[JosephRedfern]

It looks pretty slick, nice job. I echo other people's questions about the source of the data etc.

Also, how do the emergency services work in the US? If you dial 911 and ask for an ambulance, will you not be taken to the nearest ER anyway? (Asking as an ignorant Brit!)

[drglitch]

Ambulances do take you to nearest ER but more and more health insurance plans do not cover the cost of the ride (which is $1000-$2000) or have a $500 deductible for such.

Unless you're in real trouble, its often cheaper and simpler to have someone drive you.

[maxerickson]

Yes, the ambulance will take you to the nearest ER. I guess there are conditions where treatment is urgent but not so urgent you need an ambulance. Also, it can often be faster to drive in than to wait.

[rtrivedi]

I found this out the hard way. Even though I live within walking distance of an emergency room, the 911 operator told me to wait for an ambulance to arrive (even though it wasn't an emergency). The net result was me waiting 20 minutes for an ambulance to arrive and take me to the hospital, instead of walking to the hospital in 10 minutes. Luckily my insurance covered the ambulance ride to the hospital!

[nathannecro]

When I have free time, I spend some time working on ALS ambulances to maintain my certification level.

How EMS works in the US generally follows this path:

You get sick.

You then dial 911.

A dispatcher talks with you, routes your call to an ambulance company, and provides us with some information on what's going on. If the environment is no danger to you, they should generally tell you to stay put. Depending on the nature of the emergency, they'll have some first-responder/stopgap measures they'll want you (or bystanders) to do. If you have crushing chest pain for example, they'll explain how to place yourself into a recovery position (in case you vomit while unconscious), they'll ask for a nearby bystander (in case they have to instruct them how to perform CPR), and they'll do their best to keep you calm and aware of your situation. What they don't want you to do (even if you're 10 minutes away from a hospital) is try to move yourself there because:

If you become unconscious on the way to the hospital, it becomes so much harder to find you (rather than if you had stayed in a static location that you've described).

By moving, you might move from a safe environment to a more dangerous environment (sidewalk to middle of the street).

When the ambulance arrives, the medic will perform their own assessment of your condition. If you're alert, they'll ask you questions, ask you to chew some aspirin, place you on a heart monitor. If you've become unresponsive at this point, then slightly more drastic measures are taken.

When they load you into the ambulance, they'll make a determination (based upon their assessment) of where to take you. The nearest ER may not have the proper resources to deal with or handle your condition.

I'm unsure how emergency departments in hospitals outside of the US work, but here, not all EDs can provide the same level of care. If you're having an MI (heart attack), and you need cardiac care (a facility that can crack your chest open), it's far faster for the medic to assess you then immediately take you to the correct place.

As a contrary example:

If you happen to make it into an ED on your own foot-power and manage to explain what's going on to the triage nurse, then they still have to call in an ambulance to transport you to a hospital which can provide an adequate level of care. In some hospitals, they won't even begin to treat you (because of liability issues...it's horrible).

TL;DR. Some ERs cannot provide a certain level of care (Trauma Centers, Cardiac Centers, Psych, etc) and thus the closest ER may not be the correct ER to go to.

[tgokh]

As a medical student and EMS provider, I agree with all of the above except "In some hospitals, they won't even begin to treat you". Unless you end up at the rare hospital that doesn't accept Medicare, the ED's are required (by EMTALA) to provide a screening examination and treat any patient with an emergency medical condition. For example, any ED should be able to provide you initial care if you're complaining of chest pain (EKG, Chest X-Ray, Nitroglycerin, Aspirin etc). That said, if you're actually having a cardiac event, you'll need to be at a cardiac center to actually get definitive treatment, so the smaller outlying hospital will call an ambulance to transport you to the appropriate facility.

[rtrivedi]

Wow, this is incredibly useful info. Thank you! It still baffles me that in some cases hospitals won't begin to treat you because of liability issues. I guess that's a different discussion though...

In general, if you're ever in doubt, it's best to call 911. Let the professionals handle it.