When should you go to the emergency room?

Going to the emergency room is one of the most expensive options there is for receiving medical treatment. To cite just one recent story about the inflated prices that are common at emergency rooms, consider the tale of this medical student who was charged $1,000 for a tetanus shot, something that Walgreen’s charges $55 for in their retail health clinics (and you get a diphtheria shot thrown in for that too).

Because of stories like this, the emergency room is probably the last place self-pay patients should seek treatment, unless of course it’s necessary. But how to know if it’s necessary?

Most people will tell you ‘use your common sense.’ But that seems a little vague. With that in mind, I thought self-pay patients (and everybody else too) might benefit from some of the resources I’ve been able to find that can help people understand whether the emergency room is the best place for treatment, or whether an urgent care center, retail health clinic, or your doctor’s office is the appropriate (and less expensive) setting for treatment. 

Probably the best place to start would be the American College of Emergency Physicians, which offers a list of symptoms, injuries, and conditions that should be seen in the emergency room

The American College of Emergency Physicians (ACEP) offers a list of warning signs that indicate a medical emergency.Difficulty breathing, shortness of breath

  • Chest or upper abdominal pain or pressure
  • Fainting, sudden dizziness, weakness
  • Changes in vision
  • Confusion or changes in mental status
  • Any sudden or severe pain
  • Uncontrolled bleeding
  • Severe or persistent vomiting or diarrhea
  • Coughing or vomiting blood
  • Suicidal feelings
  • Difficulty speaking
  • Shortness of breath
  • Unusual abdominal pain

Scripps Health, a 5-campus hospital system in San Diego, offers a similar list concerning whether patients should head to the emergency room or an urgent care center:

… While the answer is not always simple, knowing the difference between urgent care and emergency care and where to seek treatment could save your life in an emergency.

The emergency department was designed to provide fast, life-or-limb-saving care. Many people, however, use the ER as a place to receive urgent care without realizing it. If you’re ever in doubt, it’s better to be safe and go to the closest ER. These are just a few of the conditions that are medical emergencies:

  • Persistent chest pain, especially if it radiates to your arm or jaw or is accompanied by sweating, vomiting or shortness of breath
  • Persistent shortness of breath or wheezing
  • Severe pain, particularly in the abdomen or starting halfway down the back
  • Loss of balance or fainting
  • Difficulty speaking, altered mental status or confusion
  • Weakness or paralysis
  • Severe heart palpitations
  • Sudden, severe headache
  • Sudden testicular pain and swelling
  • Newborn baby with a fever
  • Intestinal bleeding
  • Falls with injury or while taking blood thinning medications
  • Loss of vision
  • Head and eye injuries
  • Broken bones or dislocated joints
  • Deep cuts that require stitches – especially on the face
  • Head or eye injuries
  • Severe flu or cold symptoms
  • High fevers or fevers with rash
  • Bleeding that won’t stop or a large open wound
  • Vaginal bleeding with pregnancy
  • Repeated vomiting
  • Serious burns
  • Seizures without a previous diagnosis of epilepsy

They also provide an interesting bit of information, noting a recent study showing that “of patients who had visited the emergency room but were not admitted to the hospital, 48 percent went there because their doctor’s office was not open. “

The web site Health.com provides a little more explanation of several signs that the emergency room is the right place to go. Some of them are beyond obvious – ‘Go to the ER if you have: Heart attack symptoms’ – but here are a few items with more helpful information:

Go to the ER if you have:

A blow to the head…that results in loss of consciousness, a seizure, or vomiting (especially if you vomit more than once), even if it happens a few hours after you hit your head.

Any loss of consciousness or fainting…even if you think it’s just because you haven’t eaten all day. It might be nothing, but it could also signal a heart or circulation problem or even a stroke.

A possible broken bone…Red flags include a joint or limb that looks drastically misshapen or out of place, swelling and bruising, and not being able to bear weight on an injured foot or leg. (If you suspect it might just be a sprain or dislocation, call your doc.)

Go to the ER if you have: Bleeding…that doesn’t stop when you apply pressure for 10 to 20 minutes; any wound that impairs your ability to function (like a leg injury that bleeds like crazy when you bend your knee); or a gaping wound that fully penetrates the skin (so you can see muscle, for example).

Repeated episodes of vomiting…that make it impossible to keep fluids down, or nonstop diarrhea that keeps you in the bathroom, either of which can quickly lead to dehydration.

Severe pain…halfway down your back on either side of your spine, which could signal a kidney stone or infection…Any severe abdominal pain also warrants immediate care… Ectopic pregnancy, appendicitis, and gallstones are a few of the possible causes.

Finally, I found a handy chart put out by the Urgent Care Center, a site sponsored by the Urgent Care Association of America Foundation. The chart includes four levels of care, covering retail health clinics, a doctor’s office, an urgent care center, and the emergency room.


With luck, you’ll never have to try to figure out whether your injury or condition is serious enough to warrant a trip to the emergency room. But chances are at some point you will, and knowing which is the right place to head to can not only save you a ton of money but also your life or your limb.

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3 Responses to When should you go to the emergency room?

  1. Hello sir,
    Thank you for your nice posting.Repeated episodes of vomiting…that make it impossible to keep fluids down, or nonstop diarrhea that keeps you in the bathroom, either of which can quickly lead to dehydration.

  2. Josh Davidson says:

    As a new member of Liberty Health Share, our daughter suffered a broken bone this past weekend. Because it was a minor break, it was good to know that the local Urgent Care was the right choice to make. They charged $150 for the visit and $50 for the XRay. She left with her arm in a sling and soft cast. We can now have a little time to plan a follow-up visit with an Orthopedist and even price shop any additional treatments deemed necessary. We were glad to avoid the ER bills! I’m printing out your chart for future reference.

  3. I wasn’t aware when to go, I really needed to know, thank you for such a nice and informative article I hope more people are benefitted and can create a sense of adulthood to behave sensibly and know when to go to the emergency room.

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