HSE advice for patients attending Midlands emergency departments

The HSE has issued a set of guidelines to patients who may need to visit an Emergency Department (ED) over the upcoming busy New Year festive weekend to ensures that their visit runs as smoothly as possible.

Dr Anna Moore, Consultant in Emergency Medicine, Midland Regional Hospital Tullamore has issued the following advice:

1. Take a picture of your prescriptions

If you are taking medication/tablets and can never remember their names or the dose, think about taking a picture of your prescription and you can show this to the doctor if they ask you about the medication you are taking, says Dr Moore.

The list of medications you’re taking is really important. Sometimes patients would say, ‘I’m on a little white tablet’ and it’s hard to know which one of the many possible little white tablets it is. Increasingly people are taking lots of different medications and it’s very useful to know what they are when deciding how best to treat their emergency.

The importance of this is two-fold: firstly, it can affect the medication that we give patients and, secondly, it gives a clue if the patient perhaps has a long term condition. For example, Chronic Obstructive Pulmonary Disease and Asthma are both referred to as the patient being “chesty” and have similar symptoms of sudden attacks of breathlessness. However, it is really helpful to know as soon as possible which condition you are treating in an emergency situation. Obviously, don’t delay to find the prescription if it’s an emergency but a picture of a recent prescription is really helpful.

2. Try to keep your doctor’s letters safe (and your glasses)

Similarly, if you have an emergency and need to go to the ED, it’s a good idea to bring any recent doctor’s letters relating to your condition. If you do have a referral letter from your GP, that can take us a lot faster down the diagnostic route. Sometimes patients will leave it in the car and while it’s not essential, it is a huge help.

Although you can obviously arrive in a bit of a fluster to the Emergency Department, do try to get someone to follow with your glasses or your hearing aid if you have left them behind, recommends Dr Moore.

When patients are already distressed, they can be even more frightened if they can’t see and/or hear clearly. If you don’t usually speak or easily understand conversational English, try to bring a friend or family member who can translate. We can get an interpreter but it’s faster and reduces stress for you if you have someone with you when you come in to listen to the doctors and nurses and then speak to you in your language.

3. Come in if your health takes a dramatic turn

Not entirely sure whether you need to go to hospital or just the GP? The answer often lies in how quickly your condition changed, says Dr Moore.

The kind of people who should come in are people who were quite well yesterday and feel very unwell today. If you have sudden severe chest or abdominal pains, or any sudden dramatic, negative change in how you feel, make your way to the Emergency Department if no-one else is around to help.

What else needs immediate medical assistance? Any symptoms that are associated with heart attack or stroke, says Dr Moore.

People tend to know the symptoms of a stroke – things like face twisting, difficulty speaking and a loss of power in one arm or leg. These are time-critical conditions and the faster you get into us the better.

4. Hurt yourself? The Emergency Department might not be your best bet

Obviously, if it’s an injury stemming from a car accident or where you are losing a lot of blood, do go to the Emergency Department – but for minor wounds, sprains and breaks of your arms or legs, think about going to an Injury Unit instead, says Dr Moore.

If it is something like you’ve fallen over and damaged your wrist, knee, elbow, ankle or shoulder, you will be seen in the Emergency Department but the Injury Unit can see and treat you more quickly. There is an Injury Unit in Mullingar (Ballinderry), Nenagh and Roscommon.

Each Injury Unit is linked to a Hub Emergency Department so patients can be admitted there if needed. This allows people to get the service they need closer to home in a lot less time, while having access to exactly the same level of care they would receive in the ED. Emergency Departments always treat the sickest people first, so patients with less serious injuries tend to wait longer for treatment.

5. The flu generally doesn’t warrant the Emergency Department

Have a “serious dose of the flu”? Hospital is actually not the best source of help.

Mild or moderate flu-like viral illness is much more common in winter and we can’t really help with that in hospital. HSE now has a number of resources like undertheweather.ie that provide information about common unexpected but not serious conditions, including self-care and advice for pharmacist or GP services.

Obviously if you have collapsed as a result of it or are in a high-risk category (more of that below), do seek help from the Emergency Department but flu infections can put a lot of strain on hospitals, shares Dr Moore.

If someone does come in with a flu-like illness, we have to isolate them to prevent infecting other people waiting treatment for other conditions. There are only so many people we can do this for, because of limitations of available clinical assessment areas. In practice, it means we lose the function of the space in which we isolate patients who may not be seriously ill, meaning that we have less space to assess patients who may be more urgently in need of treatment. These more urgent patients unfortunately can then wait longer for assessment and treatment.

Remember it is not too late to get your winter vaccinations to protect yourself for the months ahead. To help protect you and your loved ones, make sure your winter vaccinations are up-to-date, including the COVID-19 and flu vaccines.

6. If you’re likely to be infectious, try to steer clear

If you have a loved one in hospital and come down with a respiratory illness, gastroenteritis or flu, do them (and other vulnerable patients) a favour and delay your visit, warns Dr Moore.

Things like respiratory infections and gastroenteritis are highly contagious. Spread of these conditions can result from things like not washing your hands after using the toilet and leaving germs on the handle of the toilet door that infect others. Respiratory infections are spread by the infected person breathing out germs.

7. If you’re sick, keep as hydrated as you can

If you are suffering from a tummy bug like gastroenteritis, do take the proper precautions at home if you can and avoid a visit to hospital (along with washing your hands properly to stop it spreading).

With gastroenteritis the main thing to do is rest, take loads of fluids and take something like Dioralyte if you can. With diarrhoea and vomiting, you are losing important salts and minerals (like potassium) that you would usually keep in your system, so they’re very important to replace. You may collapse if you lose too much so it’s essential to keep up with your fluid intake. Very occasionally, diarrhoea and vomiting means you can’t drink enough to keep up with the amount of fluid you are losing. If you feel very thirsty, are passing very small amounts of very dark urine (clear/light yellow coloured urine is a very reassuring sign of not being seriously dehydrated) or are nearly fainting when standing up from lying or sitting, you probably need urgent assessment by a doctor (ED is fine if you are worried, but your GP will be also be able to assess and advise).

8. But if you’re in a high-risk category… do take extra care

Dr Moore’s final advice is to take extra care if you are in a high-risk category, or have a loved one who is and gets quite sick over New Year's weekend.

The very elderly tolerate infections less well than the younger and physically stronger population. Very young babies can get a very high temperature and have difficulty letting people know how sick they are – dry nappies across the course of the day is an indicator of dehydration that may need treatment. So, if you do have an infectious condition and can go to your pharmacist or doctor for advice, please do if you can rather than coming straight into ED.

It is really important that people who do require emergency care are encouraged to attend EDs where they will be prioritised. Please dial 999 or 112 for emergency care if there is concern for serious illness or injury