Protocol when going to ED

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?

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.

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!

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 :redface:

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 :redface:

---

Oh hun :wall: 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.

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.

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.

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.

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.

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.

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.

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.

Breathing concerns in a baby I'd definitely call an ambulance.

A week ago my 3yr old sustained a head injury from a fall. I drove her straight to the bigger hospital 50kms away. I was not calling an ambulance for them to transfer her to our local hospital only for them to decide she needed to be at the bigger hospital and waste hours waiting for a transfer. We walked straight in and was triaged and sent straight to trauma. It would be the same for any pregnancy complications. Or I'd drive or be driven to a destination where I could be sure they would take me to the bigger centre.

:

---

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.

---

This is actually untrue. The way they get to the hospital has nothing do with it, everyone is given a score upon arrival according to their symptoms, and are seen accordingly. Someone who was driven in with asthma symptoms would be seen long before someone brought in by ambulance with a broken leg. It sometimes appears that people who are brought in by ambulance see dr's quickly but in reality, they wait just as long as people in the waiting room, they just wait more comfortably.

I did wonder if it made a difference time-wise if you turned up in an ambulance compared to in your own. The good thing for me is that I'd already told everything to the ambulance officers and so they'd written it all down and passed it all on to the hospital, so I think that made things a bit quicker and easier.

For me, where we live makes a difference. If I were just to go to the local hospital, I could get there quicker than an ambulance could get out here then get us back. I didn't really consider though that we'd need to go to the other big one so given the condition and distance, ambulance was warranted. The one with DD though, they all seemed so confused that we'd just turned up on our own!

I have been volunteering on the local ambulance crew and there are always people in the waiting room that we haven't delivered there. Our people did go straight into the rooms, but they were generally worse off (breathing difficulties, delirious, lethargic etc) while the people in the waiting room seemed to have no difficulty sitting there. And we need our stretchers back, so they need to be transferred to a bed.

$800-900 for an ambulance!! That shocks me. Is there some sort of subsidy for people on lower incomes? Or is proper emergency care only for those that can afford it? Here the ambulance is largely government/donation funded, with an $80 surcharge for medical emergencies. An accident would be covered fully by the ACC system.

I think ambulance costs and cover might be different state to state. I knew if we ever needed an ambulance we weren't covered and would have to pay for it. I also knew that ambulance cover on it's own, without phi, isn't that expensive. We just never got around to getting it. Bit silly really.

As for the really poor, where every cent counts and an accident leads to an ambulance ride, I've got no idea what happens. Not nice to think about people declining their care because they can't afford it.

:

---

This is actually untrue. The way they get to the hospital has nothing do with it, everyone is given a score upon arrival according to their symptoms, and are seen accordingly. Someone who was driven in with asthma symptoms would be seen long before someone brought in by ambulance with a broken leg. It sometimes appears that people who are brought in by ambulance see dr's quickly but in reality, they wait just as long as people in the waiting room, they just wait more comfortably.

---

Yep. I've arrived at the ED both ways with a similar set of problems both times & waited the same amount of time. At the hospy I went to, there is a bay where they park the stretchers, so you can't see them from the regular waiting room, which is usually 75% full of people who probably don't need to be there. But one time I arrived by car for something potentially serious, and i was triaged into a private room (they had no bays available at the time) and seen by the head of the ER in about 2-3 minutes of arriving.

Where I think it might make a difference is in a situation where the person might not know what to say to the triage nurse to communicate the severity of their symptoms. But in an ambulance, the ambos assess some of that and that info informs the triage score.

:

---

$800-900 for an ambulance!! That shocks me. Is there some sort of subsidy for people on lower incomes? Or is proper emergency care only for those that can afford it? Here the ambulance is largely government/donation funded, with an $80 surcharge for medical emergencies. An accident would be covered fully by the ACC system.

---

Im in NSW. We called an ambulance when our planned homebirth went pear shaped (it did warrant an ambulance, we couldn't actually go the 600m). 600 metres approximately $700, bubs trip a week ago 20kms $450. No idea, how it is calculated.

Maybe you used more of their stuff with the birth? Like gas or something? And the trip with DS didn't? Or maybe they consider how far to your place to begin with, but that wouldn't be fair.

In Qld ambulance cover is included in your power bill. I didn't realise that it wasn't in all states. How much does it cost to have cover? Sounds very worth it!

:

---

In Qld ambulance cover is included in your power bill. I didn't realise that it wasn't in all states. How much does it cost to have cover? Sounds very worth it!

---

It isn't in the power bills anymore, it is actually paid by the state govt for qld residents.

Oh really? Oops!

I find it crazy that other states don't have the same deal as QLD in which all ambulance cover is already paid for (we pay a levy through our electricity) but it does mean we never have to think about cover or bills.

Now how you should get there, depends on the situation, can you get there safely by driving do it... Or if you need medical attention now call the ambulance, I have gone to hospital both ways.

The time difference... Ambulance Is quicker I have to say...

For my little family, we call an ambulance if the person is in such severe pain that they can't manage or we can't move them because of it,

Or if they have stopped breathing or are getting less than 50% capacity in.

Or if they have lost consciousness.

Or if they are bleeding to an extent we can't control it and drive safely.

Pretty much anything else, we drive to hospital if that is what is warranted. We have called an ambulance twice - and I got asked to wait in the waiting room on one of those occasions. The one time DH has gone to emergency, I drove him and he was through very quickly.

I can say that I am yet to work in a hospital where ambulance delivered patients automatically gain priority. Patients are triaged based on clinical need - the same as those who walk in.

It's interesting how they assess who goes in and when. When we took ourselves with DD, we sat in the waiting room with maybe four other patients. One must have had a head wound, he was holding a towel or something to his head. DD wasn't vomiting anymore, her temp had started to come down, she was just a bit drowsy - but it was 7pm and she was only 14 months.

Anyway, we were the last there and the first to go in. I felt awful for those who had got there before us, especially towel guy. We figured it was because of DD's age. In the end she just got some special hospital-grade panadol that led to her jumping on the bed singing half the night :/

Teeki, at our hospital there is a team that sees children only, which means kids often go through more quickly than everyone else.

I think those who receive certain Centrelink payments (maybe who have a Health Care Card?) are exempt from ambulance bills?

I also think you can be charged if someone else calls an ambulance for you but you refuse treatment.

It might seem like those in ambulances get in quicker, but as others have said they might just be moved so they get the stretcher back, but still wait hours to see a doc.

There have been a few times I've attended for fluids (usually during pregnancy). I always wish GPs or at least medical centres with treatment rooms could do this as I feel bad taking up a bed and their time in hospital!

We are up at the ED a lot. We always drive ourselves, never in an ambulance. I've even driven myself up when it's been nessecary. I think driving yourself up for non life threatening emergencies is the norm, if only because of the cost.
People in an ambulance get seen quicker though.

People in Ambulance do NOT get seen quicker, everyone is triaged and it depends what is wrong with them and what category they are as to when they are seen. People by ambulance do generally get put onto a different trolley so that the ambulance can get theres back but they can still sit for hours waiting to be seen!! And if no trolleys left the ambulance has to stay as they can't get there trolley back!!!

Yeah, I've arrived both ways multiple times, and I never got seen quicker in an ambulance. The triage system is pretty unbiased.

I am surprised at the amount of people who think that if you're brought in by ambulance you're fast tracked. That's probably why our ambulances are so busy!

In NSW if you're on a low income health care card or pension card you are exempt. You still get a bill, but you call them up & they clear it for you after you provide details.
In WA if you live in an isolated area, you pay around $80 a year for cover through St Johns. If you're in a city area I think you pay more, maybe a few hundred. But I don't know. I have a feeling there is nothing for city people.

The only time I've used ambulance was when DS choked on a lolly. Had a red frog stuck in his throat for about an hour all up.
And we've had a hospital transfer. There was no bill for that one.

In regards to the ambulance being quicker, I am just going off what I was told in the ED by the doctor on a couple of occasions. It may be incorrect information, (wouldn't be the first time I've been given incorrect information), or maybe it was specific to the medical condition I was being seen for. I don't know.

I've driven to the hospital more then via ambulance (only twice). 1 trip by ambo was after I passed out, and stopped breathing..I was seen straight away. 2nd trip I'd been in a car accident, pretty bad burns to my neck and badly bleeding legs, I was seen over a hour after arriving at the hospital. They were flat out, but was checked on and off and had the paramedics next to me the entire time.

1st trip I never received a bill (had a HCC)
2nd trip I received a $976 bill but never paid it as TAC took care of it

:

---

I am surprised at the amount of people who think that if you're brought in by ambulance you're fast tracked. That's probably why our ambulances are so busy!

---

They should do a public awareness campaign so people don't tie ambulances up unnecessary :)

:

---

This is actually untrue. The way they get to the hospital has nothing do with it, everyone is given a score upon arrival according to their symptoms, and are seen accordingly. Someone who was driven in with asthma symptoms would be seen long before someone brought in by ambulance with a broken leg. It sometimes appears that people who are brought in by ambulance see dr's quickly but in reality, they wait just as long as people in the waiting room, they just wait more comfortably.

---

As stated, my comment was from what I have been told directly and from what my DH saw while working in a hospital. While you may have been told (and observed) differently, and while it's certainly possible that the policy is as you say, my views are based on what I have been told (including by Drs working in hospitals).

No one should be taking this to extremes (eg: someone with a papercut in an ambulance is hardly going to be seen faster than someone with chest pains who has brought themself in) but that is what I have been told in no uncertain terms.

It's not true, Peanutter. You can argue until the cows come home. It's not true.

What's not true, Tinks? That Drs and other hospital staff that I know personally and my husband - working in various hospitals and in EDs - have observed and done this, or that they have said it to me?

And your statement that it's not true is based on what, exactly?

Maybe they meant that people arriving in an ambulance were generally seen earlier cos they had more urgent cases on a whole.
I do believe the triage system applies to all and how you arrive has no bearing on it, (I've worked in hospitals all my working life)
I've also never heard of emergency departments not allowing people to arrive on foot, or car. I've never called an ambulance and always driven myself or others in. There's an ambulance shortage where I live and it's only 10minutes drive to the hospital from where I live, would be longer to wait.