When to go to the emergency department

When medical symptoms strike suddenly or worsen, it can be tough to know what to do. Here’s a high-level guide.  

Bonnie Bayley
January 2019

Illness or injury can happen when you least expect it – you could find yourself with crippling stomach pain. Or your child wakes in the night with a fever. Or maybe your partner suddenly complains of chest pain.

These sorts of situations can feel scary and overwhelming, and you might be worried for yourself or your loved one. You might find it hard to make a judgement call on whether to wait it out, head to hospital or call an ambulance. So, how do you decide what to do?

When is it an emergency?

The Ambulance Service of NSW advises calling 000 if you have any of these symptoms:

• chest pain or tightness
• sudden onset of weakness, numbness or paralysis of the face, arm or leg
• breathing difficulties
• unconsciousness
• uncontrollable bleeding
• sudden collapse or unexplained fall
• unexplained fitting in adults
• severe burns, particularly in young children.

Additionally, if the health issue is new, acute and worrying, seek emergency help. It’s best to call 000 rather than drive to hospital if you experience any of these symptoms. Not only is it safer, sometimes paramedics can start treating you when they arrive.

Associate Professor Paul Middleton, deputy director of emergency medicine at Liverpool Hospital advises children should go to the emergency department (ED) if they are:

• short of breath
• becoming progressively lethargic or drowsy
• aren’t interacting
• not drinking or peeing, particularly in small children
• fitting or have an ongoing fever. A fever is anything above 38 degrees Celsius.

What to do if you aren’t sure

If you have time up your sleeve and are unsure how serious your illness or injury is, a good starting point is healthdirect, which offers an online symptom checker and 24-hour telephone health advice (1800 022 222) with registered nurses. They can advise whether you should see your GP, manage the condition at home, or go to an ED.

“Things like minor allergic reactions, minor injuries to muscles and joints and small household mishaps like cuts and lacerations can generally be managed by GPs,” says Royal Australian College of General Practitioners spokesperson and GP, Dr Abhi Verma.

If a fever, vomiting or pain strikes in the middle of the night, can you wait it out and see how it goes or should you seek urgent medical help? It depends. 

“Adults can by and large replace their fluids, and if fever doesn’t resolve [with paracetamol] they can try a cool washing down, although a temperature of 40 or 41 degrees is dangerous.” says GP Dr Kenneth Moroney.

For children, call healthdirect for advice or see their list of warning signs on vomiting and fever.

In the case of pain, if it’s in waves it may not be as concerning. But constant, severe, worsening pain, and in particular headache or chest pain, calls for a hospital visit, advises Assoc Prof Middleton.

He adds that there are examples of when an ED visit might not be appropriate.

“Emergency departments are there for emergencies; they aren’t there to get in to see a specialist faster, to deal with a chronic health issue you’re fed up with or to get a bit of reassurance.”

“If you [think] it’s an emergency or a potential emergency then that’s fine, however some people use the ED for convenience.”

According to the Australian Institute of Health and Welfare, 9.3% of the 7.8 million emergency department presentations in 2016–17 were for non-urgent conditions.

Options other than the ED

If your health problem isn’t an emergency, but still needs prompt treatment, and you can’t get in to see your GP, consider these options:

• A general practice that takes walk-ins, or a 24-hour or after-hours medical practice. 
• Some hospitals have urgent care centres, which are typically walk-in, 24-hour centres staffed by nurses, who treat injuries or illnesses requiring immediate (but not emergency) care.
• An online video GP service such as GP2U.