How to Prevent Injury and Stay Out of the Emergency Room

Dear Readers,

Every year in the U.S., there are about 130 million visits to emergency departments. The cost of these urgent medical adventures represents about 4% of all health-care spending in this country. (The numbers come from the Centers for Disease Control and Prevention, CDC.)

A medical emergency is scary, expensive, often frustrating and very often time-consuming. That’s true whatever the outcome is for the patient.

This month, we profile use of emergency medicine, and suggest what you can do to cut your odds of becoming a consumer of ER services.

An Ounce of Prevention

Dr. Brady Pregerson is an emergency room physician practicing in Los Angeles. Like all docs who have been in the ER trenches for any period of time, he’s seen a lot. And he’s written about much of it in two books, “Don’t Try This at Home” and its sequel, “Think Twice: More Lessons from the ER.”

The former Peace Corps Volunteer decided to become an author as well as a doctor when he “was sewing up a friend who had cut his hand trying to clean out the inside of a wine glass,” according to theLos Angeles Times.

“And I told him, ‘I’ve seen this so many times, I should write a book on stupid stuff not to do.'”

Sure, some people end up in the ER suffering from a lack of common sense — cutting frozen food with a sharp knife, tailgating in traffic –while others are victims of circumstances or tragedy they might not have been able to avoid.

Those folks are unlike, as Times columnist Steve Lopez put it, the people “who spray cooking oil onto the open flame of a barbecue grill or decide to climb up on the roof to clean the rain gutters after a couple of beers.”

“Eighty-five percent of what is in this book is common sense,” Pregerson writes in the foreword to “Think Twice.”

The book’s table of contents gives a good preview.  “Think Twice When:

You’re Mad

You’re in a Hurry

You’re Hungry

You’re a Parent

You Carry Things


Dos and Don’ts of Emergency Prevention

Listing all of the typical problems that land on the average ER doorstep would require more time than you have to read. But of the ER docs interviewed by the L.A. Times, these tips cover some of the most common, preventable accidents they see.

  • Wear a helmet when you ride a bicycle or motorcycle. (ER staffers have been known to refer to bareheaded riders as “organ donors.”)
  • Don’t use a cellphone when you’re driving, cycling or walking across a street.
  • Don’t take aspirin if you’ve had a head injury — it can increase bleeding.
  • Make sure any prescription you’re given is legible before you leave a doctor’s office. If you can’t read what your doctor wrote, a pharmacist might not be able to, either — ER docs see lots of patients who took the wrong medication, or the wrong dose.
  • Don’t hold a bagel in your hand while cutting it; use a bagel slicer or lay it flat on a cutting board.
  • Don’t use the ER as a primary care office. As The Times story noted, perhaps as many as 7 in 10 emergency room patients with health-care coverage don’t need to be there, and they’re tying up resources. (One ER doc recalled patients who come in requesting an MRI for a headache or lower back pain. His response? “This isn’t a Chinese restaurant. You can’t order off a menu.”)

This isn’t a common problem in the ER, but it’s a dangerous one easily prevented:

  • If you garden, make sure you’ve had a recent tetanus shot. As Pregerson told The Times, more than 1 in 3 of the rare but potentially fatal causes of tetanus is the result of working in the garden. “Tetanus,” Pregerson says in his book, “is caused by bacteria found in soil and therefore also on gardening tools.”

Safety First, Safety Last

Pregerson’s website,, is a treasure trove of information and tips for people who want to stay out of trouble ranging from the flu to falling off ladders to slicing their fingers along with the Halloween pumpkin.

Its wisdom is the result of Pregerson’s personal ER experiences and curating the emergency medicine literature. The cable TV show “Untold Stories of the ER” portrays the weird problem-solving regularly faced by emergency medicine practitioners, and appeals to the medical looky-loos among us. GotSafety, in contrast, is strictly a service site whose goal is to keep you from starring in one of its episodes.

If you’re interested in how well emergency departments perform in your neck of the woods, consult the Emergency Care Environment report card, newly released by the American College of Emergency Physicians. It measures how well individual states support emergency care.

Grades in five general areas- – access to emergency care; quality/patient safety; medical liability; public health/injury prevention; disaster preparedness — are issued according to 136 criteria from data provided by the CDC and the Centers for Medicare and Medicaid Services (CMS). The District of Columbia ranked first overall this year.

In the event an ER visit is in your future, unless your situation is dire, be prepared to wait. (See our blog about how long you can expect to wait in an emergency room.)  The duration of your stay depends on where you live and the number and type of medical facilities in the area.

ProPublica, the investigative news site, has established the ER Wait Watcher, a site that enables you to locate the most efficient ER service in your area, and to anticipate how long you’ll be there.

Sometimes, as Wait Watcher makes clear, the hospital nearest to you might not be the one that sees you the fastest. The service uses data reported by hospitals and current traffic issues as reported by Google.

Another consideration for emergency treatment is how you get there. A recent post on our patient safety blog, “The Sticker Shock of Ambulance Transport,” describes how the cost of an ambulance varies widely according to insurance coverage, which entity provides the transport, the credentials of the crew on board and the nature of your problem.

If you need ambulance transport, by all means, take it, but in anything other than a true emergency, find another way to get to the ER. In any case, ask your local emergency responders and providers what ambulance services are available, and know if and how your health plan subsidizes them.

And did we mention that you shouldn’t hold a bagel while you cut it?


Here’s to a healthy 2014!

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Patrick Malone
Patrick Malone & Associates