By Jane Albright, freelance reporter

This article was written for our sponsor, Cape Fear Valley Health.

The decision to go the hospital emergency room or the neighborhood urgent care center isn't always straightforward or obvious.

Sure, if you have chest pain or fall off the roof, that’s an emergency worthy of calling 911. For so many less traumatic events, the answer is "it depends."

The question comes up frequently with Dr. Michael Zappa in his role as associate chief medical officer and chief of Emergency Medical Services for Cape Fear Valley Health System in Cumberland County.

"It's not a simple question," he said. There's a continuum of conditions to consider.

Take chest pain, for instance. Anybody with chest pain age 30 or older needs to get to an emergency department, he said. For younger persons, unless they have cardiac disease, the urgent care center may be all they need.

Another example is a severe headache, he said. A sudden onset headache with someone who seldom experiences headaches is an emergency worth going to the hospital. For someone accustomed to chronic headaches or migraines, the urgent care center will do.

There should be no hesitation about going to the emergency department, Zappa said, if someone displays these symptoms:

• Severe shortness of breath
• Passed out
• Too weak to move
• Confused or can't move an arm or leg
• Major lacerations with bleeding
• Chest pain
• Abdominal pain
• Broken bones that are obvious

You need a hospital whenever advanced diagnostics will be required, he said. Hospitals have immediate access to testing such as CT scans or MRIs.

This leaves a myriad of reasons to go to the urgent care center. Typical urgent care patients have

• Flu
• Fever
• Cough
• Bronchitis
• Asthma
• Sinus infection
• Sore throat
• An isolated injury, such as bumped elbow
• Minor laceration requiring stitches
• Sports injuries

People can get prescriptions refilled at the urgent care center, Zappa said. If they're dehydrated from vomiting or diarrhea, they can get IV fluids.

Patients with chronic conditions such as diabetes or chronic obstructive pulmonary disease can get follow-up care in an urgent care center.

Emergency departments are considerably more expensive than urgent care centers. Check your out-of-pocket expenses with your health insurance now, before an emergency occurs. But don't let costs drive your decision.

A 1985 federal law requires hospital emergency departments to treat anyone who comes, whether they can pay or not. This federal law doesn't apply to urgent care centers, even ones affiliated with a hospital, Zappa said.

To be better safe than sorry, Zappa recommends going to one or the other without delay. If you get to the urgent care center and they decide you need a hospital, they will send you to the hospital.

He knows of several examples of weekend warriors who ignored their chest pain or pooh-poohed it until it was almost too late.

"Men with chest pain are ridiculously stubborn," he said. "Denial keeps many folks from seeking help. Let's not forget about women whose heart problems often present in an atypical fashion such as indigestion or fatigue."

Emergency physicians have gone to college, medical school and an emergency medicine residency to figure out who is having an emergency or not.

Get over the idea of being embarrassed by being wrong.

"We love it when we can tell you you're not having a heart attack," he said.

The emergency room vs. urgent care

Deciding where to go when you have a sudden medical problem is not always an easy decision.

Many factors come into play including age, pre-existing medical conditions, time of day, potential complications, the degree of diagnostic testing, etc.

In general, things that could be something life or limb threatening: heart attack, stroke, sepsis, major accident, or a need for advanced testing (like CT scans and ultrasounds) to rule them out are best evaluated in an Emergency Department.

Less serious or less complex conditions may be safely and efficiently treated in an urgent care or express care. The following list is not comprehensive and is simply a guide; it is not a list of strict rules.

Urgent Care/Express Care	Emergency Department
Colds/Upper Respiratory Infections	Difficulty Breathing / Shortness of Breath
Sinus Congestion	Chest Pain
Earache	Difficulty Swallowing
Sore throat	Severe Headache
Pink Eye	Passing Out / Syncope
Mild Headache	Severe Cough
Cough	Weakness
Flu Symptoms	Dizziness
Fever	Persistent, High Fever
Simple Lacerations / Abrasions	Altered Mental Status / Confusion
Minor Trauma	Complex Lacerations
Sprains / Strains	Severe Trauma
Urinary Problems	Stroke Symptoms: Weakness; difficulty speaking, walking or moving arms
Mild Back Pain	Severe Back Pain
Sports Injuries	Falls from 10 Feet or Greater
Physicals	Pregnancy Complications
Routine Lab Work	Abdominal Pain
Sexually Transmitted Diseases	Persistent Vomiting
Vomiting / Diarrhea	Exacerbation of Chronic Diseases: COPD, Diabetes
Chronic Disease Checks: Hypertension, Diabetes, COPD	Fractures Resulting in Obvious Deformity
Skin Rashes and Infections	Severe Skin Infections
Mild Allergic Reactions	Severe Allergic Reactions

This article was written for our sponsor, Cape Fear Valley Health.