When is it appropriate to call an ambulance?

[ambulancequestion]

Hello everyone, I'm not in the medical field so I'm sorry if this is the wrong place to post, but this seemed like the best place to ask.

We had an email circulate around the office recently, a hilarious list of frivolous complants people thought they needed an ambulance for, written by EMTs. That got us talking and long story short, some of my coworkers will call for a broken wrist and others will drive themselves to the hospital with a gushing head wound.

I've always thought that if you're on death's door you should call an ambulance, but you should take a cab if you're able. But what about the gray areas? For instance, if you're alone and you break an ankle badly, then you might not be able to hobble out and find a cab, but it doesn't seem serious enough for an ambulance. What about a broken arm with bones piercing the skin?

What are your thoughts on the minimum requirements for an ambulance? By the way, we did google this but came up guidelines that were too general. Thanks for your time, you'll be educating a whole office of clueless IT people.

[EMTalex]

you should call whenever you feel you need us. 24/7. Thats what we are here for.

[Raf]

This is an excellent question that I've always wondered about myself as well. Personally if I ever got hurt I think I would go to the hospital myself.

There are some things that I know can't wait, in which case I would call an ambulance if something happened to someone I know. Amputation and cardiac arrest being two.

If I ever needed stitches or broken a bone, I would patch myself up and drive to the hospital or have someone drive me.

You just have to remember that going to an ER means waiting for HOURS for treatment. If you take an ambulance, you get instant service...at a very large price! So moral is, if it's an injury that can wait, don't take an ambulance.

[ffemt8978]

Each situation is going to be dependent upon the totality of the circumstances including: nature/severity of injury/illness, general health of patient, distance to nearest treatment center (which may be your doctor's office), time of day, transportation availability and a host of others.

Ask yourself the following questions (if you answer yes to anyone, then call EMS)

1) Is there any possiblity that I could die or be permenantly disabled from this injury/illness?
2) Do I need to see a doctor now?
3) Will me driving myself to the doctor/ER place myself or anyone else at risk of injury?

If there is any doubt about whether or not you should call an ambulance, you've already answered your own question...YES, call an ambulance.

BTW, you and your IT friends should stick around here. Who knows, you may find this to be the intersting field that we do and decide to find out more.

[islandgal]

I agree call anytime you feel it is a true emergency. However, remember (and depending on the resources where you live), when you dispatch out the aid unit you are tying up that unit from responding to other calls. For example, I've been on a calls for someone with a possible ankle fracture (and a ride was available-they managed to get to the resort lobby), and another call goes out for chest pain. I don't like when 911 is used as a taxi service to the doctor. But I never would hesitate and never feel bad showing up and having it turn out fine (yeah!!) because people are scared or overwhelmed.

[rescuecpt]

My general rule is if you are too sick to walk to the roadway to either get in a car or a cab, then call the ambulance. If you are having difficulty breathing or chest pain, call the ambulance. If you can't control the bleeding, call the ambulance. If bones are sticking out of your skin (not good!) call the ambulance. If a baby has it's head sticking out of you, call the ambulance.

[SwissEMT]

Originally Posted by EMTalex

you should call whenever you feel you need us. 24/7. Thats what we are here for.

I can tell you haven't worked in EMS yet.

[EMTalex]

yeah thats true, but im just goin of my experience back in england. my uncle was a ff and my cousin a paramedic

[Jon]

Ok. IMHO, there aren't any "minimum guidelines" for when to call an ambulance. Yes, there is abuse of the 9-1-1 system. Yes, I've heard "I've got Medicaid.. that means I get to ride in the ambulance for free instead of taking a cab."

Are there patients who go by ambulance who don't "really" need it? Yes, there are - plenty of them. On the flip-side, though, there are many examples of people driving themselves to the hospital when they should call 9-1-1.

For example... when you are having a heart attack, if the "hosptial comes to you" by way of a good EMS program, you will get faster care, and faster care upon arrivial at the hospital. Paramedics often have protocols that often let them do much of their patient care without consulting a doctor first. They can give you asprin, oxygen, nitroglycerin, use a EKG machine to do a cardiogram of your heart and determine, to an extent, whether or not you are having a heart attack. Often, they can give you morphine to reduce the chest pain and reduce the stress on the weakening heart. If you drive yourself to the ER, you might get there before you would on the ambulance... but you won't have an IV started, a first cadiogram done, asprin, and your first dose or two of nitro and perhaps morphine. You will have to register, be seen by the triage nurse, then get taken back to a bed. When you come in by ambulance, if you are REALLY sick, you get to go right back into the treatment area... in fact, in some systems, if the pre-hospital cardiogram reveals that you are having an active MI (Miocardial infarction - Heart attack) ambulance crews are bringing patients straight to the cardiac cath lab. If you drove yourself in, it will take time to get the initial evaluation done... Part of this is load on ER staff vs. EMS staff... In the field, I usually only have 1 patient I am responsible for. I can't get my patients mixed up and cause a medication error. A paramedic in the field can give patients medication on "standing orders" and do it immediatly after they determine the need for the medication. In a hospital, a nurse is often responsible for 3-5 or more patients, and only physcians can order medications.


What I am trying to say is:

If you have a valid medical complaint, ANYTHING... a fracture, nausea, whatever... and you feel that you need to get to an ER, than feel FREE to call 911. As long as you don't say "I called 9-1-1 and you HAVE to take me to the hosptial for my clinic appointment," you shouldn't have any problems with the EMS crew... they should be caring and do their best to make you comfortable. Also, when you call 911, make sure that you answer the call-takers questions fully and honestly. Don't say you are having chestpain unless you are actually having chest pain... all systems prioritize calls to some extent. In some cases, you will only get a "basic life support" ambulance, staffed by EMT's... not an "advanced life support" ambulance staffed by Paramedics... Paramedics start as EMTs and have more training on managing serious medical emergencies... for the most part, if all you need is advanced first aid (fractures, etc), than an EMT is all you need.

To get back to the point about when to call 9-1-1 - When I am treating a patient and they say they don't want to go to the hospital by ambulance, they will get there on their own - I ask this question:
-Is there someone who can drive you? (If you are saying you feel weak, or perhaps you are bleeding profusely... what happens if you pass out while driving yourself to the ER? You could further injure or kill yourself or others)

In some cases, driving yourself, or being driven to a hospital is a reasonable alternative to ambualnce transport. I work as a Security Officer/EMT at an office complex that backs up against a hospital. My boss has told me that I should "discourage" the employees from going to the hospital "on their own." In our case, in reality, it DOES take longer for an ambualnce to arrive than for me to drive myself to the hosptial. Further, we are so close to the hospital that an ambualnce crew often doesn't have time to provide lots of care going to the hospital.

Ok... I've run the gamut back and forth... basically, it is your call... if you are close to a hospital, feel that you can safely get there, and you are only minorly/moderatly sick or injured, than you can probably do OK without going by ambulance... on the same token, if you call 9-1-1, EMS will come and take you to the hospital (as long as you have an actual medical complaint). - For example... if you need stiches, or something else that is urgent, but not emergent, you could probably drive yourself to the ER.

Oh.. and a caveat - this IS NOT medical advice, just what I've wittenseed as both a patient and provider.

[Firechic]

Originally Posted by Raf

You just have to remember that going to an ER means waiting for HOURS for treatment. If you take an ambulance, you get instant service...at a very large price! So moral is, if it's an injury that can wait, don't take an ambulance.

Sorry Raf, I have to call you on this one. Just because you get to the hospital by MICU does not mean that you will automatically be seen ASAP by the hospital staff. The patient you are bringing is still triaged according to their complaint. There have been times where we wheeled the patient right into the waiting room because there were more critical patients waiting. So, MICU does not = no waiting in the ER.