Crowded ERs Affect Older Adults Most

Unlike the images on television shows, most hospital emergency departments are not typically swamped with patients suffering from dramatic life-or-death injuries or psychotic episodes.

Instead, it's older adults who most often visit the ER for treatment of problems like infection, dehydration or high fever. They also typically have conditions (such as diabetes or memory loss) that make treatment complicated and time-consuming.

Many emergency departments already are crowded with these sorts of patients, and this problem is expected to worsen as the U.S. population ages.

What this will likely mean is more emergency departments going on "divert" -- a term hospitals and paramedics use to indicate a hospital is overcrowded and can't accept any more patients. Any incoming patients are redirected to other hospitals in the area.

"Oftentimes [diverts] take patients away from the hospital where their records are, where they're known best, where their physicians are," said Dr. Paul Biddinger, an emergency physician and director of Pre-Hospital Care at Massachusetts General Hospital in Boston. "That clearly is not ideal for patient care."

But what if you're the patient in the back of the ambulance? What if you can't go to the hospital where you've been a patient? While it sounds scary, there are ways to make the situation less stressful and less dangerous:

  Keep in mind that the stress of being in an unfamiliar environment can make even the most alert patient uncertain of medication doses and the important details of prior surgical procedures.

  Shortly after arriving at the unknown hospital, call your doctor. If you can't call, ask a family member to call for you. Tell your doctor that you want him/her to be involved in your care. The emergency physician caring for you will appreciate the additional input.

  Make a list of your medical problems and prior surgeries. Review this list with your doctor to make sure nothing important has been forgotten. Keep these documents in a place accessible to paramedics or caregivers.

  Make a list of your medications and doses. Don't forget to list your allergies.

   Keep a list of all of your doctor's contact information, including phone numbers. Don't hesitate to ask the emergency physician to call your doctor when appropriate.

  Ask your doctor for a copy of your most up-to-date electrocardiogram and keep it with you. Many important heart problems are based on changes in your EKG. Having a comparison could alert doctors that you're having a heart attack sooner than they'd discover otherwise.

With fears of being treated at an unknown hospital, some patients demand that paramedics take them to their regular hospital. Laws vary, but if your care is complex, many states will allow you to be taken to the hospital where you're normally treated.

A word of caution: If your regular hospital is on divert, you may endanger yourself by going. You may wait longer than normal to get a room, to see a doctor and to start treatment. This can be deadly if you're having a heart attack or a stroke, situations where prompt treatment is especially important.

Trying to drive yourself could also be life-threatening.

"There are certain complaints such as chest pain or trouble breathing where you're potentially taking a life-threatening risk by traveling on your own," Biddinger said. "If you have any doubt, it's best to be safe and opt for paramedic transport to a hospital, even if it's not your own."

Dr. Tracy Wimbush is an emergency physician at Massachusetts General Hospital in Boston.

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