When to Call OLD

During an emergency, and especially on Shabbos, some people have a tendency to search for a Hatzolah member they are familiar with by going to their home, shul, or calling them on the phone.  This can result in significant delays in obtaining help and is strongly discouraged.  Calling the Hatzolah emergency number is the most reliable way to obtain help quickly.

Hatzolah does not provide pre-arranged non-emergency transports. Hatzolah will, however, assist you in arranging such a transport.

What is an emergency?

We are often asked to explain what constitutes a medical emergency, and by extension, what warrants a call to Hatzolah.

Clearly in any situation where there is even the slightest possibility that a delay in obtaining medical attention would endanger life or limb, one should call Hatzolah’s emergency number without delay – including on Shabbos/Yom Tov

However, while a patient who is experiencing chest discomfort or slurring his/her speech clearly falls into the above category, there are some situations that are less-clearly defined.  While a detailed discussion of every conceivable scenario is impractical and unnecessary, there are some common situations where some guidelines (along with common sense) might be helpful.

Childbirth

With some careful planning, most instances of emergency childbirth can be avoided.  Some of the most importing things to plan include: Knowing in advance who will take you to the hospital (or having the phone numbers to several car services handy along with some cash), who will watch your other children (if any) when you go, having a bag of necessities pre-packed, etc., and most importantly……when to leave for the hospital.  All this should be done several weeks before the anticipated due date.

Unfortunately, knowing when to leave to the hospital is a little more difficult than packing a bag, and every case needs to be judged individually.  As a general guideline, some experts recommend waiting until contractions are around 10 minutes apart (5 minutes for a first time mother), with contractions lasting around 45 seconds or more. Discuss this with your obstetrician in advance.  Keep in mind that most recommendations are based on expected travel time to the hospital.

It is important to use common sense.  If you live in Edison, Highland Park, etc., you probably shouldn’t be using a hospital in Manhattan, Pennsylvania, etc. for the delivery of your baby.  Babies rarely consult you to determine if it’s a convenient time to arrive, and using a hospital that is 45 minutes or more away from where you live, is asking to be placed in a difficult situation.  This lapse in judgment is a very common cause for babies being delivered in ambulances, cars, or on the side of the highway.  There are hospitals in the area that are very well known for their OB-GYN and high-risk care.

If, however, your specific medical situation requires that you continue to use an out-of-area facility, or if you have simply just moved here and haven’t had enough time to switch to a local provider, please make every effort to be in the area of your desired hospital close to your due-date – especially if it falls out around Shabbos/Yom Tov.  It is also important to take these things into consideration when visiting friends or family for Shabbos or Yom Tov.

Under normal circumstances, there should be no reason to call an ambulance for a situation of childbirth – especially if you adhere to the suggestions above.  However, if there are extenuating circumstances, or if it seems that there is the slightest chance that the baby might arrive before you can get to the hospital, this constitutes an Emergency Childbirth, and Hatzolah should be called.

In the instance of Emergency Childbirth, you will be taken to the closest appropriate hospital.  Luckily, both St. Peter’s and Robert Wood Johnson are excellent hospitals to delivering in.

High Fever

Fever itself is generally not dangerous.  The amount of temperature required to hurt the human brain is over 106 degrees farenheit.  When seizures secondary to fever do occur, it is usually in patients between the age of 4 months and 6 years, and it is most often associated with an abrupt change in temperature, rather than the temperature itself.

On the other hand, while fever itself is usually not dangerous, it is a sign of infection; and there are some infections that are dangerous.  Always consult your physician if you suspect a serious illness.

A high fever can be brought down by taking Tylenol or Motrin (unless your physician has advised against this, or you suspect an allergy) and sponging the body with lukewarm water.  Do NOT use cold water as this will cause an abrupt change in temperature, and may induce a seizure (this can occur in adults as well).  Alcohol should never be used, since there is a small risk of alcohol poisoning.

If the fever is accompanied by serious symptoms such as seizures (not to be confused shivering or chills), a change in mental status, difficulty breathing etc., call Hatzolah immediately.

Orthopedic Injuries

Orthopedic injuries typically include sprains (ligament injury), strains (muscle/tendon injury), fractures, and dislocations.  Severe injuries (usually resulting from a traumatic event) which result in an angulated, deformed, or unstable limb(s), require splinting by trained personnel to prevent additional injury, and immediate transport to the hospital via ambulance.

Remember, you can always call your physician for guidance as to whether to schedule an office visit, go to the emergency room, or call an ambulance.  In many non-emergency cases, rest, a heating pad, and elevation are generally indicated, and Advil or Motrin may be helpful to control pain and swelling.  Consult your physician.

Burns

Minor burns are classified as such by their location, and by the fact that they only make the affected area of skin red and tender.  Burns that are smaller than the size of the patient’s palm rarely pose any immediate danger.  After applying cool water or a cool compress (to stop the burning process and sooth pain) one should consult a physician and follow his/her advice (failure to do so could lead to eventual complications, such as infection and/or scarring).  For more serious burns call Hatzolah, and cool the burn while awaiting their arrival.

Particularly dangerous are burns that involve the face, fingers or toes (especially in infants/children), involve more than 10% of the body, or burns that surround the circumference of any part of the body – even if they only make the area red.  Additionally, any burn that forms blisters, or has no pain in the main area of the burn, and certainly any burn that interferes with any normal body function (i.e. breathing, moving, etc.), requires immediate medical attention, and Hatzolah should be called.

Electrical burns are an exception to the rule of the size of the burn. Most electrical burns will be much smaller than the palm of the hand but can be serious and/or fatal.  Immediate medial attention is required and Hatzolah should be called.  DO NOT touch the patient if he/she is still in contact with the source of the burn/electrocution.  Doing so will only cause you to become a patient yourself.

NOTE: A common cause of burns is excessively hot tap water. Check that the thermostat on your hot water boiler is set at 125 degrees or lower.  Higher temperature settings (or the very hot setting on some models) can result in serious or fatal burns.

Lacerations (cuts)

The first priority is to control any bleeding.  This is usually easy to accomplish by applying direct pressure to the wound with a gauze pad, clean towel, or even directly with your hand if nothing else is available. DO NOT remove the pressure every few seconds or every minute to check if the bleeding has stopped as this will eliminate any positive effect your pressure had, and will causing the bleeding to start up again.  Instead, maintain the pressure for 5-10 minutes. If the wound is on an extremity, elevating that extremity while applying constant pressure may also be helpful – except if a fracture/dislocation may also be suspected.  That being said, large amounts of blood-loss are more life-threatening than aggravating an orthopedic injury,  If in doubt, control any severe bleeding even if moving the limb is required.  However, caution should be used to minimize any unnecessary movement.

For minor cuts, wash gently with mild soap and water. Additionally, use hydrogen peroxide to help further disinfect the area.  After the area has been cleaned, apply a band-aid.  If available, some topical antibiotic ointment such as Neosporin, should be applied before applying the band-aid.  If the wound is deep or gaping, or if scarring is a concern, consult your physician for possible suturing or referral to a plastic surgeon.  If there is any loss of sensation, or a “pins and needles” feeling, or abnormal color to the area, call Hatzolah immediately.

Any time an over the counter medication or treatment option is used, be sure to follow the instructions listed on that remedy, carefully. Always be sure to check with your physician if you are unsure if something is appropriate for you – especially if you have allergies.

When not to call

Hatzolah is not a referral service, nor can we diagnose your symptoms. We do not provide general non-emergency medical advice.  We are here to provide emergency medical services to you in your time of need –  when it matters the most.  For any non-emergency situation, it is always best to consult your primary care physician.

Many people think that they will be seen by a doctor more quickly if the arrive at the hospital via ambulance.  THIS IS A FALLACY.  Hospitals are aware of this tactic.  All patients are properly triaged upon arrival, regardless of the method of your arrival.  The urgency of your treatment depends solely on your signs and symptoms.  If you arrived by ambulance/stretcher, but didn’t need to, the ER will have you transferred to a chair/wheelchair until it’s your turn.