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When you feel terrible, is it time for this... or is it really an emergency?

By Staff Sgt. Cynthia Spalding | 673d Public Affairs Photographer | Dec. 15, 2011

JOINT BASE ELMENDORF-RICHARDSON, Alaska — "Man, I'm so sick. I think I need to go to the Emergency Room." The key word here is "think." Many times patients seek medical attention at an Emergency Room (ER) when they could be better helped by scheduling an appointment with their Primary Care Manager (PCM).

Maj. Richard Weber, 673d Medical Operations Squadron, Emergency Room Flight Commander, said, "Seventy-five percent of our Emergency Room patients are routine colds, upset stomachs and prescription refills that could easily be handled by the member's primary care team."

The ER has seen an increase in the number of patients seeking care at the ER unaware of open PCM appointments. Knowing when and when not to go to the ER could alleviate wait times and ER patient overload.

"In the ER, the word 'emergency' is set up ideally for life-, limb- or eyesight-threatening situations," Weber said. "Emergent care is when we need to do something right now to prevent further harm, and urgent is when a patient needs care soon (24 to 72 hours)."

The following questions and answers, provided by Weber, are important factors potential patients should consider before coming in to the ER.

Who is eligible for care? Military beneficiaries and their eligible dependants. Veterans Affairs personnel, civilian employees and contract workers injured on duty are all eligible for emergent care. If a civilian visiting the base is injured or gravely ill, we provide care to stabilize then transfer them to a local hospital off base.

What is provided? We provide full spectrum care, everything from reassurance, as in a mother's concern for a child, all the way to resuscitation of a trauma victim.

How sick or injured do I need to be? Ideally, a high-level need of emergent or urgent care is preferred in order to receive ER assistance. As a medical tool, we are best designed for the guy who fell on the ice today versus the guy with knee pain for the past six months. As an analogy, you would not take your car to the body repair shop for an oil change; it's not the most efficient use of that service. Primary care is set up for managing routine and on-going problems.

Why do I wait long hours? There is a triage system, which is the initial screening to identify those who are in the most immediate need of our care. The triage is a simple way to rate the severity of the emergency. For example, someone with chest pain will trump someone with a cold. The unpredictable wild cards occur whenever ambulances come in, they take priority.

Should I call an ambulance? Again, ideally when life, limb or eyesight is threatened, you should call. A time not to call, for example, would be for a minor sprain, finger cut or just needing a ride to the hospital. If an ambulance is sent out on a non-urgent call and your loved one is suddenly in need of emergency care, our response could be delayed due to the previous non-urgent call.

What if I go into Labor? Birthing labor is usually an expected event. The Labor & Delivery (L&D) unit is also open 24 hours. Expectant mothers can go directly to L&D or we can assist them getting there.

Are there times people don't go to the ER when they really should? In the military healthcare system, problems more arise more often when patients bypass other closer ERs to get to a military hospital because patients believe they won't be "covered" at an outside ER. A quick call to TriCare or their PCM afterwards will start the process of covering non-military ER visits.

"During the summer provider PCS, patients became so accustomed to not having PCM appointments available, many patients just come directly to the ER," Weber said. "The clinics have vastly improved their appointment availability in the past few months."

There are many avenues patients can use to contact their PCM such as MiCare, TriCare Online, or even leaving a telephone message with the clinic. For example, medication refills can often be done over the phone as well.

"I hope that patients will understand that the ER is not first-come, first-serve, it's the patient with the most emergent need that comes first," Weber said.