Protocol when going to ED

[Teeki]

Is there a right way to go to an emergency department of a hospital? Are you not supposed to turn up on your own?

Two years ago today, we were staying in a hotel, we were back there between a wedding and reception when DD suddenly got very sick - lots of vomiting, very hot. We called the nurse on call number but he wasn't at all helpful, so we asked if we should just go to hospital. He said he could call an ambulance if we wanted. We declined, called the hospital and drove there. It wasn't the kind of emergency that warranted am ambulance, but they seemed very confused by us driving ourselves there!

Then on Friday, DS got sick. I was at the GP with him and he said he needed to be in hospital. We went round to the nurses room and he was put on oxygen. I had said ok, I'll take him straight there, but they didn't want him in the local one so we took an ambulance to the big one. I didn't question it.

But the way they reacted when I said I'd go there, is it not normal to take yourself there?

[Floweryfields]

I have a friend who is a nurse in an ED, they get a lot of walk ins. I've driven myself to hospital in the middle of the night before - didn't want to call an ambulance and I live 3 blocks from the hospital. I don't think it's that bizarre.

[OceanPrincess]

I've only had one ED trip (so far!) and I drove with my 36wk preggy belly, DS1 and DD. We parked and walked in. They greeted me, triaged us, no drama. I think it's fine!

[peanutter]

I think they absolutely do their best - and to reiterate (in response to the OP) I don't think there's anything odd or problematic with presenting yourself to ED when there's an emergency

[Cassius2]

We have i reckon 99% of the time rocked up at ED on our own steam. I count ourselves really fortunate that we havent needed an ambulance each time.

The only two times i have called the ambos is when 1) DD1 at 4 weeks of age stopped breathing in her sleep at home and 2) when i had a PPH 5 weeks after DD3 was born.

I have come very close to calling an ambulance for DD3 after a spate of long seizures in the middle of the night, but opted to drive her in instead (with DH driving and myself with her in the back).

For us, the ambulance was immediate attention but that was also quite easily demonstrated that both instances needed immediate care. When we have walked in, we have had mixed results. There was only one instance where I think that the triage missed the boat but that was my own fault as I am an eternal optimist and do not do 'sick' very well and try to always look chipper and happy...even when i am passing out lol.

Also, with DD3 I think there was a situation where we took her in and again, because i do tend to downplay things we were triaged as potential febrile seizures (even though i knew they were not)...DD3 had a slight temp and appeared fine. So we waited quite a few hours (but i wasnt mad or anything as obviously unwell kids were going in with vomiting and dehydration etc), but once DD had a seizure in the waiting room and proceeded to decorate the floors with her vomit we were in within minutes. one of the nurses witnessed it, so that really helped.

We arrived two days later with DD3 for the same thing on our own steam and that time were seen immediately and admitted to neurology.

What i have summed up from my experience is that it really doesnt matter how you arrive. what matters is the nature of the emergency AND communication. the communication side is one thing that i have had a steep learning curve on since our issues with DD3. I need to be her advocate and have learnt how to communicate concerns and suspicions of her health and wellbeing much better. it has saved all of us (myself and the medical teams that work with us) a lot of time and unnecessary interventions/hoops etc.

[dinky]

I have done walk ins and ambulance transfers to our local ED. The triage system works quite well IMHO. Ambulances are triaged the same as walk ins, but they will try to get them off the stretchers asap. It doesn't happen fast enough though! It's how the public system works, and to be honest, we have received excellent treatment each and every time we have been there. I drove my DH to hospital when he had a heart attack, he refused to allow me to call an ambulance, but would allow me to take him to the local Dr, I took him straight to ED. He wasn't happy, but was triaged and in resus in under 5 mins and in surgery in 30 mins, it saved his life!

There is nothing wrong with taking yourself to ED. If you feel that it is safe to do so. I have been told by DH's specialist that I am NEVER allowed to drive him again and to call an ambulance straight away should he have more chest pain, which I have had to do a few times. Thankfully we are covered with our PHI. For a 10 minute trip it cost $1000. I myself, was taken from one hospital to another and then transferred to another, $4500 those cost me, but we were covered.

[surprised]

And if you're not convinced yet about having private cover for these things, imagine the cost of a helicopter transfer!

[Teeki]

Thanks, it had me wondering! Mostly because I haven't gotten around to getting ambulance cover yet and Friday's trip is gonna cost us $8-900

[trishalishous]

Ive always just driven myself up. we live out of town, and ambulance is on the oppostie side of town, with the hospital in the middle. much quicker to go in ourselves

[Tegam]

Also it's important to just all an ambulance if you are just too upset to drive. You will only cause an accident if you are distracted by a sick child behind/beside you while driving!

[Lily Dust]

With the condition DS presented with then no, apparently ambulance is more common due to the need for oxygen. Under 12 weeks breathing can cease altogether etc. If a bub is presenting with sub or intercostal breathing and a tracheal tug then they prefer paramedics to treat on route. I've been turned away with an 8 week old who was limp and not feeding in the ED simply because of a small town with lack of knowledge. The after hours GP service when we contacted them said it was their protocol if a baby has a tracheal tug to transfer via paramedics asap. I've questioned it and they were quite (professionally and kindly) forceful on the matter.

I think it depends on the reason you are presenting in the first place ITMS

Thanks, it had me wondering! Mostly because I haven't gotten around to getting ambulance cover yet and Friday's trip is gonna cost us $8-900

Oh hun are you sure you have to cover it since it was Dr to hospital transfer? Get it though! We pay about $100 a year and in the 2 out of 5 trips we've had it has been well over $1000 invoiced.

[Teeki]

Yes, that's what DS had - the tracheal tug. I hadn't noticed because he was so rugged up, I'd only noticed his chest heaving quickly. When they put him on oxygen I realised how serious it was and the Dr explained they wanted him to go 30 minutes away and who knows what could happen with breathing like that, in a rear-facing car seat for that long

The Dr actually mentioned the fee, he asked if we have cover and do did the medics. The Dr did kind of stop when I said no but seriously, if he's gonna stop breathing and needs an ED I'm happy to pay the fee!

The annoying thing is we have a long list of things to do now I'm back at work, and health/ambulance cover is next for this week. Just poor timing for us unfortunately! But good that I am back at work and we've done the tax because it's not really an issue.

[Amity]

For me - it depends on what the issue is. I took DS2 to ED last night after a footy injury. I drove him there myself as it wasn't massively serious.

I have called the ambulance for asthma attacks and croup in my sub 2yo children.

I regret not calling an ambulance for DS1's concussion which was at school - and was disappointed that they didn't do it.

[~Hestia~]

Have taken the boys in a few times plus DH and I have presented once or twice each. None of these instances were life threatening so we just took ourselves in.

[*Ang*]

Have been to ED a number of times with the children - injuries e.g. DD's broken wrist a fortnight ago, or asthma/chest related and each time we simply take ourselves there. Twice after being seen to and triaged we were admitted for a number of days (asthma). Also been myself for pneumonia, again drove ourselves there.

Never once have we been questioned as to why we didn't take an ambulance and in fact majority of cases at the hospitals that I have attended are walk ins.

[Amy_jellybean]

I guess it depends on how much of an emergency it is. I drove myself to the hospital 40 mins away while having contractions at 34 weeks hahaha.

[nyigi]

Yep I think it depends on the nature of the problem.
My rule of thumb is that if it's urgent or you can't get there safely on your own then you call an ambulance, otherwise you take yourself in.
Only trick is sometimes I'm not the best judge of the urgency. So far only been one case when I was told I should have called an ambulance rather than getting there myself and even then I don't think it was clear cut. DS had febrile seizures, I called the hospital once they'd finished (didn't want to move from him to get the phone before hand) and they told me to bring him in myself but make sure someone else drove so I could keep an eye on him. When we got there the doctor checked him over and said he was fine but that I should have called an ambulance as soon as they started.

On the tracheal tug note, yep my DS also had this and I also didn't notice it. Just took him to the doctor cause his cough had been going on for a long time. She called the hospital straightaway to let them know we'd be coming in. We did get ourselves there though. Then stayed a week on oxygen, ventolin, and antibiotics. Not at all what I'd expected from that doctor's visit.

[peanutter]

I have always presented myself / my child, as it's never been an emergent (is that the word?) situation, and/or I will get them/myself there faster, and I have been comfortable relying on the triage system to make sure I/the person I'm taking will get seen to at an appropriate priority.

That being said, I have heard enough times (and from my DH's observations when working as security in a hospital) that due to the relationship between the paramedics and the hospital staff that people coming in ambulances will get tended to faster - so if I was ever worried and thought that I need that extra speed in the system, I would call an ambulance for that reason.

Obviously, if it was ever a situation where I was concerned about moving them, or in an emergent situation where an ambulance would get to me before I could get to a hospital (eg: no hospitals on Hamilton Island, but there was an ambulance, and DS1 had a really bad croup attack - ambulance!) or anything that I thought in and of itself needed an ambulance, I would have no hesitation in calling one.

But generally speaking, I have not needed an ambulance, we've presented ourselves, and it's been fine.