WHEN TO CALL AN AMBULANCE, AND WHEN NOT

Avoid having a claim for an ambulance rejected by understanding exactly when you should, and when you should not, arrange for an ambulance to take you to hospital. The most important differentiator in deciding whether an ambulance is appropriate or not, is whether the situation is a real emergency, or not. Read on to see the difference…

Ambulances should always be available for real emergencies. An ambulance should never be used as a transport mechanism when you could have travelled in a private vehicle.

Nedgroup Medical Aid Scheme and ER24 have embarked on a stringent programme to decrease the misuse of ambulances and to try to ensure that ambulance transports are reserved for patients who fit the definition for emergencies:

What is an emergency?

The definition is as follows: “An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or even death.

All ambulance cases will be audited to assess whether the patient was admitted into hospital and/or whether there was a need for specialised emergency care. If the patient was not admitted and did not require specialised care, the ambulance claim may be rejected and the member may be billed for the transportation.

When should you call an ambulance, and when not?

To help members understand when calling an ambulance is advisable, and when it will probably just end up costing them money, ER24 has put together the following handy comparison of emergencies versus non-emergencies. If you are uncertain whether a situation warrants calling an ambulance, you can also call ER24’s helpline on 084 124 for advice.

Emergency
EMERGENCY
CALL AN AMBULANCE
phone
NOT AN EMERGENCY
REFER TO YOUR PHARMACIST / GP
  • When a person has or is reasonably believed to have suffered an acute injury or illness requiring medical attention and/or medical transportation by ambulance
  • A doctor/ registered nurse/ paramedic has requested the urgent transport of a patient by ambulance
  • Acute life-threatening scenario
  • Only indication for use is availability of transport.
  • Patient’s life or usual activities would not be immediately threatened by referral to an alternative care facility for treatment at a later time.
  • Non-urgent health need outside of usual office hours
  • Alternative transport/ home remedy available
Persistent shortness of breath / Wheezing / Ongoing chest pain that worsens on breathing. Wheezing and difficulty of breathing associated with asthma (with no response to usual medications) Coughs, colds, flu, bronchitis, earache, sore throat – with or without fever, general weakness
Acute or persistent, severe chest pain, especially if it radiates to the arm or jaw and is accompanied by sweating, vomiting or shortness of breath. Ongoing, dull, nagging chest discomfort
Sudden, severe onset of abdominal pain (the kind that makes it impossible to walk and wakes one up in agony) Abdominal pain caused by menstruation, constipation and / or other minor abdominal complaints.
  • Difficulty speaking
  • Confusion / Altered mental state
  • Weakness / Paralysis
  • Sudden loss of balance, especially with a history of high blood pressure / in the elderly
  • Sudden loss of vision
  • Seizures
  • Unconsciousness
Fainting, dizziness and headaches in an otherwise healthy person
Fever:

  • > 40°C
  • Does NOT respond to Paracetamol
  • Associated with all-over body rash
  • Children under 2 months with fever > 38.5°C
Fever:

  • < 38.5°C
  • Responds to use of Paracetamol
  • No rash
Ongoing, persistent diarrhoea & vomiting with dehydration (usually > 8 episodes/ day) Diarrhoea and / or vomiting, patient able to walk around
Trauma:

  • Deep cuts that require stitches – especially on the face
  • Bleeding that won’t stop
  • Large open wounds
  • Broken bones / Dislocated joints
  • Head injuries with loss of consciousness
  • Eye injuries
Trauma:

  • Common sprains & strains
  • Superficial cuts
  • Bleeding stopped with pressure
Severe testicular discomfort Painful urination, blood in the urine
Burns:

  • Large surface area
  • Burns to the face or a large part of the hand
  • Where the burn encircles the limb
  • Electrical burns
Burns:

  • Minor burns and scalding
  • Small surface area
Major allergic reaction: Breathing difficulties, swelling of lips / tongue or throat, dizziness or fainting, rash and itching over entire body Minor allergic reactions: watery eyes, runny nose, minor rash and itching
Poisoning – accidental or intentional
Back pain after trauma (such as falling), or after back surgery < 3 months previously Back pain after heavy lifting, generalised back spasm
Pregnancy – complicated

  • Before 37 weeks are completed, emergency determined
  • Rupture of membranes (waters broken)
  • Excessive bleeding during pregnancy
  • Contractions ≤ 5 minutes apart
  • Complication in current or previous pregnancies
  • Pregnancy Induced Hypertension diagnosed
  • Crowning of the head
Normal pregnancy/ labour reached > 37 weeks
  • Suicidal thoughts expressed
  • Sudden aggression / psychosis
  • Previous history of psychiatric admission, possible relapse requiring emergency admission
Depression/ emotional trauma