When you’re experiencing a medical emergency, the best place to go is the emergency department, rather than an urgent care center. But how can you tell when your illness or injury is an emergency? Before you seek medical care, ask yourself some key questions.
“What’s my general health? Am I young? Am I old? Do I have multiple medical problems?” says Maryland-based emergency medicine specialist Dr. James M. Williams, spokesperson for the American College of Emergency Physicians. “What do I think the capabilities of the facility are that I’m going to? For example, urgent care is decidedly less broad in the depth of the services that it offers than the emergency department.”
Some people misjudge their symptoms, visiting an urgent care center when the emergency department is the appropriate venue. About 3 percent of people who go to urgent care centers are referred to emergency departments, where they receive treatment for serious conditions; researchers at Penn State Hershey Medical Center found that 21.8 percent of people referred to the emergency department by urgent care centers require a hospital stay.
“If you think you’re going to be admitted to the hospital,” Williams says, “clearly urgent care is not the place to start your journey.”
These four conditions should always be assessed in an emergency department.
Chest pain
Chest pain might be heartburn or anxiety, but it may also be a heart attack. Seeking quick care at an emergency department could be life-saving. Urgent care centers aren’t designed to diagnose or treat heart attacks, but some people with chest pain walk into these nonemergency facilities.
“The assumption by the general public is, ‘Oh, well, they’ll do an EKG and make sure I’m okay,’ [but] that’s a fallacy, because an electrocardiogram tells us the rhythm and the rate of the heart; it tells us nothing about the size of your coronary arteries,” says Orlando-based urgent care physician Dr. Franz Ritucci, physician liaison for the American Academy of Urgent Care Medicine.
Emergency department physicians can perform diagnostic blood work that checks for levels of troponin, a group of proteins that become elevated when the heart has been damaged; urgent care facilities can’t do this. Troponin testing has been shown to quickly diagnose or rule out heart attacks among patients in the emergency department. Emergency physicians can also administer ultrasound stress tests (treadmill tests) to assess heart function.
“In the urgent care facility, we don’t have that type of capability, so more likely than not, you’re going to be transferred over to the emergency department,” Ritucci says. “You’ve not only gone to a facility that wasn’t the appropriate place, you’ve incurred another bill.”
Issues with breathing
People who are short of breath may have asthma, chronic obstructive pulmonary disease, upper respiratory infections or other conditions. Emergency physicians are best qualified to diagnose and treat conditions that make it difficult for someone to catch their breath. The cause may turn out to be nothing serious, but it’s better for doctors at the emergency department to investigate, in case it requires someone to be intubated.
“It may be anxiety, or someone trying to get back in shape who became really winded,” Williams says. “That might be different than somebody who was simply walking and all of a sudden had chest pain and shortness of breath and was sweating.”
Traumatic injuries
Urgent care facilities have X-ray machines and can treat simple fractures, but more complex injuries need to be handled at emergency departments.
“It’s called an open fracture when a bone is protruding through the skin, and you need to be going to the emergency room,” Ritucci says. “If you sustained a significant crush injury — a barbell went on top of your foot and you cannot bear weight whatsoever on that, or for hand crush injuries — you may be better off going to the emergency room.”
American and Israeli researchers have shown that people with open hand fractures are often sufficiently treated in the emergency department, rather than requiring surgery. (The appropriate care is not available at urgent care centers.) Repositioning bones that have broken through the skin, known as an open reduction, can be quite painful, so it’s best to be in a hospital setting for the procedure.
“It’s an excruciating condition to have, and sometimes you have to be given morphine,” Ritucci says. “You’re probably better served in the emergency department, where you can be given IV sedative medication, pain medication.”
Passing out
Fainting should be assessed by an emergency physician, in case it happened because of a medical emergency. Passing out could indicate a sudden drop in blood pressure, low blood sugar levels, dehydration, heatstroke, a seizure or stroke.
“Someone who passes out, or may have found that ‘Hey, I’ve got a little bit of a slurred speech; I lost some power in a limb, but it came right back,’” Ritucci says, “that could be what’s called a TIA, a transient ischemic attack, and that is something that has to be further evaluated in the emergency department, not at the urgent care center.”
Up to 86 percent of emergency room patients who have fainted are hospitalized for treatment or evaluation, according to Canadian researchers, so visiting an urgent care center may require an emergency department referral or a hospital admission.
“They have a much more significant depth of facilities and testing and interventions that they can perform,” Williams says. “It’s not just what I can diagnose, but also, I have all the specialists, typically, in the hospital to take care of that.”