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When To Call 911

Making the call on when to call is a tricky debate among parents, pediatricians, and paramedics. Some contend that panicked parents call 911 for nosebleeds and sprained ankles, tying up rescue services at the expense of those who truly need them. Others argue that when it comes to a child's health, you're always better safe than sorry. But there's no disputing one thing: The time to map out a 911 plan is now, when you're calm. Here's a primer on when and how to reach out for help.

Is It an Emergency?

That's the million-dollar question. While there are legendary tales of misuse, the majority of unnecessary calls are from well-intentioned parents on the fence about whether the event qualifies as an emergency, says Dennis C. Whitehead, M.D., chief of emergency medicine at Dickinson County Hospital, in Iron Mountain, Michigan. "It's easy to see in retrospect that a child had gas pains, not appendicitis," he says, "but when you're flustered and you don't have any diagnostic tools at hand, how do you know?"

Follow your instinct and dial 911 if you have the terrifying feeling that your child might die, says Scott D. Berns, M.D., medical director of the pediatric trauma service at Hasbro Children's Hospital, in Providence. That means you should call right away if a child is turning blue, not breathing, lethargic, or unconscious. But if the situation is not as clear-cut, you should probably call your pediatrician first to see whether you should come into the office, drive to the emergency department, or call an ambulance.

In those gray areas, there's another reason to think twice (quickly) before calling 911: "An ambulance ride is a very traumatic event. If you've got a situation that isn't life-threatening, save yourself that experience," suggests Dr. Berns. And the cost of the ambulance -- which can total upwards of $2,000, depending on where you live -- is hardly incidental. It's certainly worth finding out your health provider's policy ahead of time so you know what you're in for. Kaiser-Permanente, for example, recently signed a first-ever contract for its enrollees with a national emergency medical service. Under the program being rolled out this year, members call a local emergency number (not 911) and are guaranteed paid medical transport.

On the other hand, if you think you're too distraught or distracted to drive safely -- and particularly if you feel that your child is in grave danger -- then you're better off calling an ambulance, even if you're not sure the ride is covered. Although you might think you can get your child to the hospital more quickly in your own car, remember that paramedics will be able to start treating your child's condition or injury en route to the emergency room. And you can always take on your insurance carrier later.

We tend to think of 911 as a monolithic emergency system, but it actually comprises hundreds of local or state services that range from wildly sophisticated to surprisingly spartan. A state-of-the-art network, dubbed "enhanced 911," is available in about 60 percent of the country and gives the dispatcher who answers the phone the capability of seeing the number you're calling from, the address you're calling from (unless you've moved recently or you're dialing from a cell phone), and, in some cases, access to a mapping program that red-flags road closures or traffic delays. The basic service, or 911, simply gets you into your local police or ambulance number. If you live in the 20 percent of the country that doesn't have 911 service, you'll need to dial a different local emergency number (which often taps into local police), so check your specific town for details.

Whatever number you dial, well-trained help is at hand before a rescue team even arrives. The dispatcher who answers your call is the first critical member of the emergency team, so listen -- and respond -- to her questions carefully, even though you're anxious. For example, if you're calling to report that your son is choking, the dispatcher is likely to ask you a series of scripted questions. What does he look like now? Did you see him put something in his mouth? And the queries may be intentionally redundant: Is your child breathing? Is he conscious? "For the frantic parent, it seems unnecessary, but in a crisis, many of us misstate information," says James M. Atkins, M.D., a professor of internal medicine at the University of Texas Southwestern Medical School. The dispatcher is assessing the problem so she can tell you what to do while help is on the way.

And though it's natural for you to want to hang up and rush back to your child, many dispatchers encourage parents to stay on the line. They'll want to hear if the child is getting better or worse. They'll also walk you through some important instructions, such as turning on the porch light to make your house easier to spot, or coach you in crucial procedures, such as how to clear an airway, says Bob Waddell, EMS systems specialist for the Emergency Medical Services for Children National Resource Center, a not-for-profit group based in Washington, D.C. At this point, dispatchers often speak slowly. "They're trained to speak methodically when they hear you panicking in order to calm you down," says Waddell. You'll be better able to help your child if you're not hysterical.

Part of knowing when to dial 911 is knowing when not to. Strange as it sounds, some people would rather call the rescue squad than their own physician. "We've found that many of the parents who call an ambulance at 3:00 a.m. didn't want to bother their doctor," says Dr. Berns, who is also a pediatric emergency physician. But if your child is screaming in pain in the middle of the night, most pediatricians agree that you should call them. After all, that's their job.

To ease parents' reluctance, some pediatricians are establishing round-the-clock office hours. "There's often a window of time when parents aren't certain what to do, and this is a way to encourage them to ask," says Mark DiDea, M.D., medical director of Kid Care After Hours, an after-hours service at Arnold Palmer Hospital for Women and Children, in Orlando. Parents describe symptoms to a registered nurse and are directed either to call 911, head straight to the ER themselves, or contact their doctor the next day during office hours.

Regardless of how available your doctor is, find out the limits of the office ahead of time: Are they set up to give stitches? Do they handle casts? You should also do your own emergency prepwork: Map the fastest route to the hospital, update your first-aid skills, and familiarize yourself with your insurance carrier's rules. Though I was naive with our daughter (I probably should have called 911), I was also lucky. Our pediatrician was nearby, available, and had the antidote at hand. We got what any parent in an emergency wants -- a happy ending.

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