Insider’s Guide to the Emergency Room

Knowing how to navigate an ER can save time, frustration―even a life. Medical experts advise on how to make your next trip as painless as possible.

trauma-unit-vehicle
Photo by Scott & Zoe

Whoever came up with the expression “to add insult to injury” may have been visiting an emergency room. ERs can be chaotic places, populated by so many bewildered patients and busy staff members brandishing unfamiliar forms that just making your way through one can add a throbbing headache and a foul mood to your list of maladies. To make the experience less of an ordeal, Real Simple asked 10 emergency-medicine specialists to answer the most common ER conundrums, from how to navigate a crowded waiting room to how to get attention from overloaded doctors. With their insider methods under your belt (or hospital gown), you should come away from your next visit with at least your sanity intact.
 
 

Is it better to go to the ER in an ambulance or by car?

“When you have chest pain, shortness of breath, weakness, altered mental status, or uncontrolled bleeding, have someone call 911,” says ER nurse Connie Meyer. Ambulance workers (emergency medical technicians, or EMTs) are skilled in life-support techniques and will call ahead and alert the ER to set up necessary equipment―especially useful for strokes and heart attacks. “In these cases, the two minutes you save in a car won’t offset the benefit of having qualified personnel en route,” advises internist Marc K. Siegel.
 
For non-life-threatening injuries (a broken hand, a small laceration), have someone drive you. “In such cases, arriving by ambulance doesn’t equal faster care,” says Meyer.
 
 

Which ER should you go to?

EMTs will hustle a critical patient to the nearest ER. But if you are going by car, then you’ll want to do some advance planning. Ask your primary-care physician about the best ERs in your town. Some are known for treating trauma cases (burns, poisoning), while others may have specialists on duty or offer testing not widely available.
 
Also find out which hospitals are covered by your insurance and where your own doctors have admitting privileges. That hospital will have access to your records, which can expedite the care. Finally, you can look into a hospital’s ratings on the U.S. Department of Health and Human Services website (hospitalcompare.hhs.gov).
 
 

What should you have ready in case of an emergency?

The unanimous answer from medical experts: quick access to your medical background, which they say is crucial for the best care. Besides an insurance card, you should carry a wallet-size medical card that provides a brief, thorough account of your background. (Learn where to go to create one at realsimple.com/er.) Keep it behind your driver’s license; if a patient isn’t able to speak, paramedics will always look through a wallet. Here’s what should be on the card.
 

  • A list of prescription and over-the-counter medications, including dosages, frequency, and any recent changes in them, plus a list of any herbal supplements or vitamins you’re taking.
  • Allergies, even to contrast dye or latex.
  • Any major surgery you’ve had.
  • Doctors’ names and phone numbers.
  • Contact numbers for you and your health-care proxy or next of kin.

What happens if your child or elderly parent goes to the ER when he or she is with a caregiver?

In a life-threatening situation, emergency-room staff will always make treating the patient top priority. But when the patient’s condition is not critical, a child or an elderly person brought in by a caregiver may find a reduced delay for treatment if the caregiver has a notarized consent-to-treat form signed by you. The website of the American College of Emergency Physicians offers a printable form for treating children at emergencycareforyou.org. For an elderly parent, the caregiver should have access to a legal document called an advance directive. This form serves as a combined durable power of attorney for health care and a living will. You can print out an advance-directive form at the website of the American Academy of Family Physicians (aafp.org; the signatures of two witnesses are required).
 
 

Who are all those people at the ER?

It’s common to feel as if you’re being shuffled along a production line. Here’s whom you’ll probably meet, in order, on your next visit.
 

  • Greeter. A nonmedical staff member who may ask what help you need and relay that information to the triage nurse.
  • Triage nurse. The person who takes your vital signs (temperature, pulse, blood pressure, respiratory rate) and decides your place in the line based on your condition and its severity.
  • Registration clerk. The person with the clipboard who takes down personal information (name, age, address, insurance details) to generate your medical record and ID bracelet and labels for tests.
  • Primary nurse. Your point person once you’re admitted. On orders of the doctor, the primary nurse may arrange for you to have X-rays or blood and urine tests and may give you medications.
  • Emergency physician. The doctor who “bounces from patient to patient like a good waiter at a busy restaurant,” says physician Mark Morocco, a director of emergency medicine in Los Angeles.
  • Emergency technician. He or she assists nurses, stocks the ER, and helps transport patients between departments.
  • Patient advocate. Typically a social worker or a nurse skilled in mediation. This person may circulate through the waiting room periodically to make sure that no patient is being overlooked. The advocate can assist in placing patients in follow-up care programs and facilities.

Are there any shortcuts to getting in and out faster?

If by “shortcut” you mean jumping queues, then no. “ERs are democratic,” says J. Stephen Bohan, an emergency-medicine physician in Boston. Patients move according to the severity of the injury or illness. If you have a noncritical emergency and can choose a time to go, opt for 4 A.M. to 9 A.M., usually the quietest period, and avoid the peak hours of noon to 10 P.M. Some hospitals have urgent-care/fast-track clinics for patients who need immediate aid but have only minor illnesses or injuries that don’t require the hospital facilities of an emergency room. Check ucaoa.org for a list of urgent-care centers by state.
 

What’s the best way to advocate for yourself? What’s the worst way?

Be calm but persistent and assertive, says emergency physician Linda Lawrence. It’s OK to be a (polite) squeaky wheel if your needs aren’t being met. If the nearest staff member can’t help you, ask to speak to the nurse supervisor. If you still aren’t making any headway, ask for the name of the patient advocate.
 
To get more attention from the staff, never:

  • Be rude or combative. This can cause extreme resentment in staffs that Siegel describes as “overworked and stressed.”
  • Lie about or exaggerate symptoms. This will make it tougher for your doctor to make a diagnosis and can lead to unnecessary testing and harm.
  • Call 911 from the waiting room (yes, it happens).

What do you do if your condition worsens while you’re waiting?

Speak up. Go to the nurse (sometimes the only medical staff member you’ll have access to in the waiting room) or the doctor in charge and ask him or her to repeat your vitals because you’re feeling worse.
 
 

When you’re being seen by the doctor, what kind of information should you volunteer?

If you have your wallet-size medical card, you’re already a step ahead. Don’t edit; give a complete history of how the symptoms began, what affected them, and any other information you feel might be relevant. (For example, you’re nauseated. Were you recently out of the country? Did you eat something unusual? Or you have a pain in your side. Were you ever diagnosed with kidney stones or ovarian cysts?) Sometimes patients, especially teenagers, clam up when family and friends are present, so don’t be surprised if a physician asks others to step out while he speaks with the patient privately.
 
 

How will you know if you should see a specialist?

The ER doctor will tell you, but you can always ask. For example, if you have a broken wrist, you could ask, “Do you think an orthopedic surgeon might have a role here?” Hospitals have specialists on call, but if one isn’t available and your situation is not critical, you may need to see one after you are discharged.
 
 

What should you do if the doctors are pushing for release and you don’t feel that you or your family member is ready to leave?

Although overcrowding is a real problem, ERs are careful about not pushing people out the door. Ask the attending doctor to reassess the case. If you still disagree, ask to see the patient advocate.
 
 

What should you ask the doctor before you leave?

Ask for contact numbers in case you feel worse later. In addition, most hospitals discharge you with a blizzard of paper about the condition that brought you there, plus preprinted at-home care instructions that they can amend with specifics, like warning signs that you aren’t healing properly. Both you and a second person should scrutinize the instructions and seek needed clarification from the attending doctor or nurse before leaving, even if they’re hustling you out of your room. Don’t be afraid to ask questions like: “For how long should I take my medicine? What are the possible side effects? Will it interfere with other drugs? What activities should I avoid? When and with whom do I follow up?” Having a better understanding of the ailment that brought you in, plus the follow-up care it requires, will increase the chances that you won’t have to make a return visit.