When ya gonna call?

Just a quick aside- I'm working on finding more choice words, but if my proofreading has missed a profane word, please forgive it. Also, as to my background, I am an EMT-Intermediate '85', undergoing Paramedic training as of the time of this writing. I've decided to dedicate a blog specifically to providing what I'm quite sure are some fresh and valuable tips to you, the patient, on how to utilize the system in the US to its fullest. Please be aware, however, that when I speak of how a system operates, I speak in generalizations and operations can vary from locale to locale- thus, my statements may be inaccurate for your area. Please take the time to learn the details about your local emergency system. Also, if there are any questions, I'll do my best to address them within reason, so feel free to ask.

This first article is about when and when not to call for Emergency Medical Services (or more simply: 911, EMS, an ambulance, the paramedics, etc.). My reasons for choosing this as the first article- after a bit of debating between this one and 'A trip to the doctor's office'- come from my remembering that before my medical training, I really didn't know what the line was between what constituted an emergency and what didn't. I remember a few situations where I wondered to myself, in stalemate, whether or not I should call for an ambulance or not. In today's densely-packed society, the likelihood that any of you, if not all of you indeed, may encounter or, heaven forbid, have an emergency in the next few years is extremely high. Assuming that the rest of you are like I was, and couldn't actually decide between there being an emergency or not, I'm writing this so that you can be prepared and can properly identify an emergency early on and possibly save a life.

First, what constitutes an emergency? Well, there's quite a few answers, but here's a great rule of thumb: Any significant deviation from someone's normal status of existence. For example, if someone hasn't just had inexplicable and horrific chest pain their whole life, and they suddenly develop persisting and bad chest pain, you need to really watch them, because that's one major sign of an emergency. If a person who's usually pretty much like a normal person in the middle of the day suddenly starts getting confused, mentally 'slow', sleepy, and/or generally acting strange, chances are that it's an emergency and you need to call EMS. Here's a few solid guidelines of an emergency, along with explanations.

- If someone has had a persisting fever for three days OR has a fever over 103 F; that's 39.4 C for those of you who don't use Fahrenheit (see: Everyone). The reason for this is that it's an indicator of a very serious infection, be it viral, bacterial, or fungal. Also, the very high, persistent fever can be extremely dangerous to the brain and other body organs.

- If someone's having trouble breathing, especially if it's spontaneous. If they know what it is and can manage it with their own inhaler or other methods, then allow them to do so. However, stay attentive- if it doesn't resolve with self-treatment, and they're clearly having a lot of difficulty breathing (you can see their head moving back and forth from how hard they're working their chest muscles, you can hear loud wheezing sounds, they're leaning way forward, they can only talk to you one or two words at a time, you can see their nostrils flaring, you can see them using their neck/shoulder muscles to try and help them breathe, and ESPECIALLY if their lips start to turn blue) then you need to start picking up the phone. Stay nearby so that you'll know if the situation gets better or they stop breathing, in which case the dispatcher will be able to provide you with instruction on how to help until EMS arrives. Also related is if you find them not breathing or if they start choking. Call EMS IMMEDIATELY when you see that someone's choking (IE: Can't cough, can't breathe, can't talk, clearly struggling) because sometimes things like the Heimlich maneuver don't work and require more advanced interventions.

- If someone is completely unresponsive (meaning that you've tried to wake them by calling to them and that you've tried to wake them by pain stimulus such as pinching their fingernail against their finger) or is very lethargic or confused, particularly if it's clear that they shouldn't be. This should immediately start throwing red flags and cause you to start checking to see that they're still breathing or still have a pulse. If you can't stir them, or they look pale, sick, sweaty, or unusual in some other way, then you need to start dialing for an ambulance.

- If someone has a seizure. Of course, I'm referring to the classic Tonic-Clonic seizure that everyone immediately thinks of when you say 'seizure'. True, people have conditions that can induce seizures regularly, but they usually have medications that almost completely control it, so they shouldn't be having one in the first place. So, yes, call EMS. If they don't have epilepsy or other seizure-inducing conditions, then you should have absolutely no doubt whatsoever that it's an emergency and NEED to tell the medics about it when they arrive. Also, be careful to note if they hit their head on anything if they fell over. The reason seizures are such a big deal is that they can be an indicator of very serious underlying conditions, not to mention that they don't breathe at all during the extent of the seizure, so they could be suffering from dangerously low oxygen levels.

- If someone becomes suddenly confused or starts acting strange (particularly if they start acting drunk without actually being drunk) and it doesn't immediately resolve, you need to be reaching for that phone. Like seizures, it can be a sign of a very serious underlying condition that could be immediately hazardous to their health. Also similar would be if they spontaneously lose consciousness or fall out, even if they return to consciousness right away and especially if they hit their head on the way down.

- If someone has a new or sudden onset of severe, persisting (see: lasts more than a few seconds at a whack and clearly isn't something like muscle pain. If someone tries to pass off a very, very bad chest pain as indigestion, you need to remain skeptical about it, as denial is even considered to be 'classic' in the heart attack patient) pain, particularly in the chest and/or abdomen. There are a plethora of reasons for this, and almost all of them are very serious.

- If someone is found to be without a pulse and isn't decomposing (there are other ways to tell if it's far too late to resuscitate them, but those are better left to those trained to recognize it). Absolutely call 911, every, single, time.

- If someone starts vomiting or otherwise excreting blood in ways that they really shouldn't be (also, black, tarry, and sometimes face-meltingly bad smelling stool is a sign of a lower GI-bleed, which is also an emergency).

- If someone has been vomiting excessively for three days or more, thus unable to keep anything, even water, down. One day may pass, two days is on the fence and understandable if you call, three days should leave no question because now they're getting very dehydrated, first and foremost.

- If they've got an illness (like asthma or allergic reactions) that you're aware of and it's worse than you've ever seen it get before or it's getting to a clearly life-threatening point.

- Suicide threats should always result in a call to emergency services and should never -EVER- be shrugged off.

- If you're seriously debating on whether or not to call EMS, you should probably call. You can always ask the dispatcher to cancel the response if things get better.

- Trauma is a bit trickier to deal with, so bear with me. If they fell from three times their height or more (only twice their height for children), hit anything on the way down, hit their head/neck, or are clearly injured from the fall, who ya gonna call? Also, any car crash should always result in EMS being called (Unless all occupants assure you otherwise or the crash was clearly minor with minimal, if any, damage), particularly if the cars struck going in opposing directions. If someone hits their head hard enough to create a lump, cause bleeding, or cause them to lose consciousness, call EMS and insist that they seek treatment (mind that you can't hold them there because that's false imprisonment). If they were involved in an accident and broke a bone, the car rolled over, another involved person was killed, another involved person was ejected, or the cars or plainly mangled wrecks, it's time to call. If an eye was put out, call. ANY motorcycle crash needs to have EMS called. If anything was amputated, call. If they're bleeding and you can't immediately control it, they've lost/are losing a lot of blood really quick, have extensive injuries, or are spurting bright red blood, call. If they were burned (excluding all but the worst sunburn) over at least 1/8 of their body or had been on fire, had been inside of a structure while it was on fire, are still on fire, have burns around their lips, have a hoarse voice after being involved with a fire, or have burns with blackened/white and waxy charred skin, you need to call. If someone complains of neck or back pain after an accident or injury, you NEED to call.

- All of this goes doubly sensitive for children and elderly.

- If you smell alcohol on their breath but they're giving the impression that they may be having a medical emergency, such as having a large bruise on their head or stating that they're having chest pain, it's just safer to assume it's not the alcohol talking and call. Now, understand that it can be very difficult to tell if an intoxicated person is having an emergency or not because alcohol can mask a lot of signs and symptoms very well, as well as causing the person to answer questions inappropriately, so just be safe rather than sorry.

- If you notice a lot of people all passed out or behaving unusually in a certain area (ex: you walk in the mall to see everyone slumped onto the floor, everyone passed out or acting strangely inside of a neighbor's house, etc.), then you both need to get out posthaste AND call, because there's a very good chance that there's a hazardous materials incident (carbon monoxide in the case of the 'neighbor' example) happening. Also, call right away if there's an explosion of any sort that wasn't supposed to happen, if a tanker truck has overturned or crashed, if you notice any unusual clouds or smoke leaving a structure or vehicle, or any strong unusual smells- especially if you're in a location that handles chemicals, such as a home utility store.

- If they tell you to call 911, don't you even dare second-guess them. Do it.

- Pregnant woman in full, strong, late labor. EMS has the tools to help safely deliver a baby and handle any complications that may ensue. A taxi driver or a department store does not.

I know it's a lot, and I don't at all expect you lot to memorize the whole list, but if you even take a little bit away from this, it's going to help a lot.

Also, a quick note of the Dont's.

- Don't call EMS to take you to your doctor's office. We are EMERGENCY medical services, we do not take people to their doctor's offices. If you fake a problem- thinking it'll get you to your doctor's- you're going to the ER anyway. Not only do you put undue strain on a system that's spread thin in a lot of places to begin with, but you put other people's well-being at risk. This also goes for trips to the pharmacy and to visit relatives in the hospital as well as anything else of that sort. Just call a cab, they're at least $500 cheaper and you won't be putting anyone else's life at risk by stretching a thin resource even thinner.

- Don't call us because someone tapped your bumper and you think you're going to get more insurance money that way. People actually do this, and see above for why not to. Besides, it makes you look like a drama whore, and it makes you a drain on the system, both financially and logistically. If you're honestly in pain- honestly in need- that's fine, that's what we're here for. Otherwise, find some other way to abuse the system.

- If you need non-emergency transport to a specialized facility, don't call 911. Many ambulance services will have private, non-emergency numbers which you can use to schedule a non-911 truck to take you.

- We are not a rolling pharmacy. We cannot (excepting the UK's Paramedic Practitioner) hand out something for your headache or fever because we can't prescribe medications. There are a number of reasons for this policy, but the most important of them is because we don't want to disguise the symptoms of what could be a serious underlying condition and end up inadvertently causing more harm by allowing the condition to continue unrecognized.

- Don't turn away EMS because you're stubborn. If you're having an emergency, you need to go. Many a person has made themselves beyond help because they tried to tell themselves that their crushing chest pain was just indigestion for a good three days before finally admitting, well past any window for recovery, that it's something else. I understand money's tight these days, but you can't earn, save, or spend money if you're dead.