"Where are all the people that are having heart attacks? Are they staying home not being treated for this heart attack, because we're seeing not just our overall volume go down, but we're actually seeing people come in less for those particular conditions," says Dr. Sovndal. A typical pre-COVID work day would include a myriad of different ailments from chest pain to headaches to broken bones, he says. "What we see now overall is that [visits to the emergency room] have dropped."
Early recommendations to avoid going to the emergency room were heeded a bit too well, says Dr. Sovndal. In his hospital, Boulder Community Health, overall emergency room admissions have fallen by 30 to 40 percent. Similarly, Phillip L. Coule, MD, vice president and chief medical officer at the Augusta University Health System in Georgia, tells the American Heart Association that admissions to his hospital were down by 25 to 40 percent in April. A recent study published in Journal of the American College of Cardiology reports a 38 percent decrease in visits to the ER for serious heart attacks.
Dr. Sovndal doesn't want people to be afraid to seek medical attention.
"We're prepared for COVID-19. But we're also prepared to do our normal job as well," says Dr. Sovndal. "We put protective mechanisms in place to protect those people that are coming in for non-COVID complaints. The way that you check in, the way that you're moved through the department, the number of people that are allowed in the department, all those things are safeguards to try to keep people safe with the fact that we're in the middle of a pandemic."
Here's what you need to know about visiting the emergency room right now.
What precautions are hospitals taking to protect patients?
Emergency rooms look very different today than the would have looked six months ago, says Dr. Sovndal, who authored a soon-to-be-released book titled Fragile. "The waiting room is set up differently," he says. Instead of patients being packed together, they are now following social distancing guidelines. Everyone who comes in gets a mask. Visitors aren't allowed. Tests are done in a way that limits the number of times a patient has to be transferred in and out of a room. Rooms are thoroughly cleaned between patients. And for some test results, Dr. Sovndal says he calls patients' cell phones to relay results instead of suiting up in personal protective equipment to re-enter their room.
There are also negative pressure rooms reserved for COVID-19 patients, where the room is designed so when the door is opened, air from the hall comes in instead of air from the room flowing out. Dr. Sovndal says these rooms are present in all newer hospitals, and that some older hospitals may also have them.
Can I go to the emergency room for a non-COVID emergency?
Health-care professionals are concerned that people who really needed help just aren't coming in, says Dr. Sovndal. He does't want patients to feel discouraged to go to the emergency room.
"If you need to come to the ER, if you are afraid that you have a serious condition or something that you're worried about, we are prepared to see you and we're happy to see you," he says. "If you are having a condition that is concerning, you're having severe abdominal pain, shortness of breath, bad headache, neurologic deficits, pre-stroke symptoms—we think you absolutely should still be calling 911 and still be coming to the emergency department to be seen. Because those conditions can't wait to see how they go and see how they see if they get better on their own."
What if I have a pre-existing condition, is it safe to go in?
"If you told me that someone has a pre-existing condition of hypertension and heart disease, and now they're short of breath, that person absolutely needs to go to the emergency department because they could be having a heart attack," says Dr. Sovndal. "When you have pre-existing conditions, you're you're at risk for not just COVID, you're at risk for a lot of different things. If you have diabetes, hypertension, heart disease, we know that those patients are at increased risk for all kinds of problems. And you add COVID to that, that means that they're at more risk to be having a real life-threatening problem aside from COVID. So they still need to go to the ER when they're having abdominal pain, or chest pain, or shortness of breath."
How is telemedicine being used in emergency rooms?
In his hospital, Dr. Sovndal says he and his colleagues had started to use telemedicine more frequently before the pandemic, and that it's ramped up over the past few months.
"We were already seeing a little push into telemedicine anyway, just because of the convenience it offers for people making appointments, getting in when they have trouble traveling, when they're elderly," he says. "I think we saw a little burst of it now that we have COVID, meaning everyone pushed a little bit harder to get telemedicine going more substantially than it was before. We have a telemedicine COVID hotline, essentially that you can call into, and then primary care providers are also really using telemedicine to try to take care of those patients that just have a question or simple things like medication refills that they can do over the phone."
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