Is the ER Enough? Surgeries, Specialized Equipment, and You

er specialty treatment

Emergencies are scary. Your body floods with hormones that spike your energy, fear, and anxiety. At that moment, you need to know that you can turn to someone you can trust.

This article will help you understand what an emergency room can handle—and what it can’t.

Emergencies Requiring Immediate Surgery

True emergencies that require immediate intervention include stroke, myocardial infarction, and significant bleeding. Other surgical conditions, including ruptured appendix, will often not be taken to the OR in less than 1–2 hours after arrival to the ER—even at some of the Level 1 trauma centers. In many surgical cases, fluid and antibiotic treatment are able to buy the time necessary to prep the OR and get the team in house.

I have spent a significant amount of time working at various free-standing emergency rooms and have helped to create Emergis ER. Here are the typical capabilities of North Dallas freestanding emergency rooms:

Trauma

Ambulances don’t typically stop at freestanding emergency rooms (or smaller hospitals, for that matter) with trauma patients. They would only make these stops if the patient suddenly arrests or becomes combative en route to a trauma center. But that is pretty rare. If they do stop, Emergis ER has all of the airway equipment—including ventilator, RSI drugs, and more—needed to stabilize the patient, provide emergency care, and facilitate transfer as needed.

Stroke

I discuss stroke at length in another article you can read here. In short, freestanding emergency departments (FSEDs) like Emergis ER are fully capable of handling the initial care of someone suffering from symptoms of a stroke. It is better to get the right help immediately than to drive further away to a hospital, wait for triage, wait for diagnostics, and then get the treatment.

Chest Pain/Heart Attack

This is the one type of patient that I would immediately direct to a chest pain center if at all feasible. And when I say “chest pain center,” I don’t mean just any hospital. There are some very nice hospitals in Collin county (Texas) who do not have a cath lab available. I have personally seen much panic and confusion when a patient has presented to one of these smaller specialty hospitals due to lack of significant exposure or experience in managing these critical patients. Patients assume that if the ED is connected to a hospital, then it must be able to provide all manner of care. Not true. These patients will be transferred to the nearest chest pain center—many times by the ED at these small hospitals calling 9-1-1. Strange, an ED calling 9-1-1. Does this happen from FSEDs? Sometimes. Is it in the best interest of the patient? Yes.

This leads us into the trained technicians and clinicians. Did you know that many of the FSEDs are staffed by the same physicians who staff the emergency departments at our local trauma centers? It’s true. Many of the physicians on my team are all board-certified emergency medicine trained physicians—the same staff that staffs the EDs at Level 2 and 3 trauma centers in Collin and Dallas County. Some are even credentialed at the Level 1 trauma centers in the DFW area and in Oklahoma. We don’t take the capabilities of our staff lightly, and we vet each one to make sure they are capable of providing emergency medical treatment—not just medical treatment.

Emergencies Requiring Specialized Equipment

MRI

Unless you are a Level 1 (maybe Level 2) trauma center, the MRI staff goes home at 5 pm with the rest of the staff. It is pretty rare to base emergent care off of an MRI due to the length of time it takes to get the study completed. Additionally, if a patient is that critical, the last place you want them to spend an hour is inside of an MRI tube. Most MRIs are performed as inpatient or outpatient studies. An MRI’s place in the ED for emergent intervention is pretty limited. I typically only get an MRI if I suspect a significant spinal infection or injury that can not be visualized with a CT scan; otherwise MRI is not of much utility for the emergent patient in the emergency department.

Specialists

It is extremely rare to have a specialist other than a cardiologist (covered above) or a trauma surgeon (also covered above) provide their services in the ER for any Level 3 or 4 trauma center. Television is very misleading in this regard. Most specialist will weigh in, in person, for inpatient treatment, rather than as an in-person consultation in the emergency department.  The consultation is usually in the form of a phone call, either from an FSED, or a hospital-based ED.

Call, Check In Online, or Visit Us

If you or a loved one is suffering a medical emergency, you can go to the nearest emergency room and expect to receive the same level of care that you would receive at a typical hospital ER. If you are not sure if the situation requires emergency care, call us now to speak with a licensed member of our staff.

jsteadmansAbout the Author:

Dr. Jon Steadman is a board certified emergency medicine trained physician and the chief medical officer at Emergis ER. You can find Dr. Steadman using his expertise from working at many different emergency room settings within the Dallas area as well as Oklahoma and Mississippi to bring a high level of clinical excellence and patient satisfaction to Emergis ER.