Guidelines for When to Call 911 First and When to Call Your Doctor

We are very fortunate to have a fine and well trained paramedic squad to respond to medical emergencies in Palm Beach County and the City of Boca Raton around the clock.  Additionally, patients of my concierge medical practice have direct have access to me 24 hours a day.

I educate my patients how to use the services so that they get the most appropriate attention for the medical condition they are experiencing.  Thus, it is important to have basic guidelines of when it’s appropriate to call 911 in a life threatening emergency.  All too often, 911 is called for non life threatening emergencies which can delay emergency response time to other families’ life threatening crises by diverting attention to their non critical situation.

I suggest my patients call 911 immediately if they, or someone they are with, experience any of the following:

  1. Breathing Difficulty
  2. Chest Pain suspicious of a heart attack or pulmonary embolus
  3. Loss of consciousness or change in mental status
  4. Uncontrolled Bleeding
  5. Severe Trauma creating the possibility of life threatening internal injuries.
  6. New and uncontrolled pain suggesting a major and severe injury or illness

In these situations, I ask patients to call 911 immediately and then call me if they are free and not attending to or providing resuscitation for the patient. When the paramedics arrive on the scene they will take the steps necessary to save the patient’s life. They will attempt to stabilize the patient and bring them to the nearest emergency room even if it is not the hospital of choice or the hospital where the patient’s physician has staff and admitting privileges.

In situations other than those mentioned above, when 911 is called, the paramedic unit is responding to a non critical situation. When doing so, they are unavailable to respond to some other individual’s life threatening situation.

In most cases, irrespective of their findings, the paramedic’s protocol will direct them to recommend that the patient be taken to the emergency department for additional evaluation. They often choose to take the patient to the closest medical facility not the one the patient would prefer to go to.  This often results in long and lengthy time spent in the ER waiting to be seen by the ER staff and undergoing numerous laboratory and imaging tests because the ER staff does not know the patient’s medical history.

I remind my patients to call me first in non life threatening situations so that I may intervene and direct the evaluation. I speak to the paramedic team at the site to judge the severity of the situation and to make suggestions to the patient and family.

When I meet the patient at the ER, I know my patient well enough to judge, without many tests, if they are sick enough to stay and be admitted. The process is facilitated by knowing the patient’s medical history and knowing what the patient looks and acts like when they are well.

Very often, instead of going to the ER, the patient can safely be treated in my office, their home, or the office of a colleague who specializes in the type of medical condition  they are experiencing. This saves the patient time and gets them the attention they need for their non life threatening situation without overloading an acute care hospital’s emergency department.

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