The health conditions that warrant a trip to A&E and the ones that don’t

How do you know which symptoms to take seriously and when to seek an alternative? We consult an expert

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Now is not the time to go to A&E unless you really need to.  There’s nothing more demoralising than waiting for hours on end in an overflowing waiting room when you’re in pain.
And unless you’re really in dire straits, you’re unlikely to get any help while waiting, as new research shows.
The findings from the Care Quality Commission (CQC) show patients are routinely left in pain and misery, without any assistance from medics.
The survey of more than 45,000 people who used A&E services in England this year found  that 28 per cent of patients at major A&E units waited more than an hour to be assessed by a nurse or doctor, while 47 per cent of all A&E patients said they got no help with their condition or symptoms while they were waiting.
Of course there are times when a trip A&E is absolutely essential, but many of us head to A&E when we’d be better off calling 111 to find out what service we need first.
There are urgent treatment centres in most hospitals, which can provide help when it’s not a life-threatening emergency (broken bones and sprains, cuts, stomach pain, vomiting and diarrhoea, high temperature and mental health) and walk-in centres, which can help with many of the same problems. You might even be better off waiting for that elusive GP appointment or asking your pharmacist to help, if you’re suffering from general aches and pains, skin rashes, earache or cystitis.
But there are of course situations when a trip to A&E could save your life. 
If you’re over 35 and you have central crushing chest pain that feels like someone sitting on your chest or pulling a tight belt around your chest and it’s radiating to your arm or neck: “You need to go to A&E immediately,” says A&E doctor Mark Harmon, who is a Clinical Entrepreneur at eConsult Health.
Rather than waiting for an ambulance, get someone to drive you if you can: “Ambulances are supposed to respond within 9 minutes, but currently it’s much longer.”
The FAST test (Face, arms, speech, time) helps you understand the signs of stroke.
Any facial drooping, speech disturbance, sudden onset numbness or weakness: “That’s a sign you should get to the hospital pretty quickly”.
There are two major types of stroke. Eighty-five per cent are ischemic which means a clot in the brain blocks the flow of blood. “You have 90 minutes. If it’s acted on quickly you can bust the clot and restore flow to the brain. The longer it goes on without treatment the less good the prognosis.”  Rather than waiting for an ambulance, get someone to drive you. Get to the hospital and don’t stand at the back of the queue.”
Blood in the stool or vomited or coughed up, isn’t immediately life threatening. “It can look extremely dramatic and scary but actually it isn’t,” says Harmon. It does need to be investigated however; ask for an urgent GP appointment or get help from 111.
But if you’ve been in an accident and you’ve severed a finger, a limb or an artery then you need to get to hospital pretty quickly. “If you’re feeling dizzy, if you’re having palpitations, if you pass out, all these are very concerning signs and show your blood pressure is dropping as a result of the blood loss.”
Harmon says to apply pressure to the wound. “You can make a tourniquet using a cloth or plastic bag placed 5cm above the wound. If it’s a stabbing, the key thing is not to remove the object as it’s acting as a tourniquet to stop the bleeding.”
Anaphylaxis is rare but certainly life threatening. “If you’re having difficulty breathing or your tongue or lips are swelling up, absolutely you need to get help urgently,” says Harmon. “However if you just have a rash and nothing else, absolutely not.” 
Asthma is very serious and a big killer. “Patients don’t take it seriously. If an asthmatic comes into A&E with shortness of breath I would never criticise them. This is one of those things that can change very quickly.”  Again, rather than waiting for an ambulance, get someone to drive you. 
Harmon says asthmatics should be using their brown inhaler to prevent symptoms, “religiously, even when you’re feeling well.” 
A fall is the biggest killer of the over 65s.  The key thing is not to fall in the first place, “but even with the best of intentions it’s not easy.”
If you’re deciding whether to go to A&E the key things to look out for are broken bones. “That manifests in pain, difficulty in moving and being unable to bear weight.” 
A hip fracture might be very fine and hard to recognise. “If your leg is shortened and the foot is turned outwards that’s classic signs of a hip fracture.”
If you hit your head it might not be immediately clear you need to go to A&E but if over a few days you become less lucid, have a dull headache and feel drowsy: “That can be a sign of a subdural haemorrhage, a low pressure bleed that should definitely be investigated.”
Acute sudden onset pain could be appendicitis. “Often around your belly button and down into your right groin area could be a perforation of the appendix (and should be seen immediately).”
If you’re pregnant and you have excruciating pain around the ovaries: “It could be an ectopic pregnancy. That is urgent and needs to be seen.”
A tricky one as the symptoms can be quite varied and vague. Such as high fever (e.g. above 38.5 or below 36), acute confused state, fast heart rate combined with dizziness, not passing urine within 12-18 hours and acute abdominal pain or neck stiffness. “Often it is the combination of symptoms that are more concerning.
If patients are on chemotherapy or immunosuppressed in any way, then they should have a much lower threshold,” says Harmon. “It often presents in the elderly as a change in mental state/lucidity (often initially due to a simple UTI).” Time is of the essence; sepsis can deteriorate very quickly and can kill an affected person in as little as 12 hours. 
Many parents can worry about this. “If your child is running a temperature above 40 seek help.” You need to rule out meningitis, especially if your child has a stiff neck, a rash that doesn’t fade when you press a glass against it, is bothered by light, is drowsy and hard to wake, has a high pitched cry that’s not like their normal cry, is vomiting or having fits. Like sepsis, meningitis can deteriorate very quickly. 
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