Emergency departments: when to go and what happens

Emergency departments are designed for time-critical illness and injury.

Almost all frustration with them comes from one misunderstanding: the queue is ordered by urgency, not by arrival.

Symptoms that justify immediate attendance

• Chest pain or pressure, especially with sweating or breathlessness.
• Sudden weakness, facial droop or difficulty speaking.
• Severe difficulty breathing.
• Heavy bleeding that does not stop with pressure.
• Loss of consciousness or a fit.
• Severe injury or suspected major fracture.
• Sudden severe headache unlike any before.
• Signs of severe infection with confusion or very high fever.

Call an ambulance rather than travelling yourself

• For suspected heart attack or stroke.
• For severe breathing difficulty.
• For loss of consciousness.
• For major trauma.
• Treatment often begins before arrival.
• Know the local emergency number in advance.

What triage means

• A trained clinician assesses everyone on arrival.
• Patients are graded by clinical urgency.
• The sickest are seen first regardless of arrival time.
• A long wait usually means you are not critically ill.
• Tell staff if your symptoms change while waiting.
• Re-assessment on deterioration is part of the process.

What to bring

• Identification and insurance details.
• A written list of medicines using generic names.
• Allergy information.
• Details of your usual doctor.
• Recent test results or discharge letters if relevant.
• Phone charger; waits can be long.

Describing the problem clearly

• Say when it started and how quickly.
• Say what makes it better or worse.
• Say whether it has happened before.
• Mention recent surgery, travel or new medicines.
• Say plainly what worries you most.
• Do not minimise symptoms out of politeness.

What usually happens

• Registration and triage.
• Observations and often blood tests.
• Assessment by a doctor or advanced practitioner.
• Imaging if indicated.
• A period of observation while results return.
• Discharge, referral, or admission.
• Waiting between steps is normal.

Arriving by ambulance does not mean faster treatment

• Ambulance patients are triaged in the same way.
• Arriving by ambulance helps when treatment is needed en route.
• It does not move you up the queue by itself.
• Call for clinical reasons, not to be seen sooner.

Alternatives for non-urgent problems

• Your family doctor or their out-of-hours service.
• Urgent care or walk-in centres.
• Pharmacists for minor illness advice.
• Telephone or online advice lines.
• Dental emergency services for dental pain.
• Learn which of these exist locally before you need them.

Bringing a child

• Ask whether there is a separate paediatric area.
• Bring comfort items and snacks if allowed.
• Bring the child's vaccination record if available.
• Report drowsiness, poor feeding or a non-fading rash immediately.
• Trust your judgement if the child seems seriously unwell.

Bringing an older relative

• Bring the medicine list; it is often decisive.
• Mention any recent fall.
• Mention new confusion, which is always significant.
• Bring glasses and hearing aids.
• Stay with them if permitted.
• Ask about pressure care if the wait is long.

Why the wait can be long

• Results take time to return.
• Imaging may be queued behind more urgent cases.
• Specialists may need to be called in.
• Beds may not be available for admission.
• Ask for an estimate rather than assuming you are forgotten.
• Ask whether you may eat and drink while waiting.

Practical comfort while waiting

• Bring a phone charger and something to read.
• Bring a jumper; departments are cold at night.
• Ask before eating in case a procedure is planned.
• Tell staff if you need the toilet and are unsteady.
• Ask for pain relief rather than waiting to be offered it.

If you are abroad

• Carry your insurance emergency number.
• Carry a medical summary in the local language.
• Ask whether interpreting is available.
• Keep every document you are given.
• Notify your insurer as soon as practical.

Ask whether observation is an option

• Some departments have short-stay observation areas.
• This allows monitoring without full admission.
• Ask whether it applies if you feel unsafe going home.

Before you leave the department

• Ask what the diagnosis or working diagnosis is.
• Ask what results are still outstanding and who will act on them.
• Ask what symptoms should bring you back.
• Ask who arranges follow-up.
• Ask for the discharge letter in writing.
• Make sure your own doctor will receive a copy.

If you are sent home and worsen

• Returning is appropriate, not an imposition.
• Bring the paperwork from the previous visit.
• Say clearly that you were seen recently and have deteriorated.
• Mention any result that was still outstanding.

After you get home

• Read the discharge instructions carefully.
• Collect any prescribed medicines promptly.
• Book the follow-up you were told to arrange.
• Return if the listed warning symptoms appear.
• Keep the paperwork with your records.

If you are told to come back

• Ask exactly which symptoms should bring you back.
• Ask whether to return to the same department.
• Ask whether you need a referral to be seen again.
• Keep the paperwork from this visit to bring with you.

Using the department well

• Go when it is genuinely the right place.
• Use alternatives for minor problems.
• Report deterioration while waiting.
• Be patient with staff, direct about symptoms.
• Never delay attending for a genuine emergency.

The point to remember

Three things:

1. The queue is ordered by urgency, not arrival time.
2. Tell staff immediately if symptoms change while you wait.
3. Before leaving, ask what results are outstanding and who will act on them.

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