Today I am going to take a break from coronavirus, and talk instead about acute care, with an emphasis on when to use and not use the emergency room.

There are five main sources for acute care:  the emergency room, 911, our office, walk-in clinics, the phone/internet, and the Poison Center.  If there is one take-away message from this blog, it is the following: IF YOU DO NOT FEEL A NEED TO CALL 911, YOU PROBABLY DO NOT NEED TO GO THE ER RIGHT AWAY.  Instead, you have time to call and get advice first.

I equate rushing to the ER with 911 calls.  When needed, which one takes priority depends on several factors, including how close you are to the ER, traffic, your ability to drive when stressed, and whether you need one person to drive and one to attend to your child.  Around here, 911 generally responds very quickly, and is usually the better choice.

What sorts of issues require 911?  Severe trauma is an obvious choice, by which I include such things as extensive burns, fractures sticking out of bones, near-drownings, and head trauma with loss of consciousness.  Head bumps where a child is feeling well do not require a 911 call, even if there is a large bruise or the noise of the collision was very loud.  The most common non-traumatic condition requiring 911 would be stopping, or severe difficulty in, breathing.  Note that high fever in and of itself, hives without beathing problems or vomiting, bee stings with just local swelling and pain, rashes, and vomiting without the sudden onset of unremitting pain (as opposed to nausea) leave you time to call someone for advice first.

Seizures, surprisingly, will not usually require 911.  They are most often seen in younger children in association with a high fever, and tend to be benign.  In order to cause problems, a seizure needs to go on for at least 20 minutes, and most will stop within ten.  As such, I recommend waiting five-ten minutes into a seizure and then calling us if it stops, or 911 if it does not.  That having been said, a seizure is incredibly hard for a parent to watch, and calling 911 is a reasonable, and understandable, reaction.

If you are uncertain what to do with an acute, but not serious condition, I suggest calling or using the internet as the first step.  We have triage available 24 hours a day (but prefer you call during office hours for non-emergent issues).  If we are backed up, many insurers also offer an 800 number you can call for advice.  Our web page also has a very useful section (Child Health Library) which discusses various symptoms, and what do for them.

Going to an emergency room is an expensive undertaking, and is often associated with long wait times.  As such, for most illnesses that need to be seen, our office, or a walk-in clinic, is a better choice.  When to use us versus a walk-in clinic?  As a general rule, we prefer you see us.  We know your child, have access to his medical records, and are experts in pediatrics.  A walk-in clinic does not have those advantages, and the providers there feel, understandably, that they have only one chance at your child, and had better not miss anything.  As such, they are more likely to order potentially unnecessary blood tests and X-rays, and prescribe unnecessary medications (usually antibiotics).  If you do feel a need to use a walk-in clinic, I strongly recommend you use a pediatric one; there are many in the area.

When is a walk-in clinic a better choice than our office?  The most obvious situation is when we are closed or fully booked.  We do have some evening and weekend hours, but are not open as much as a walk-in clinic.  Potential infections, even if the child is hurting, can usually wait until we are open; for example, an antibiotic for an ear infection does not work right away, and the important medicine at night is the pain relief and not an antibiotic.  I do understand that there are times when it is impractical to come during office hours, in which case a pediatric walk-in clinic makes sense.  Another time when they can be a better option is for trauma when an X-ray is clearly going to be needed, as they have that available on-site, while our office would have to send you out.  As a counter-example, though, many apparent injuries will not necessarily need X-rays; jammed fingers, and ankle injuries where a child can walk, even if limping, often do not require X-rays, and can often be avoided by seeing us first.

Lastly, there is the Poison Center at 800-222-1222.  A simple overdose, where for example one parent gives a dose and the other gives a second one shortly thereafter, is very unlikely to cause problems; you can call us for that.  The more potentially dangerous issues are when a child has taken large doses, or an unknown substance.  Although our call center can handle many of these, the Poison Center can handle pretty much all of them, and I recommend it be on speed dial on your phone.