Emergency Care: The Complete Guide

Key numbers at a glance

Why the first minutes matter, and how to recognize an emergency

In most of the conditions that kill quickly, such as cardiac arrest, heart attack, stroke, severe bleeding, anaphylaxis and a completely blocked airway, the treatment exists and works well. What decides the outcome is often how fast it starts. Heart muscle and brain tissue are lost steadily while blood flow is cut off, and blood loss or a closed airway can become fatal in minutes. The most valuable thing an ordinary person can do is recognize the problem early and get help moving.

The hardest part is usually not the technique but the decision. People wait to see whether chest pain settles, assume slurred speech is tiredness, or worry about wasting an ambulance crew's time. Emergency physicians are clear that this hesitation is where much of the harm happens. If you think something might be an emergency, that is the right threshold for calling 911. Dispatchers and crews would far rather attend a false alarm than arrive too late.

Some symptoms should always lead to a 911 call rather than a drive to the hospital or a wait-and-see approach. They share a common feature: they suggest that the heart, brain, airway or circulation is failing, and that treatment on the way to the hospital, or a hospital team alerted in advance, could make a real difference. The list below is not exhaustive; if something feels seriously wrong, call.

Two patterns are worth memorizing because they are both common and easy to miss. The first is stroke, which the F.A.S.T. reminder covers: Face drooping, Arm weakness, Speech difficulty, Time to call 911. The second is a heart attack that does not look like the movies. Instead of crushing chest pain, it may show up as pressure, breathlessness, nausea, a cold sweat or pain in the jaw, back or arm, particularly in women, older adults and people with diabetes.

Children and babies have their own warning signs: a baby or child who is floppy, unusually drowsy or hard to wake, who is breathing very fast or with visible effort, or who has a rash that does not fade when pressed together with a fever. Do not wait to see whether a rash like that changes, and do not let a child's brief rally reassure you if the overall picture is worrying.

• Chest pain or pressure lasting more than a few minutes, or that goes away and comes back
• Sudden weakness or numbness on one side, facial drooping, or difficulty speaking
• Severe difficulty breathing, or lips or skin turning blue or gray
• Bleeding that will not stop with firm pressure
• Someone who is unresponsive, or not breathing normally
• A seizure that does not stop, or a first seizure
• Swelling of the lips, tongue or throat, or other signs of a severe allergic reaction
• Sudden, severe headache unlike any before, or sudden loss of vision or balance
• Signs of serious infection getting worse fast, such as confusion, mottled skin or very little urine

Calling 911 and helping the dispatcher help you

When you call 911, the first question is usually where you are. Know your address, or look for landmarks, mile markers or cross streets if you are outside. Cell phone location is not always precise, especially in large buildings, so say the floor, apartment number or entrance. Stay calm enough to answer the questions in the order they are asked: they are designed to send the right help and to get you started on care before it arrives.

Put the phone on speaker so your hands are free. Dispatchers are trained to talk callers through CPR, choking care and bleeding control, and many will stay on the line until crews arrive. Do not hang up until the dispatcher tells you to. If you can, send someone to unlock the front door, turn on an outside light and put pets in another room, which saves precious time when the crew arrives.

Text to 911 is available in many areas for people who cannot speak safely, or who are deaf, hard of hearing or speech-impaired. Calling is still the faster option when you can, because a voice call carries more information more quickly. If you text, send your location and the type of emergency in the first message, keep messages short and plain, and avoid abbreviations or emojis.

Why an ambulance beats driving

For a suspected heart attack or stroke, do not drive yourself and avoid being driven. Emergency medical services (EMS) can start treatment on the way, record the heart's rhythm, handle a cardiac arrest if it happens in the vehicle, and alert the hospital so that the right team is waiting. With stroke in particular, the receiving hospital being ready can shorten the time to treatment. A private car offers none of that, and a driver who is frightened is not a safe driver.

Choosing the right place: 911, the ER, urgent care or your doctor

The US system offers several doors, and choosing the right one matters both for your safety and for your bill. The emergency room, also called the emergency department, is open around the clock for serious illness and injury. Patients are seen in order of medical need, a process called triage, not in order of arrival, which is why a sprained ankle can wait hours on a busy night. The ER is the right place for emergencies and usually the slowest and most expensive place for everything else.

For problems that need attention today but are not life-threatening, such as a sprain, a minor cut that may need stitches, an earache, a urinary tract infection or a fever in an otherwise well adult, urgent care centers, telehealth visits and your doctor's office are generally faster and cheaper. Many primary care offices keep same-day slots and have an on-call clinician after hours, and many insurers run a free 24/7 nurse advice line, usually printed on your insurance card.

When you are unsure, a nurse line or your doctor's after-hours line can help you decide. But if the symptoms are on the 911 list, skip that step. Nurse lines, telehealth and urgent care are not designed for life-threatening emergencies, and an urgent care center will simply send you on to the ER, losing time. Saving these numbers in your phone now means you will not be hunting for them when you are worried.

• 911: life-threatening emergencies, or anyone who cannot safely get to the hospital
• ER: serious illness or injury that cannot wait, when it is safe to get there yourself
• Urgent care or telehealth: same-day problems that are not life-threatening
• Your doctor or nurse line: advice, ongoing problems, and deciding where to go
• Poison Control, 1-800-222-1222: possible poisoning or medicine mistakes in someone who is awake and breathing
• 988 Suicide & Crisis Lifeline, call or text 988: a mental health or substance use crisis

Your rights and costs in an emergency

Worry about cost should never delay emergency care. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), hospitals with emergency departments that participate in Medicare must screen anyone who comes in with a possible emergency and stabilize them, regardless of insurance or ability to pay. In a medical emergency, go to the nearest ER rather than searching for an in-network hospital.

The federal No Surprises Act, in effect since January 1, 2022, protects most people with health insurance from surprise out-of-network bills for emergency care. You should pay no more than your plan's in-network cost-sharing for emergency services, even at an out-of-network hospital. Air ambulances are covered by these protections; ground ambulances are not, though some states have their own rules. If you are uninsured or cannot afford a bill, ask the hospital billing office about financial assistance and payment plans after you have been treated.

Myths that cost time

Myths are worth retiring too. You do not need to be sure it is an emergency before calling 911. A mild-seeming stroke or TIA is not a false alarm. Antihistamines do not replace epinephrine. Ice and butter do not help burns. Waiting to see whether symptoms pass is the single most common mistake. Putting on a brave face does not help either: tell the dispatcher and the triage nurse plainly what the worst symptom is.

Cardiac arrest: CPR and AEDs

Cardiac arrest is not the same as a heart attack. In a heart attack, a blocked artery starves part of the heart of blood, and the person is usually awake. In cardiac arrest, the heart's electrical rhythm fails and it stops pumping effectively; the person collapses, is unresponsive and stops breathing normally. Without immediate help, survival falls quickly with every minute. What bystanders do before EMS arrives is one of the biggest factors in whether the person lives.

If someone is unresponsive and not breathing normally, call 911, put the phone on speaker and start chest compressions straight away. Occasional gasping is not normal breathing; it is a common sign of cardiac arrest and a reason to start, not to wait. Push hard and fast in the center of the chest, at least 2 inches (5 cm) deep in an adult but no more than about 2.4 inches (6 cm), at 100 to 120 compressions a minute, and let the chest come all the way back up between compressions.

If you are untrained, the American Heart Association recommends Hands-Only CPR for adults and teens: continuous chest compressions without rescue breaths. Do not stop to check for a pulse, and keep pauses as short as possible. If you are unsure whether you are doing it right, keep going; imperfect compressions are far better than none. Swap with another person every couple of minutes if you can, because compressions get shallower as you tire.

Using an AED

An automated external defibrillator (AED) is a portable device that analyzes the heart's rhythm and, if a shockable rhythm is present, delivers a shock to restore it. AEDs are found in airports, gyms, schools, offices and many public buildings, and they are designed for untrained people. Once you switch one on, it gives spoken instructions. It will not shock unless the rhythm needs it. Send someone to fetch the nearest AED while you continue compressions, attach the pads as shown in the pictures, and stand clear only when the device tells you to.

Children and babies

CPR technique is different for infants and children, and rescue breaths matter more for them because cardiac arrest in children is more often caused by a breathing problem. This is one of the clearest reasons for parents, grandparents and caregivers to take a pediatric CPR course. If you are untrained and alone with a child who is unresponsive and not breathing normally, call 911 and follow the dispatcher's instructions.

Heart attack and stroke

A heart attack happens when a coronary artery becomes blocked and part of the heart muscle is deprived of blood. The classic symptom is chest discomfort described as pressure, tightness, squeezing, fullness or pain, lasting more than a few minutes or going away and coming back. It can spread to one or both arms, the back, neck, jaw or stomach, and it often comes with shortness of breath, a cold sweat, nausea or lightheadedness. Less typical symptoms are a major cause of delay, so do not let the absence of dramatic chest pain reassure you.

Call 911 rather than arranging your own transportation, sit down and stay as calm as you can, and loosen tight clothing. Unlock the door if you are alone, so the crew can get in if you become too unwell to answer. Chew an aspirin only if the dispatcher advises it and you are not allergic to it. If the person becomes unresponsive and stops breathing normally, start CPR and use an AED.

A stroke happens when the blood supply to part of the brain is interrupted, either by a clot or by bleeding. Remember F.A.S.T., and also call 911 for sudden severe headache, sudden loss of vision, sudden loss of balance or sudden numbness on one side. Note the time the symptoms started, or the last time the person was seen well, and tell the crew: it affects which treatments are possible. Do not give food, drink or medicines, including aspirin, because aspirin can worsen a stroke caused by bleeding and swallowing may be unsafe.

Symptoms that go away still count

A transient ischemic attack (TIA), sometimes called a mini-stroke, causes stroke symptoms that resolve on their own, often within minutes. It is tempting to treat it as a false alarm, but the risk of a full stroke is highest in the days that follow. Call 911 for stroke symptoms even if they have gone away, and make sure the person is seen by a doctor the same day. The same logic applies to chest discomfort that comes on with exertion and settles with rest: it is a reason for a prompt doctor's visit.

Breathing emergencies: choking and anaphylaxis

Choking comes in two forms. In mild choking, the person can speak, cough or breathe, and the best thing to do is encourage them to keep coughing; hitting the back of someone who is coughing effectively can make things worse. In severe choking, they cannot speak, cough or breathe, may clutch at their throat and may turn blue. Act immediately and have someone call 911.

For adults and children over 1, give 5 back blows between the shoulder blades with the heel of your hand while they lean forward, then 5 abdominal thrusts, and repeat until the object comes out or they become unresponsive. For babies under 1, give 5 back blows and 5 chest thrusts, supporting the head, and never use abdominal thrusts. Avoid blind finger sweeps in the mouth, which can push the object deeper. If the person becomes unresponsive, start CPR. Anyone who has had abdominal thrusts should see a doctor afterward because of the risk of internal injury.

Anaphylaxis is a severe, rapid allergic reaction affecting breathing or circulation. Signs include swelling of the lips, tongue or throat, difficulty breathing or swallowing, a hoarse voice, wheezing, and widespread hives with faintness or collapse. Epinephrine is the first-line treatment, and delay in giving it is a major cause of death. Use the epinephrine auto-injector in the outer thigh at the first sign, then call 911.

After epinephrine

Lay the person flat with legs raised, or let them sit up if breathing is difficult. Do not let them stand or walk, even if they feel better, because a sudden drop in blood pressure on standing can be fatal. A second dose may be given 5 to 15 minutes later if symptoms do not improve, which is why people at risk are advised to carry two auto-injectors. Antihistamines do not treat anaphylaxis and should never delay epinephrine. Always go to the ER even if symptoms resolve, because they can return hours later.

Severe bleeding, shock and burns

Direct pressure controls most bleeding, and the most common problem is not pressing hard enough or for long enough. Use whatever clean cloth is at hand, press firmly and continuously on the wound, and call 911 for bleeding that will not stop, spurting blood or a large or deep wound. If blood soaks through, add more dressing on top rather than removing the first layer, and resist the urge to lift it to check, which restarts the bleeding. If an object is embedded in the wound, leave it in place and press around it.

For life-threatening bleeding from an arm or leg that direct pressure does not control, a tourniquet can save a life. Bleeding control courses teach how and when to use one. Watch for signs of shock, the body's response to severe blood loss: pale, cool, clammy skin, rapid breathing, confusion or fainting. Keep the person lying down and warm, and do not give them anything to eat or drink in case they need surgery.

With burns and scalds, the first minutes affect how deep the injury becomes, and cooling is almost always cut short. Cool the burn under cool or cold running water, not ice, for at least 10 minutes, and time it. Remove clothing and jewelry near the burn unless stuck to it, keep the rest of the person warm, then cover the burn loosely with a clean, non-stick dressing or plastic wrap. Never use ice, butter, oils, creams or toothpaste, and do not pop blisters.

Which burns need emergency care

Call 911 for large or deep burns, burns to the airway, suspected smoke inhalation and electrical burns, which can cause internal damage that is not visible on the skin. Go to the ER for chemical burns, burns to the face, hands, feet, genitals or major joints, burns larger than the person's palm, any burn in a baby or young child, and any burn that looks white, brown or charred. Acetaminophen (Tylenol) or ibuprofen, taken as directed on the label, can help with pain from minor burns.

Head injuries and concussion

Most bumps to the head are minor, but bleeding inside the skull can develop hours after an injury that looked trivial at the time. That is why the advice is to watch the person closely, ideally with someone staying with them for the first 24 hours, rather than to judge purely by how they seem in the first few minutes. Getting checked early is better than waiting for symptoms to declare themselves.

A concussion is a brain injury caused by a blow or jolt to the head or body, and it does not require loss of consciousness. Symptoms can include headache, confusion, feeling foggy, nausea, sensitivity to light or noise, and problems with balance, memory or concentration, and they may take hours or days to appear. Rest for a day or two, then bring activity back gradually. Avoid alcohol in the first days, and never return to sports on the same day as a suspected concussion. A step-by-step return-to-school or return-to-sports plan helps young people recover safely.

People taking blood thinners are a special case. Their risk of bleeding inside the skull is higher, so any head injury, however minor it seems, needs prompt medical assessment, even if there was no blackout and they feel fine. The same caution applies to older adults who fall and hit their head, because bleeding can develop slowly and the early signs, such as mild confusion or unsteadiness, are easy to put down to something else.

• Call 911 for loss of consciousness, a seizure, or increasing drowsiness or confusion
• Call 911 for repeated vomiting or a headache that keeps getting worse
• Call 911 for weakness or numbness, one pupil larger than the other, or clear fluid from the nose or ears

Sepsis and infections that turn serious

Sepsis is the body's extreme response to an infection, in which it starts damaging its own tissues and organs. It can follow any infection, including minor ones such as a skin wound or a urinary tract infection. It can kill quickly, it is more treatable when it is caught early, and in its first hours it is often mistaken for flu.

Signs include confusion or slurred speech, shortness of breath, a high heart rate, fever or feeling very cold, extreme pain or discomfort, and clammy or sweaty skin. Passing little or no urine, extreme shivering, and skin that is mottled, blue or very pale are particularly worrying. A normal temperature does not rule it out. In children, watch for very fast breathing, a seizure, a rash that does not fade when pressed, or unusual floppiness.

Adults 65 and older, babies, and people with chronic conditions or weakened immune systems are at higher risk. If someone with an infection is getting worse quickly, call 911 or go to the ER, and say the word sepsis. Asking directly, "Could this be sepsis?" prompts the team to look for it and start urgent treatment, including antibiotics, as quickly as possible. Keeping vaccines up to date and cleaning and caring for wounds promptly lowers the risk of the infections that lead to it.

Poisoning, overdose and mental health crises

For a possible poisoning, including taking too much of a medicine, swallowing a household chemical, or a child getting into pills, call Poison Control at 1-800-222-1222. The line is free, confidential and staffed around the clock by experts who can tell you whether the person can be watched at home or needs the ER. Call 911 instead if the person is unconscious, having a seizure or struggling to breathe. Do not try to make the person vomit unless you are told to.

For a suspected opioid overdose, signs include pinpoint pupils, very slow or stopped breathing, blue or gray lips, and being impossible to wake. Naloxone can reverse an opioid overdose and is available over the counter as a nasal spray. Call 911, give naloxone if you have it, and start CPR if the person is not breathing normally. Naloxone wears off sooner than some opioids, so the person still needs medical care even if they wake up.

A mental health crisis is an emergency too. If someone is thinking about suicide or is in emotional distress, call or text the 988 Suicide & Crisis Lifeline. Call 911 if someone is in immediate danger, has harmed themselves, or has taken an overdose. Stay with the person if it is safe, remove access to means of harm where you can, and listen without judgment.

Children, older adults, pregnancy and other higher-risk groups

Babies and young children can become seriously ill faster than adults and cannot always tell you what is wrong, so trust your sense that something is not right. Floppiness, being hard to wake, breathing that is fast or labored, a rash that does not fade when pressed, signs of dehydration such as few wet diapers, and a fever in a very young baby are reasons to get help quickly. Your pediatrician's after-hours line can advise on less urgent concerns. Learn the infant choking steps, which differ from those for older children and adults.

Older adults often have less typical symptoms of serious illness. A heart attack may cause breathlessness or fatigue rather than chest pain, and infection may show up as new confusion or falls rather than fever. A fall may hide a fracture or, in someone on blood thinners, a head injury. Do not assume a change is just aging. If you care for an older relative, keep an up-to-date list of their medicines and conditions to hand to responders.

During pregnancy, call 911 or go to the hospital for heavy vaginal bleeding, severe abdominal pain, a seizure, a severe headache with vision changes, chest pain or trouble breathing, or a baby that stops moving or moves much less. Tell every responder that you are pregnant. People with diabetes, heart or lung disease, a weakened immune system, or those taking blood thinners should also have a lower threshold for seeking urgent help.

Getting ready: a practical plan for the year ahead

Emergencies are easier to handle when a few decisions are already made. Most of the preparation takes an afternoon, and it pays off for everyone in your household. People who have rehearsed what they would do, even just by talking it through, act faster and more calmly when it counts, and children as young as school age can learn to call 911 and give their address.

Over the next month, take a CPR and first aid course from an organization such as the American Red Cross or the American Heart Association, save the key numbers in your phone, and write down each family member's medicines, allergies and conditions. Put that list somewhere responders can find it, such as on the fridge or in your phone's emergency medical ID. If anyone in your home has a severe allergy, check that auto-injectors are in date and that everyone knows where they are kept and how to use them.

Through the year, keep a stocked first aid kit at home and in the car, and know where the nearest AED is at work, school and the gym. Find your nearest ER and urgent care center, check which urgent care centers are in your insurance network, and find your insurer's nurse line number on your card. Lock up medicines and household chemicals out of children's reach. Refresh your CPR training regularly, since skills fade without practice, and talk with your family about what each person would do in an emergency.

• Week 1: save 911, Poison Control (1-800-222-1222), 988, your doctor's after-hours line and your insurer's nurse line
• Week 2: write a medicine, allergy and conditions list for each family member
• Week 3: book a CPR and first aid course; check auto-injector expiration dates
• Week 4: stock or refresh your first aid kit, and locate the nearest AED, ER and in-network urgent care

Every guide in this topic

• Recognizing an Emergency: What Published Guidance Supports
• CPR and Defibrillation: What the Evidence Actually Says
• Choking: What the Evidence Actually Says
• Severe Bleeding: What the Evidence Actually Says
• Anaphylaxis: Emergency Response: What the Evidence Actually Says
• What the Guidance Really Says About Suspected Stroke
• Suspected Heart Attack: Sorting the Evidence From the Noise
• Sepsis: What the Evidence Actually Says
• The Evidence on Burns and Scalds, Without the Hype
• Head Injury: What Published Guidance Supports

Frequently asked questions

How do I know if it is serious enough to call 911?

If you think it might be a life-threatening emergency, that is the right threshold. Call for chest pain or pressure, signs of stroke, severe breathlessness, heavy bleeding, a seizure that does not stop, unconsciousness or a severe allergic reaction. Dispatchers would far rather send help to a false alarm than arrive too late, and they will help you decide on the call.

Should I drive someone with chest pain to the hospital myself?

No. For a suspected heart attack or stroke, call 911. Paramedics can start treatment on the way, deal with a cardiac arrest if one happens, and alert the hospital so the right team is ready. A frightened driver in a private car can offer none of that and may cause a crash.

What if I start CPR and do it wrong?

Someone in cardiac arrest will not survive without help, so imperfect CPR is far better than none. Push hard and fast in the center of the chest at 100 to 120 compressions a minute and keep going until help or an AED arrives. The 911 dispatcher can coach you. A hands-on course builds confidence for next time.

Can I hurt someone by using an AED?

AEDs are designed to be used by untrained people. The device analyzes the heart rhythm and only delivers a shock if one is needed, and it talks you through each step. Make sure nobody is touching the person when it says to stand clear. Using one quickly gives a person in cardiac arrest the best chance of survival.

Should I give aspirin to someone having a heart attack or stroke?

For a suspected heart attack, chew one aspirin only if the 911 dispatcher advises it and the person is not allergic. For a suspected stroke, do not give aspirin, food, drink or other medicines, because some strokes are caused by bleeding in the brain, which aspirin can worsen, and swallowing may be unsafe.

Why go to the ER after anaphylaxis if the epinephrine worked?

Symptoms of anaphylaxis can return hours later, even after they have resolved, and the effect of one epinephrine dose wears off. Emergency staff can monitor the person, give further treatment if needed and arrange follow-up. Afterward, see your doctor about an allergy action plan and make sure you carry two auto-injectors.

When should I call Poison Control instead of 911?

Call Poison Control at 1-800-222-1222 for a possible poisoning or medicine mistake when the person is awake, breathing normally and not having a seizure. Experts there can tell you whether home care is safe. Call 911 instead if the person is unconscious, having a seizure, struggling to breathe or getting rapidly worse.

Is urgent care a good substitute for the ER?

For problems that need same-day attention but are not life-threatening, such as sprains, minor cuts or ear infections, urgent care is usually faster and cheaper. It is not equipped for heart attacks, strokes, severe breathing problems or major injuries. If you go to urgent care with one of those, you will be sent on to the ER and lose valuable time.

Will the ER treat me if I do not have insurance?

Yes. Under federal law, hospitals with emergency departments that take part in Medicare must screen anyone who arrives with a possible emergency and stabilize them, whether or not they can pay. Afterward, ask the billing office about financial assistance, charity care and interest-free payment plans before putting the bill on a credit card.

How long should I watch someone after a head injury?

Have someone stay with the person for the first 24 hours, because bleeding inside the skull can develop hours after an injury that seemed minor. Call 911 for repeated vomiting, a worsening headache, a seizure, increasing drowsiness or confusion, or weakness. Anyone taking blood thinners should be checked by a doctor promptly after any head injury.

When to speak to a doctor

Call 911 for chest pain or pressure, signs of stroke (face drooping, arm weakness, speech difficulty), severe breathlessness, bleeding that will not stop, a seizure that does not stop, unconsciousness, signs of anaphylaxis, or anyone who is unresponsive and not breathing normally. Call Poison Control at 1-800-222-1222 for a possible poisoning in someone who is awake and breathing, and call or text 988 for a mental health crisis. For urgent problems that are not life-threatening, call your doctor's office or after-hours line, use your insurer's nurse line, or go to urgent care. See your doctor after any emergency visit, after a TIA (the same day), and after any head injury if you take blood thinners.

Where this comes from

• American College of Emergency Physicians — Know When to Go
• American Heart Association — Hands-Only CPR
• American Heart Association — Warning Signs of a Heart Attack
• American Stroke Association — Stroke Symptoms
• American Red Cross — First Aid Steps
• American Academy of Allergy, Asthma & Immunology — Anaphylaxis
• CDC — About Sepsis
• CDC — HEADS UP: Concussion Signs and Symptoms
• Poison Control — Get Help
• CMS — Emergency Medical Treatment & Labor Act (EMTALA)

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.