My Child is Hurt. Do I Need an Emergency Room or Express Care Facility?

Featured Speaker

Rebecca Bloch, MD

Illness and injury can occur when you least expect it. 

Where you go for emergency treatment depends on the type of injury or illness you are experiencing.

Dr. Rebecca Bloch is here to help you learn about what types of issues should be treated at an emergency department vs a first care facility and how you can help keep wait times down for unnecessary visits to the ER.

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Melanie Cole (Host):  Illness and injury can occur when you least expect it. Where you go for emergency treatment depends on the type of injury or illness you are experiencing. What types of issues should be treated at an emergency department vs. a first care facility. My guest today is Dr. Rebecca Bloch, she is the Medical director at Brighton First Care and associate medical director at Maine Medical Centers emergency department.  Welcome to the show Dr. Bloch, tell us, what is first care vs. an emergency room. 

Dr. Rebecca Bloch (Guest):  Thank you for having me. Well, a first care facility or an urgent care facility is really a facility where you go for an urgent condition where you might seek treatment and an urgent care, as opposed to emergency department that is a full-range facility attached to a hospital. There are a huge variety of urgent care, some providing less facilities and some with more. I speak from experience at Brighton First Care, which has a full range of capabilities including imaging with x-rays and CAT scans as well as IV fluids and medications and monitoring, which is more of a full-range first care than some urgent care.

Melanie:  If our children are playing on the swing set, Dr. Bloch, and they fall off and they cut up their arm or they break an arm, what would signal coming to the first care? What is a parent to do? And in those panic situations, Dr. Bloch, how do we make that decision?

Dr. Bloch:  That’s a really good question. Most cuts and bruises and scrapes can be handled really well at an urgent care facility. The one exception that I always tell people is that if you think your child might need sedation or some medication to make them sleepy during a repair, then that would be something that would be better handled in an emergency department. Most parents know their children really well and they know if this is going to be the case. That being said, a lot of kids are anxious and worried about having a cut repaired. We have a lot of things at an urgent care that can help with that including the skin glue sometimes. We use a topical medication that numbs the area. We can handle a lot of cuts, bangs, and bruises at the first care, but a cut that needs medication for the child to be sleepy for the repair to happen, that’s better to do at an emergency department. The second part of your question is something like a broken bone. That’s something we are also really capable of handling at an urgent care. We have x-rays and splinting material, but the one type of fracture or broken bone that we really shouldn’t take care of at an urgent care is one where a bone is sticking through the skin. If a bone is ever sticking through the skin or if there’s a cut over where a broken bone happened, that should really go to an emergency department. 

Melanie:  Do you have the capability to do x-rays at the first care? 

Dr. Bloch:  Absolutely. The first care has x-rays. We also have CAT scan and ultrasound imaging, but that’s not the case at all urgent cares. We do have x-rays all of the time and we have CAT scan and ultrasound as well. 

Melanie:  Now what about if somebody needs follow-up care for their child? They come in with a fracture or a cut, something that you deal with at first care. Then what? Do the records go transfer to their pediatrician or to the hospital medical record system? How does that all work?

Dr. Bloch:  Our process is that when a patient is seen at first care, their records will go to the physician that is listed as their primary care physician. They will be copied on the records so that there is some continuity of care and their primary care physicians know that they’ve been seen.  

Melanie:  Okay, so the records are copied. Everybody has a copy of those. Now what about things like x-rays and all those? Those go through. Would you ever give the patient actual copies of these things?

Dr. Bloch:  There are a couple of ways to do that. The x-rays can actually be put on a physical disc for the patient so that they can bring those x-rays to a specialist or their primary care physician if they need to. That usually happens when someone is out-of-state or they’re going to be traveling to a different provider with their x-rays, although a lot of our specialists in orthopedics or primary care physicians can actually access their records through our medical records system now or electronic medical records.  

Melanie:  When we come in with a child, Dr. Bloch, usually, the child is very scared and crying and emergency rooms are busy and bustling and pretty scary places. What’s different about the first care as far as how fast the child gets seen? Is it less scary than the emergency room when we’re talking about children?

Dr. Bloch:  That’s a good question. I think that it’s much less scary to be in a smaller waiting room in the urgent care and they’re usually taken a lot more quickly. That being said, we also have a pediatric area at the emergency department at Maine Medical Center, where pediatric patients are not put with necessarily the general population.

Melanie:  Okay. So, that gives both offers then when you’re in that situation where you have to decide. Would an ambulance ever take you to urgent care or no, not in any situation?

Dr. Bloch:  No. Ambulances don’t go to urgent care. This is purely for people who have driven their child in, brought their child in, walked in through the door. The ambulances all go to the emergency department. 

Melanie:  Does insurance cover first care? 

Dr. Bloch:  Yes, it does. Insurance covers first care the same way it would cover either a visit to a patient’s physician or a visit in the emergency department. 

Melanie:  That’s really fantastic and so much nicer for parents to be able to come in to that smaller, more comfortable facility. Now we only have a few minutes left, but as far as a few more conditions that parents might know about that would happen, if it’s like pink eye, it’s infectious, something nasty and you know your pediatrician’s office is closed, is that something first care can take care of as well?

Dr. Bloch:  Yes, that’s a great reason to go to a first care. When you need something that might need to be treated quickly or something like pink eye or strep throat, those things where a child might need to be put on the antibiotics in order to also go back to school, we often provide very quick treatment for that and notes to excuse them from that day at school. Those are very common things that we see at urgent care. 

Melanie:  What situations, Dr. Bloch, would you like parents to know that they have to go to the emergency room? 

Dr. Bloch:  There are a couple of situations in children that I think it’s really important that they go straight to the emergency department. One is a fever in a child under three months old. Over three months, fevers can be handled very well at urgent care, but under three months is really a time to go to the emergency department because it involves a more extensive workup. Another situation is something like a severe allergic reaction. Allergic reactions with a rash or itching can often be handled in the urgent care, we see those all the time, but if a child has a known allergy to something like a bee sting or nuts and has tongue or lip swelling, or any difficulty breathing, those are really conditions where they should be seen quickly in the emergency department. We talked a little bit before about falls and injuries. I would say a head injury in which a child lost consciousness for more than a few seconds or isn’t acting normally when they’re being taken in, that’s something I’d really go straight to the emergency department for. Whereas a minor head injury when they’re acting normally and didn’t have a loss of consciousness, can definitely be evaluated in an urgent care safely. 

Melanie:  In just the last minute, tell patients listening, and parents listening, why Brighton First Care might be the best choice for them. 

Dr. Bloch:  Brighton First Care is really a great combination of a facility where it is a smaller facility, often less stressful and less wait time than to be seen in emergency department. We really have a huge variety of treatment available. We have full imaging capabilities. We have also abilities to start IV medications, IV fluid hydration, full laboratory studies. We really have a broad spectrum of capabilities there that bridge between the need for whether they go to visit their primary care physician and the emergency department. We offer a lot of services that can be done very quickly in a very timely fashion that sometimes you don’t need the full emergency department visit for. 

Melanie:  Thank you so much. It’s really great information. You are listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.orgmmc.org. This is Melanie Cole. Thanks so much for listening.