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When to head directly to an emergency department

woman clutching chest

Many hospital emergency departments are under intense pressure, with patients experiencing long waiting times amid staff shortages and an increase in admissions.

Only a third of patients seeking urgent treatment are being seen within 30 minutes, while an increasing number of Australians – including 35 per cent of Queenslanders – are visiting emergency departments for less urgent issues.

Dr Andrew Thompson, a registered doctor at InstantScripts, a telehealth and prescription service, offers the following guidance.

“There are medical issues and injuries for which patients should go to emergency, as they could be potentially fatal or quickly escalate in severity. Examples are suspected concussion, breathing problems, blood loss, accidents and chest pain, for which patients should seek immediate treatment by calling 000 or, if they can travel, go direct to the closest hospital.

“However, for less urgent issues, there is a range of effective treatment alternatives – even after hours.”

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He says a good first step in sourcing alternatives is to do some research in your local area. The list could include late-night dental surgeries and pharmacies, walk-in after-hour medical centres with X-ray facilities, and online telehealth services that offer fast doctor consultations and prescriptions.

Keep the list on devices and in areas that the rest of your household can access. If you don’t have a regular GP, consider finding one in your local area, he says.

Below, Dr Thompson tells when you should seek emergency treatment and when you could explore other avenues first.

1. Suspected sprain, fracture or broken bone. Uncomplicated breaks and other bone injuries don’t always require a trip to a hospital. Walk-in medical centres with integrated services, such as X-ray, pathology and surgery facilities, can be a good option. Some operate after hours, particularly in metro areas. X-rays referrals can be obtained from telehealth services such as InstantScripts, where a doctor provides a consultation followed by a referral.

2. Acute dental pain. Oral pain can often point to a dental infection, which will need to be treated before a patient sees a dentist. A doctor can recommend pain relief or prescribe antibiotics for the infection and, once treated, a visit to your dentist is the next step. For those who need immediate dental work, after hours and emergency dental clinics – some of which have dental surgeries – are readily available in major metro areas. Emergency medical centres can also assist with dental pain, and some are equipped with dental surgeries.

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3. Migraine. Severe ongoing headaches and migraines can be a source of concern and stress, particularly if they occur when many local medical centres are closed. Patients could consider an after-hours telehealth consultation before heading to an emergency department. Telehealth and prescription medicine services can diagnose first-time presentations and recommend treatment plans, as well as direct severe cases to an ED. Severe migraine symptoms such as confusion, trouble speaking, numbness, vision changes or fever require a trip to an ED. For symptoms that don’t subside in 24 hours or worsen, visit a doctor in person.

4. Fever. A fever can point to a number of ailments that are rarely harmful. However, when a fever occurs in a baby under three months, lasts more than three days or is accompanied by other symptoms, such as breathing difficulties, drowsiness, a stiff neck, ongoing vomiting or diarrhoea, hallucinations, muscle spasms and sensitivity to light, the patient will require immediate attention at an ED. In all other cases, and in children over three months and adults, a fever can be effectively treated at home. If it occurs late at night, visit a late-night pharmacy for medicine to break the fever. Those who are unsure if a fever is serious can use a telehealth service for an after-hours consultation or speak to a registered nurse by calling the HealthDirect helpline (1800 022 222). Fever can be one of the first symptoms of COVID so, in the current climate, it may be wise to seek a COVID test.

5. Severe flu, COVID-19 or suspected pneumonia. Babies, young children and over-60s with suspected pneumonia, and anyone who has a virus that comes with sustained fever, difficulty breathing and severe chest pain should be taken to an ED. Anyone else suffering any viral infection can seek immediate doctor consultations through a telehealth service or walk-in medical centre. Anyone with respiratory symptoms should also seek a COVID test.

6. Severe and sudden pain. Anyone experiencing constant, severe and worsening chest or abdominal pain should visit an ED. Those who choose to visit a doctor in person may be required to do a number of tests to rule out severe issues. For lower back pain or any other pain associated with muscles or joints, treatment can be sought at a walk-in medical centre or a late-night pharmacy can provide pain relief. For those who still want reassurance quickly, helplines such as National Home Doctor (13SICK) provide after-hours in-home doctor services within four hours.

7. Urinary tract infection (UTI). One of the most common reasons Australians visit an ED is for UTIs – a relatively common concern that can be treated with antibiotics. Seek a telehealth consultation. Some doctors may want a test to confirm a diagnosis, and in those cases patients could visit a walk-in medical centre for a urine test, while some pharmacies offer at-home tests.

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8. Extensive rashes or other skin concerns. If a rash covers the entire body, or is accompanied by other symptoms, such as pain and fever, it warrants an ED visit. Cases with isolated rashes can be seen by a GP, and a walk-in medical centre is a good immediate option – particularly for mild rashes or skin concerns. GPs can offer treatment options before recommending a dermatologist.

9. Allergic reaction. Severe symptoms such as anaphylaxis, light-headedness, difficulty breathing, wheezing, confusion and anxiety – and even first-time presentations of allergic reactions – should be tended to in an ED. Minor allergic reactions can be treated through a telehealth service or medical centre. Some mild cases may simply require an over-the-counter antihistamine.

10. Mental health symptoms or concern over the mental health of a loved one or friend. There are numerous mental health services for help and advice. Those experiencing suicidal ideation or have attempted to self-harm should seek immediate help, either at an ED or through a helpline such as Lifeline (13 11 14). For prolonged mental health issues, telehealth services can provide strategies. A GP can develop a comprehensive Medicare-covered mental health plan that provides access to a psychologist. Anyone with a serious concern for the wellbeing of another can also request a police welfare check to ensure they are safe.

Have you been trying to avoid emergency departments during the pandemic? Have you embraced telehealth appointments? Why not share your views in the comments section below?

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Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

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