Should you go to the ER or Express Care?

Sometimes, you don’t even have to ask the question — it’s obvious that it’s an emergency and you need to call 911 immediately. Other times, an express or urgent care facility might be the best choice. How do you decide when you’re not sure?

I’ve got some great advice from two experts.

Dr. John Southall, Director of the Emergency Department at Mercy Hospital in Portland, Maine and

Francine Wilbur, Family Nurse Practitioner and Lead Provider for Mercy Express Care.

What is the difference between an emergency department and express or urgent care?

The emergency department is designed to care for and stabilize all emergencies, especially things that require some sort of intervention. Anything that is threatening to life or limb or has that potential are things that we certainly can treat very well in the emergency department — things that would be beyond the scope of an express care. ~Dr. Southall

Express care is a walk-in clinic for minor or acute illnesses that do not require emergency treatment. We provide treatment for broken bones, minor illnesses, minor cuts and other injuries, rashes, tick bites, coughs and colds and such. We also do a lot of physicals for schools, sports and camps as community service. ~Francine Wilbur

Are wait times usually the same whether you go to the ER or an express care?

An emergency department will see anybody who shows up with any complaint, no matter how minor or how major, without regard to payment — that’s actually the law. Therefore, if somebody has a minor illness they could have a bad experience because they may have to wait behind people who have more significant illnesses. If somebody came in with, for instance, a minor ankle sprain or something of that nature, they might have to wait behind somebody with chest pain or bad abdominal pain and they may wait for a period of time.

Whereas with express care, the concept is to be able to see people with more minor illnesses in a much more convenient fashion. Usually, patients are seen in order of presentation. However, if somebody went to the front desk and said I’m having terrible chest pain they would see them quickly and call 911 to get that patient to an emergency department. ~Dr. Southall

When should you call 911 and not have someone drive you in (or drive yourself)?

Anyone who is having chest pain or shortness of breath or other life threatening symptoms or if they’re in acute distress should call 911. Unfortunately, we frequently see patients who drive in when they shouldn’t. It can be a delay in care if they’re coming to us first. We do what we can, get them in, maybe start a line on them and call 911 but if they’re having those symptoms, they should definitely call 911. ~Francine Wilbur

If anybody is altered or they’re confused or they have severe difficulty breathing or you can’t wake them up, these are the things that we should be calling 911 for.

[Emergency responders] can start your treatment in the ambulance and then get you to the hospital more quickly. One of the things that many people don’t know is they can actually begin a lot of medication even before you get to the hospital. An example of that might be somebody having a bad COPD exacerbation [difficulty breathing] or an allergic reaction. They can start steroids in the field or give medication for an allergic reaction. They can even begin to treat some other things like congestive heart failure or a heart attack before they get to the hospital so certainly, we do like to see patients calling 911. ~Dr. Southall.

So … Should you go to the ER or Express Care?

To make it easier for you to know which is more appropriate — the ER or urgent or express care — here’s a handy chart to look at before you have an emergency situation. Many thanks to Dr. Southall and Francine Wilbur for all the helpful information.

EMERGENCY CARE VERSUS URGENT/EXPRESS CARE

CONDITION	URGENT/EXPRESS CARE	EMERGENCY CARE
Allergic reactions		✔️
Allergies (seasonal)	✔️
Animal bite (severe)		✔️
Asthma attack (minor)	✔️
Asthma attack (severe)		✔️
Bleeding that won't stop		✔️
Broken bone (bone sticking out of skin)		✔️
Broken bone (bone not sticking out of skin)	✔️
Burn (small)	✔️
Burn (large)		✔️
Chest pain or severe chest pressure		✔️
Cough, common cold, flu	✔️
Coughing or vomiting blood		✔️
Cuts (minor) and stitches removal	✔️
Dehydration, not drinking and eating	✔️
Dental pain	✔️
Difficulty breathing or shortness of breath		✔️
Dizziness, weakness or loss of coordination or balance		✔️
Earache	✔️
Eye problems (pink eye, eye irritation)	✔️
Fainting		✔️
Fever not related to the common cold or flu (infants younger than 8 months old)		✔️
Fever not related to the common cold or flu (infants older than 8 months, children and adults)	✔️
Foreign object removal		✔️
Headaches and migraines	✔️
Headache — sudden and severe; chronic migraines		✔️
Head injury (without passing out)	✔️
Incision and drainage; abscess	✔️
Insect, spider or minor animal bite	✔️
Medication refills (non-narcotic)	✔️
Poisoning		✔️
Pregnancy test	✔️
Pregnancy-related issues (pain, bleeding)		✔️
Rash	✔️
Rash with fever		✔️
Seizure		✔️
Sore throat	✔️
Sprain or strain	✔️
Stomach pain		✔️
Swallowed object		✔️
Urinary tract infection	✔️