WHEN TO GO TO THE ER NOT ALL SYMPTOMS REQUIRE A HOSPITAL VISIT, BUT KNOWING WHICH ONES DO CAN SAVE YOUR LIFE.

Byline: Evan Henerson Staff Writer

Your stomach aches. Actually, it doesn't just ache. It hurts.

But you've experienced indigestion before. Maybe this pain in the gut is simply a sour reaction to that heavy barbecue you ate earlier in the day.

So you take an antacid, get off your feet and figure the problem will take care of itself.

But a couple of hours later, the pain is worse. And it's Sunday, meaning a phone call to your physician's office reaches an answering service that can't schedule you for an appointment for at least 24 hours.

The pain seems too intense to wait a day or two. What do you do?

There's always the emergency department of your closest hospital or medical center. Certainly that's a popular option.

An estimated 300,000 people visit emergency rooms around the country every day, according to data collected by the American College of Emergency Physicians.

And overall visits are on the rise, up an estimated 23 percent between 1992 and 2002, according to the Centers for Disease Control and Prevention.

Experts say much of the increase is attributable to cases that don't require urgent care. Some 53 percent of all ER visits fall short of the standards for emergent care (requiring care within 15 minutes) and urgent care (requiring care within an hour), according to the Center for Studying Health System Change.

So does your stomach pain warrant an ER visit? How do you decide? How long do you wait before taking action?

``It's a challenge,'' says Dr. Robert Hockburger, chairman of the department of emergency medicine at Harbor-UCLA Medical Center and an ACEP spokesman.

``On the one hand, we don't want to keep people from coming to the emergency department if they have symptoms that concern them,'' he said. ``On the other hand, given how busy emergency departments are, we don't want to encourage people to come in for every little sign or symptom that comes out of the blue.''

An ER visit will undoubtedly eat up a portion of your day: between four and six hours at most California hospitals, said Dr. Stephen Jones, medical director of emergency services at Northridge Hospital Medical Center.

In addition, the insurance co-payment is considerably higher for an ER visit than for an appointment with a primary care physician. And people who go to an out-of-network hospital for emergency treatment can expect a very hefty bill, particularly if the ER doctors start conducting numerous tests.

Of course, time and money spent become immaterial for people who truly require urgent care, ER physicians say.

When it's time 

Chest or upper abdominal pain or pressure is one of the 10 major warning signs you're experiencing a significant medical ``emergency'' and should head straight to a hospital, the ACEP says.

If you're experiencing symptoms such as dizziness or shortness of breath, uncontrolled bleeding or severe vomiting, a visit to the ER is a must.

And the faster a person receives treatment for a heart attack or stroke, the better the prospects for survival and recovery.

Deep cuts or wounds that require stitches are another ``don't wait'' situation, experts say, because the longer you hold off, the better the chance of infection.

``Certainly, there's a percentage of people who made decisions to come in to the emergency department or called 911 who saved their lives,'' Jones says. ``If they didn't, or if they had waited a few hours or a day, it would have made a huge difference. Sometimes the signs and symptoms of serious illness can be rather subtle.''

But ER doctors admit there's little they can do for some seemingly unbearable conditions that plague patients.

Not worth the wait

Back pain is one example. ER doctors may be able to administer immediate pain medication or muscle relaxants. But if the pain is mostly in the lower back and not radiating into an arm or leg, an ER doctor most likely will refer you to a specialist. And you may have been more comfortable making that appointment from home.

During flu season, ERs fill up with feverish and headachy people who will wait several hours only to be sent home with a simple prescription.

If a group of people is discussing whether a person should seek ER treatment, a single vote for the ER should be the decider, says Dr. John Bibb, an attending physician at Cedars Sinai Medical Center.

``Physicians are not supposed to evaluate their own personal medical problems, therefore patients shouldn't either,'' Bibb says. ``I would rather see a patient and say, `This is no problem; you'll be fine,' rather than have the conversation, `Why did you wait so long?' ''

Seniors and children

Seniors are often less inclined to ``wait out'' feelings of discomfort given the increased possibility that a minor sickness could signal something more ominous. Parents of infants or young children also may not choose to wait until they can reach a pediatrician.

``It's not easy to communicate with (young children),'' Hockburger says. ``They can't tell you how much pain they're in. All you can do is recognize that they seem to be breathing more quickly or more labored.''

For serious, time-sensitive situations such as a heart attack, Jones advocates calling 911. Emergency medical technicians can now perform specialized tests in people's homes. If the results come up positive for a heart attack, EMTs can alert the hospital and have critical treatment in place when the patient arrives.

``We've been having some phenomenal results getting patients upstairs, getting that balloon in,'' Jones says. ``When you see people are walking in with signs and symptoms of a heart attack, it's sometimes frustrating. You think, `Why didn't you call 911?' ''

Evan Henerson, [phone]

[e-mail]

DANGER SIGNS

The following warning signs are indications of a medical emergency:

1. Difficulty breathing, shortness of breath.

2. Chest or upper abdominal pain or pressure.

3. Fainting, sudden dizziness or weakness.

4. Changes in vision.

5. Confusion or changes in mental status.

6. Any sudden or severe pain.

7. Uncontrolled bleeding.

8. Severe or persistent vomiting or diarrhea.

9. Coughing or vomiting blood.

10. Suicidal or homicidal feelings.

BE PREPARED

Emergency departments can be crowded, and patients are seen based on the severity of their illness rather than on a first come, first served basis. Here are some recommendations to make your visit as painless as possible.

1. Bring a list of medications and allergies. What medications do you take? How often?

2. If possible, bring a medical history form (available at www.acep.org) with explanations of past diagnoses/procedures and contact information for your regular physicians.

3. Know your immunizations. The list for children may be lengthy. For adults, it often may include tetanus, flu and hepatitis B.

4. Remain calm. Doctors and nurses can communicate more easily with patients who are composed.

CAPTION(S):

4 photos, 2 boxes

Photo:

(1 -- cover -- color) Is it really an EMERGENCY?

Know the symptoms that warrant a trip to the ER

(2) To speed diagnoses, CT scans are viewable on computer screens in the Northridge Hospital John McCoy/Staff Photographer

ER.

(3) A medical team converges on a patient in the emergency room at Northridge Hospital Medical Center. A trip to the ER can be a lifesaver or a time-waster, depending on the reason for the visit.

(4) no caption (emergency room files)

Box:

(1) DANGER SIGNS (see text)

Source: American College of Emergency Physicians. For more information, visit www.acep.org/webportal/PatientsConsumers.

(2) BE PREPARED (see text)

Source: American College of Emergency Physicians