have a higher co-pay than a regular doctor's visit. Our regular doctor can usually see us on a weekday if we call first thing in the morning, so "Doc in a Box" is reserved for weekend and holiday disasters, and the ER for middle of the night issues.

Amethyst

[SteveL]

In order to capture the market, and keep people from going to clinics at Walmart, et al, the major health networks in our area have added urgent care hours on the weekends at many of their office locations. And, some have opened additional "Emergency" treatment centers. I think these are level 3 trauma qualified. The quality of care and cost is far different between these different networks.

So, if you are in a health plan with a network, it behooves you to find out in advance, what urgent care, or other emergency type facilities are available/mandated for use.

One interesting thing we have discovered is that for regular Medicare users with a drug plan, it is always cheaper to get vaccines (like shingles) at Walgreen's than at the Dr. office.

[Coffee Mavin]

Our urgent care facilities are absolute crap. The hospitals are starting to open Emergency Clinics which will provide better care for urgent situations. If I chose to go to the ER, I know I am paying for 24/7 service & all that equipment I might need, so I expect it to cost.

For me the decision is easy, is my situation life threatening or not.
Yes = 911 for fastest response. If you have an actual life threatening situation you would be an idiot to drive yourself to the hospital. Way to endanger yourself and anyone else on the road.

No = call the Dr office the next morning for an appointment or go to ER if you don't want to wait.

If you aren't sure if it is life threatening or not, then call your regular doctor's office while someone else calls 911 for you. Your regular doctor has an on call service for urgent situations. However if it is chest pain, the doc will tell you to go to the ER due to liability.

As for Paramedics running EKG & declaring your wife good, that is a bit of a stretch. Paramedics are not authorized to diagnose. They are also under-trained as compared to an RN, PA, Nurse Practitioner or Dr. If you did not follow up that incident with a visit to a cardiologist for proper tests then I'd guess neither of you actually thought it was a heart related issue to start with. Paramedics are not a rolling doctors office. Do you know whether you were dealing with BLS or ALS ambulance service? If it was BLS then you may not have even had a Paramedic providing you service but an EMT which is an even lesser trained person.

[Coffee Mavin]

Quote:

Originally Posted by imoldernu Two common situations. 1. A cut that is bleeding extensively, and obviously needs a few simple stitches. 2. A very painful ankle sprain What do you do?

Neither of these are life threatening situations. Why would you think they require emergency room treatment?

[imoldernu]

Quote:

Originally Posted by Coffee Mavin Neither of these are life threatening situations. Why would you think they require emergency room treatment?

Ummm...
1.It's Saturday, your doctor is not in and the bleeding hasn't stopped.

2.You cannot walk.

Prayer ?

[MRG]

Quote:

Originally Posted by Coffee Mavin Neither of these are life threatening situations. Why would you think they require emergency room treatment?

Well what would you do? Urgent care around here is open 8-5, but after 2 good luck getting in. Docs office sure, if you could get in. Do you just compress wound, or go MacGyver and attemt to stitch it up yourself? How does a non trained person know? What if its a 3 day weekend?
The sprain I get, just wrap, OTC products, endure the pain.

I've seen all kinds of people in the ER with non life threatening issues, sure their last in line, but what do you do?

Heck years ago (before urgent care) my last PCP's office told me to go to the ER, for a case of diarrhea! All the OTC products(double doses) no help, PCP refused to call in a scrip. They gave me great advise 'drink lots of fluids on your 60 mile drive'.

The look on the ER DRs face was priceless, 'who's your DR, he actually sent you here'? I'm very glad I went, my PCP had just misdiagnosed an inner ear infection, perscribed an antibiotic he had record of me being allergic to(different name or I would have known). ER doc gives me a scrip, informs me the inner ear diagnosis is 100% wrong. Tells me the other name of the antibiotic I had been given by PCP, I regognize it and know I can't take that antibiotic, no need to I didn't have an infection! Only other thing I wish he'd done was perscribe a new PCP. That happened a few years later. That PCP was very challenged by his job.

No argument just looking for suggestions.

MRG

[ERhoosier]

Quote:

Originally Posted by imoldernu ......Upon looking up Nurse Practitioner in Wikipedia, I was very surprised to see just what that title means. Without getting into details, and understanding that state laws may be different, the skill and education of a Nurse Practitioner may well be very near to the equivalent of a doctor......

Not really. I am NOT anti-NP, and in fact have NP friends. NP's are clearly an important and valuable part of HC delivery in the US and will remain so in the coming years. But it's useful to realize their training is quite different from MD/DO's.

Consider typical Family Practice NP vs MD/DO FP education. The requirement for NP certification in Family Practice subspecialty is a Master's degree program (2-3yrs) with min 500 hrs clinical instruction included within that degree program. Note 50wks x 10hrs/wk = 500 hrs.
Family Nurse Practitioner Certification Eligibility Criteria
The requirements for a physican Family Practitioner are doctorate (MD or DO) PLUS 3 additional years of residency training. During residency, clinical work weeks are now limited to 80hrs/wk.
http://www.acgme.org/acgmeweb/Portal...pr07012007.pdf
Obviously both FP professionals can pursue additional training (PhD's, fellowships, etc.), but the above are typical educational backgrounds (& BTW- both backgrounds are beyond min legal licensure req's in most states).

Doctorates are clearly not required for NP's, and are not pursued by most NP's (outside academic settings). Back in 2004 it was proposed to require doctorates, but this still remains controversial even within nursing community.
http://www.aanp.org/images/documents...curriculum.pdf
2015 DNP Requirement for APNs | allnurses
And many states do not require a Master's degree for NP licensure.
Nurse practitioner (NP) : MedlinePlus Medical Encyclopedia
State by State Nurse Practitioner Requirements

[Coffee Mavin]

Quote:

Originally Posted by MRG Well what would you do? Urgent care around here is open 8-5, but after 2 good luck getting in. Docs office sure, if you could get in. Do you just compress wound, or go MacGyver and attemt to stitch it up yourself? How does a non trained person know? What if its a 3 day weekend? The sprain I get, just wrap, OTC products, endure the pain. I've seen all kinds of people in the ER with non life threatening issues, sure their last in line, but what do you do? Heck years ago (before urgent care) my last PCP's office told me to go to the ER, for a case of diarrhea! All the OTC products(double doses) no help, PCP refused to call in a scrip. They gave me great advise 'drink lots of fluids on your 60 mile drive'. The look on the ER DRs face was priceless, 'who's your DR, he actually sent you here'? I'm very glad I went, my PCP had just misdiagnosed an inner ear infection, perscribed an antibiotic he had record of me being allergic to(different name or I would have known). ER doc gives me a scrip, informs me the inner ear diagnosis is 100% wrong. Tells me the other name of the antibiotic I had been given by PCP, I regognize it and know I can't take that antibiotic, no need to I didn't have an infection! Only other thing I wish he'd done was perscribe a new PCP. That happened a few years later. That PCP was very challenged by his job. No argument just looking for suggestions. MRG

To #1 - First Aid. Butterfly Bandaids or Steri Strips hold skin together. There are medical glue products out also that take care of minor, need a couple stitch situations.

To your #2 situation & that Doc - Find a new freaking doctor!!! Sounds like you have an inattentive doc & that is dangerous to you. Are you actually allergic to the drug the doc prescribed (anaphalactic reaction) or does it just disagree with your stomach or something like that?

[imoldernu]

Quote:

As for Paramedics running EKG & declaring your wife good, that is a bit of a stretch. Paramedics are not authorized to diagnose. They are also under-trained as compared to an RN, PA, Nurse Practitioner or Dr. If you did not follow up that incident with a visit to a cardiologist for proper tests then I'd guess neither of you actually thought it was a heart related issue to start with. Paramedics are not a rolling doctors office. Do you know whether you were dealing with BLS or ALS ambulance service? If it was BLS then you may not have even had a Paramedic providing you service but an EMT which is an even lesser trained person.

Well, we did follow up... Complete tests... scans and a nuclear stress. All was fine. A xero defect result.
While we were in the ambulance, the EMT strongly advised that we go to hospital for observation. Since DW is farily strong minded, and had diagnosed herself with indigestion, it would have taken five people to get her into a hospital bed.
Sometimes its not just the money... in our case medicare and supplement would have paid.

Not everyone has insurance... Or knows about the alternative choices. The emergency rooms in Florida... during snowbird season oftern have wait times of three or four hours, and often even the triage nurses are overwhelmed.

The purpose of the original post was to remind that when a crisis occurs, the answer is not always 911, or hospitalization, and that knowing which clinics were open, the hours and what kind of services they provide can provide an alternative, IF that information is known ahead of time.
In my florida community, I care for people older than myself on an as needed basis. When someone has a concern, I am less two minutes away, and can do a follow up as needed for 911, or in some cases help with diabetic shock or falls.... which happen more often than we might believe. In these cases, where there is an ambulance or firetruck response, bringing an older person to the hospital may be unnecessarily traumatic.

.................................................. .....................
As to the Nurse Practitioner definition... I was not trying to equate an NP with an MD, but to simply show that the level of education was considerably higher than what many, including me, would think of, considering the word NURSE. (thus the quote) At our recent bridge game, I asked everyone what they thought a Nurse Practitioner was, and the answer ranged from a Nurse who was still practicing, to a head Nurse, and no one knew that an NP was able to prescribe.

[MRG]

Quote:

Originally Posted by Coffee Mavin To #1 - First Aid. Butterfly Bandaids or Steri Strips hold skin together. There are medical glue products out also that take care of minor, need a couple stitch situations. To your #2 situation & that Doc - Find a new freaking doctor!!! Sounds like you have an inattentive doc & that is dangerous to you. Are you actually allergic to the drug the doc prescribed (anaphalactic reaction) or does it just disagree with your stomach or something like that?

Thanks.
I fired that doc a couple of years after that incident. Should have done it then. I gave him another chance, the next time he almost killed me.

MRG

[Free To Canoe]

Quote:

Originally Posted by imoldernu Two common situations. 1. A cut that is bleeding extensively, and obviously needs a few simple stitches. 2. A very painful ankle sprain What do you do?

2. Living in CA, back east for xmas. Slipped on the ice while playing with the dogs (those darn dogs!) and twisted my ankle. I hobbled around OK on it and what is the ER going to do for me but give me out of state medical bill hassles. Drove back across the US and went back to work. Three weeks later it still hurt and was swollen. The xray showed a clean break of the ankle! Strike one for Dr. Free to Canoe.

We were hiking in a remote area when DW dislocated her shoulder.
Called 911 to find the closest hospital. They would not tell me. EMS arrived and decided that I should get her to a hospital. Would the ambulance ride be safer? No. More comfortable for DW? No. Wasted 30+minutes with these losers while DW was in extreme pain.
Drove home to our hospital for the fix.

These judgment calls are difficult.
The chest pain thing is a tough call.

[ggbutcher]

After 20 years of military medical (Sick Call), I think I'd be dead by now if I hadn't met and married DW, who has a much better understanding of the medical establishment than I.