Caitlin Whyte (Host): Welcome to Hally HealthCast, the Wellness Podcast from Hally Health, your partner in helping you live your healthiest life. Every episode on our podcast addresses a new topic important to your health and wellbeing, bringing in doctors, specialists and other health experts who offer advice and answer your most pressing questions.

Today's episode is all about urgent versus emergency care. National preparedness month isn't until September, but emergencies don't care what month it is. So, in the interest of helping us all be more prepared in the event of an emergency, let's take a few minutes right now to learn more about this important topic.

Here with us is Dr. Michael Smith. He's the Chief Medical Officer for Health Alliance and Emergency Medical Services Director for Carle Regional EMS. Welcome Dr. Smith, and thank you so much for being with us today and sharing your knowledge and expertise. Let's begin with your perspective on today's topic as an emergency medical services professional.

Dr. Smith, what is the difference between urgent and emergency medical care and when should we seek one over the other?

Michael Smith, MD, FAEMS: Well, it's my pleasure to get together and talk with you this morning. I've been a Boarded Emergency Medicine Physician for the past 30 years and a subspecialist in EMS and both emergency and urgent care are important services for the community. The short answer to your question is that urgent care is a great option for acute primary care needs.

That is, minor illnesses and injuries where one might usually go see your family doctor, but their office is booked full, or perhaps it's an evening or a weekend, a time when they're not readily available. Emergency medicine at the hospital, the name sort of speaks to the topic. The emergency department is best to serve those who have an acute concern that might be dangerous or potentially life-threatening.

So patients can choose either one, but there are advantages and disadvantages to each venue.

Host: Thank you, Dr. Smith. That certainly makes the difference clear. But let's go a step further. Let's say we've determined that a visit to the emergency room is called for. How do we decide how to get there? When should we call an ambulance instead of trying to go to the ER on our own?

Michael Smith, MD, FAEMS: So the threshold for calling an ambulance is when one feels that the emergency situation might not be safe to transit by private car. So there are some emergencies that are so immediately life-threatening when an ambulance is always the right answer. A good example might be when a person is suspected of having an acute heart attack or when a person has severe respiratory distress.

Other situations might cause a person to seek care at an urgent care or an emergency department, but it's clearly safe to go by private vehicle. Examples, there might be nausea or vomiting, a fever, a cough, a cold, anywhere where a reasonable person would say getting to the hospital by private vehicle is safe. That's going to be the right answer. So the EMS system accessed through 911, is there when a person has an immediate life threat, and you're concerned that driving by private vehicle might not be safe. In most circumstances though, taking your private car to either the emergency department or to an urgent care is the right answer.

Host: Well, thank you Dr. Smith. That's definitely worth remembering. Okay. Even if we call the ambulance in a medical emergency, critical minutes may pass before it arrives. That points out the lifesaving importance of knowing how to administer first aid at the scene. So as an emergency medical services professional, what do you think everybody should know about Basic First Aid?

Michael Smith, MD, FAEMS: So I think as responsible citizens, it, it's a great idea for everyone to have training in basic first aid and CPR. The good news is, in the United States, our dispatch system is sophisticated, and so even if you haven't been through a dedicated course, when you call 911, our dispatchers are able to walk you through the most important steps that are needed to be done before an ambulance gets there. So in an ideal world, everyone would learn CPR, and everyone would learn to control life-threatening bleeding because those things need intervention before our paramedics can get to the scene. Even in a situation where a person hasn't had formal training, though, when you call 911, it's important to know not just to give the nature of the call and the address and hang up, rather, we want you to stay on the phone with the dispatcher and those folks in turn are trained in how to instruct you in real time to intervene before the ambulance arrives.

Host: Great answer. Thank you, Dr. Smith. Now, one thing we haven't talked about yet is of course costs, whether people have health insurance or not, there are substantial cost differences between urgent and emergency care, and for those who do have insurance, oftentimes coverage and benefits are different. So can you summarize, just in general, the usual cost differences between urgent and emergency care and how health insurance coverage and benefits might differ?

Michael Smith, MD, FAEMS: Sure, and there is a wide difference. In general, the most cost efficient way to access the medical system is through your primary care doctor's office. There is a wide variability between insurance companies and insurance products, so rather than give you specific numbers, what I will say is that in general, an urgent care, the cost is going to be similar to slightly more expensive than going to see your primary care doctor. Whereas at an emergency department, the cost is going to be somewhere in the five to 10 times frame what accessing through either of those other opportunities would be. In other words, emergency care is best utilized when a person suspects there may be a true emergency.

It is a very expensive option, but it's always there and it's certainly something that we as a society need. In an ideal world, though, the large majority of both urgent and routine medical care happens in a primary care setting, whether that be your family doctor's office or an urgent care type facility.

Host: Excellent comparison, Dr. Smith. Thank you. Well, now that we have a pretty clear idea of when to seek urgent care as opposed to emergency medical care, it's probably worth asking as well, why is it so important not to go to the emergency room when urgent care will suffice, or why you shouldn't go to convenient care in a genuine emergency? Won't we get good fast care in either case?

Michael Smith, MD, FAEMS: Yes, I think it's absolutely true that one can access quality, quick care in a variety of settings. What it really comes down to is cost. Medical expenses in the United States are, in my opinion, already, way too costly and the charges go up every year. So ultimately we want people to get excellent professional care in the setting that is the most price advantageous to their budget.

And with the realities of insurance companies charging deductibles and copays, it is a very expensive proposition to seek care through an emergency department. So it's there and it should absolutely be utilized anytime a person feels they may have a medical emergency, but for cost efficiency with excellent quality care; both the primary care office and the urgent care should be the first things people think of when they encounter an acute problem that doesn't strike them as potentially dangerous. In those dangerous situations, by all means, we want individuals to still seek emergency care, and if they think it's that true second to minutes type emergency, we want them to access that emergency care by calling 911 and letting our paramedics respond and help them wherever they're at.

Host: Thank you Dr. Smith. Definitely a lot to consider, but it brings us to our last question. If you could communicate one key message about urgent and emergency medical care, what would it be? What would you want everyone to be aware of?

Michael Smith, MD, FAEMS: So I would want everyone to be aware that emergency departments in the United States stand ready to assist when patients are in times of crisis. Another reality though, is that emergency departments in the United States face ever increasing volumes of patients, and so, in the context of very expensive care that is very heavily burdened in society; we want to see you in the emergency department anytime you think you have an emergency, and we also want you to get care in primary settings anytime you have a health need that you think can be adequately treated in a period of hours to days. Ultimately, the ER stands ready to help you. We just want to make sure that we are trying to carefully use that resource for the patients who need it most.

Society can help us by self-selecting and taking the less urgent, less emergent presentations to alternative venues of care. That ultimately is good for everybody.

Host: Well, marvelous responses and information Dr. Smith. You have been an absolute pleasure to have on our podcast. Thank you so much for joining us and for all that you do every day at Health Alliance and Carle for so many people and families. And that concludes today's Hally HealthCast. Tune in next time as we tackle yet another topic important for your health and wellbeing, and remember, Hally Health is your partner in helping you live your healthiest life.

Visit hally.com. That's H A L L Y.com for resources, information, tips, and much more. Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in again.