er room visit

The dos and don'ts of going to the ER

Ers across the country are filling up in a return to the pre-pandemic norm. before you see a doctor at the emergency room or call 911, read these tips from dr. michael daignault,..

During this past winter's COVID-19 surge, fueled by the highly transmissible omicron variant, a lot of front-line and customer-facing industries were impacted by widespread infections. 

Local emergency medical service systems were hit especially hard. Communities were told to call 911 only for “true-life- or limb-threatening emergencies.” But this gave those of us who work in the EMS and the emergency room a pause. We thought: “Isn’t this the way the 911 system is supposed to be used?”

ERs across the country are seeing a rapid return to pre-pandemic volume. My ER in Burbank, California, has had some 200-plus patient days recently.

More: Which supplements are most likely to land you in the ER?

As we head deeper into spring and then summer – traditionally the busiest time for ERs – and in the context of reiterating the importance of using your local ER appropriately, I wanted to present some practical "dos and don'ts."

Do not "wait it out."  If you have dangerous cardiac symptoms like chest pain or stroke-like symptoms including severe headache, dizziness, weakness to one side of your body, facial droop, or slurred speech. These symptoms could signify a heart attack or stroke – life-threatening conditions that are time-dependent. If not identified and treated within a matter of hours, the damaged part of your heart or brain could be unsalvageable

A study from spring 2020 surveyed nine major hospital systems and found the number of severe heart attacks being treated in the U.S. had plummeted by approximately 40%. Patients were either afraid of going to the ER because of fear of COVID-19 or were unable to access their primary care doctors or specialists. Early treatment with clot-buster medications or a trip to the catheterization laboratory is critical. As we say in the ER, “Time is heart (and brain).”

Read next: Are you at risk for a heart attack during your workout?

Do bring a list of your doctors, known medical problems and prescriptions, including your dosage and any recent changes. Do not assume such critical information is “in the computer.” Even though all hospitals use electronic medical records, they’re often not integrated. It’s extremely difficult and time-consuming for us to call other hospitals or pharmacies for this information. Time that would be better served attending to your emergency!

Also, if you were referred by a doctor’s office or urgent care center for an “abnormal” lab value or image, please bring the report and CD of the image with you. 

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Do not assume you’ll be able to jump the line if you come by ambulance. It won’t work. And it’s a misuse of the EMS system. As with all visitors to the ER – whether you walk in or come by ambulance – you’ll be quickly evaluated by a triage nurse who will determine whether you need to be seen immediately by a doctor based on an assessment of your “chief complaint” and vital signs. If you’re assessed to be “stable” and asked to wait in the waiting room, this is a good thing! It means you likely do not have a life- or limb-threatening emergency. Please be patient.

Do focus on the reason that brings you to the ER. As much as we’d love to help you out with multiple concerns, we simply don’t have the time, staff, or resources. Please don’t be upset if your doctor asks you “What's the main reason you came to the ER today?” Or “What’s bothering you the most?” We can always refer you back to your primary doctor or a clinic to assess most chronic medical concerns.

Do not call and ask “What’s the wait time in the ER right now?”  We are not a restaurant. We have a rule: If you have to ask the wait time, you probably don’t have an emergency. Post-pandemic wait times are up to multiple hours at ERs across the country. Your time may be better spent at urgent care or use the telehealth function most insurance companies offer now. You can speak to a nurse about your medical complaint, and they can direct you appropriately.

Do bring your own charger for your phone/tablet/laptop. We don’t have extras. Also, most places do have free Wi-Fi but it can be spotty. Better yet, bring a book or magazine.

And finally, please do ask your doctor to go over your discharge plan. This is perhaps the most crucial aspect of the entire ER visit. Ask for a copy and review your lab and imaging results. And please follow up with your primary doctor or specialist. If the doctor recommends you follow up, there’s probably a really good reason.

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What to expect at the ER: A guide to navigating the emergency room

• Your ER experience and wait time will depend on the severity of your condition. 
• Reasons to go to the ER might be excessive bleeding, a high fever, a seizure, or chest pains. 
• If you need to see a doctor immediately, but it's not an emergency, urgent-care is another option. 

When you or a loved one arrives at an emergency room (ER) in the US, you should expect to have a nurse briefly assess you shortly after arrival. The nurse will determine the severity of your condition, which will determine your wait time. If you're in serious condition, you may be brought by paramedics or EMTs and be taken directly to a trauma ward, or seen by a doctor immediately depending on your condition. 

People in the ER are treated in order of how sick they are, says Eric Chu , MD, an emergency medicine physician at the University of Connecticut School of Medicine.

"For example, if you are brought in after having a cardiac arrest, you will be taken to the resuscitation bay where you will be seen immediately. In other cases, you may walk into the waiting room, be assessed by a nurse, and then depending on your acuity, have to wait until a room is open for you," says Chu. 

Average wait times in the ER can range from 25 to 50 minutes , depending on how busy the hospital is. "I think the biggest factor on how long it'll take to be seen in the ER is where you live and which hospital you go to. I have seen patients wait six hours just to be put into a room. It also depends on what time and which day you go. Mondays are notorious for being the busiest day of the week and the weekends are usually the least," says Chu. 

Here are some instances when you might need to go to an ER, and what you can expect once you're there. 

What to expect at the ER

When you arrive at the ER, a trained emergency nurse will assess your condition and determine the urgency of your situation; this process is referred to as " triage ."

While you're waiting to see a doctor, you may be x-rayed, given medications for your symptoms, or be asked to provide blood or other samples, according to Chu. 

"You will be seen by a doctor, physician assistant, or nurse practitioner when you are moved to a room. Treatment or further tests may be done at this time. Consultants, including cardiologists, nephrologists, or neurologists, may also be involved in your care, if required. Then, depending on how sick you are, you may be discharged or admitted to the hospital," says Chu.

When should you go to the ER?

As the name suggests, an ER is essentially for emergencies that could be fatal or cause permanent disability. 

You may also need to go to the ER if you or a loved one have been in an accident or have experienced trauma and require immediate attention.

On the other hand, if you're feeling unwell and need to see a doctor immediately, but it's not an emergency, you can go to your primary care doctor if they have a same-day opening or go to an urgent-care clinic . 

Many urgent care clinics are open every day, and you can get treated faster and for a substantially lower cost than at an ER. If your symptoms are mild and you can wait a day, you can also visit your primary care physician during clinic hours.

What to bring to the ER

If possible, you should try to gather some essentials before you go to the ER, to help the ER physicians understand your medical history and any allergies you might have.  

"Things that are helpful to bring to the ER include your home medication list, the names of your doctors, any paperwork from recent hospital or doctors' visits, and your insurance information (if you have insurance). For example, if you had a recent heart attack, it may be helpful to bring the paperwork from that admission and what medications you have been taking," says Chu. 

You should also try and take a trusted family member or friend along with you to help with paperwork and answer any of the physician's questions, if you are too ill to do so yourself. 

If you're not going to the ER under acute circumstances, Chu recommends bringing a book or a phone charger, since you could be waiting a long time. 

What is the cost of an ER visit?

The cost of your ER visit will depend on the tests conducted, medication and treatment provided, and your health insurance coverage, says Chu. This can vary from hospital to hospital. "One hospital may charge you $30 for a medicine while another may charge you $300," he says. This variation in cost can be due to several factors . For example, larger hospitals, teaching hospitals, or hospitals that provide highly specialized services may charge considerably higher fees.

The average cost of an ER visit is around $1,500 . Sprains, which are among the top causes for ER visits, could cost around $1,100, whereas treating a kidney stone could cost around $3,500. If you have insurance, it may help cover some of this cost, depending on your insurance plan.

Whether your ER visit is covered by insurance can depend on several factors, including whether the hospital or provider are included in the insurance provider's network, says Chu. 

"It can also depend on whether your insurance covers certain costs, like an ambulance ride, for example. An ambulance ride that is not covered by insurance can be quite expensive," says Chu. Ambulance rides can range between $224 and $2,204 per transport. 

Insider's takeaway

You may need to visit the ER for life-threatening situations. The course of your visit can vary quite a bit depending on your condition. While ERs provide necessary and oftentimes lifesaving services, they can involve long wait times and expensive bills, making urgent care or your primary care provider a better option if the situation isn't an emergency. 

Related stories from Health Reference:

• How hypertension, heart disease, and stroke are related
• What causes high blood pressure and how to know if you have hypertension
• How to lower blood pressure with a heart-healthy diet and exercise
• 7 of the most dangerous things that put you at risk of a heart attack
• What is a good resting heart rate, for adults and kids

• Main content

When to Visit the ER

Unsure when to visit the ER? Learn about common signs and symptoms that indicate you should seek emergency care.

This article is based on reporting that features expert sources.

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It's 2 a.m., and you wake up with a terrible pain in your lower back . It's 5 p.m. on a Sunday afternoon, and you suddenly feel extremely nauseous. It's 9 a.m. on a Wednesday morning, and the cough that's been bothering you suddenly seems to take a turn for the worse. What should you do?

Depending on the severity of the problem and your overall health, the answer to that question may be to head to the emergency room – a unit within your local hospital that handles all manner of emergent medical issues.

“ER providers are able to very quickly assess and treat sudden, serious and often life-threatening health issues,” explains Dr. Sameer Amin, chief medical officer with L.A. Care Health Plan, the largest publicly operated health plan in the country that serves nearly 2.9 million members.

The ER, also known as the emergency department, is open 24/7 and can handle a wide range of illnesses, including physical and psychiatric issues, adds Patrick Cassell, patient care administration, emergency services, with Orlando Health in Florida.

Some ERs are Level 1 trauma centers that can handle “very high-level stuff,” he explains, while others, such as those in a community hospital or more rural settings, might need to transfer patients to a larger facility. These transfers happen when the acuity (severity) of the need exceeds the hospital's capacity to care for the patient on-site.

Common Reasons to Visit the ER

So, what constitutes an emergency?

“For us, an emergency is what the patient thinks is an emergency,” Cassell says. “It’s something that we don’t get judge-y about.”

According to a report from the Healthcare Cost and Utilization Project at the Agency for Healthcare Research and Quality, in 2018 (the most recent year data was available), U.S. residents made 143.5 million emergency room visits. Circulatory and digestive system conditions were the most common reasons for an emergency room visit, and 14% of those seen in the ER were admitted to the hospital .

Some common reasons to visit the ER include:

• Chest pains .
• Shortness of breath or difficulty breathing.
• Abdominal pain, which may be a sign of appendicitis , bowel obstruction, food poisoning or ulcers .
• Uncontrollable nausea or vomiting.
• COVID-19, influenza and other respiratory infections .
• Severe headaches .
• Weakness or numbness.
• Complications during pregnancy .
• Injuries, such as broken bones, sprains, cuts or open wounds.
• Urinary tract infections .
• Dizziness, hallucinations and fainting .
• Mental health disorders or suicide attempts.
• Substance use disorders.
• Back pain .
• Skin infections, rashes or lesions on the skin.
• Foreign object stuck inside the body.
• Tooth aches .

When to Seek Urgent Care Instead of the ER

If you're questioning where to seek care, you should opt for the emergency room if you might have a potentially serious condition or are in severe pain, advises Dr. Brian Lee, medical director of the Emergency Care Center at Providence St. Joseph Hospital in Orange, California.

However, if you’re having a medical issue that’s not a full-blown emergency, but your primary care provider can’t get you in for an appointment, that’s a good time to head to an urgent care provider.

“Urgent care clinics are best equipped for a less dire level of care,” Amin explains. “They fill the gaps when the health concern will not require a hospital stay but still needs immediate treatment.”

Deciding between the ER and urgent care also depends on your medical history, notes Dr. Christopher E. San Miguel, clinical assistant professor of emergency medicine with the Ohio State University Wexner Medical Center in Columbus. For example, most people with a cough and a low-grade fever can be treated at an urgent care clinic without difficulty.

“If, however, you have a history of a lung transplant, you should probably be seen for your cough and fever at an ED,” he recommends.

Because urgent care centers typically offer less robust interventions than what you’d find at the emergency room, they can’t help in all situations. They can, however, refer you to a local ER if you do require more intensive care. They also tend to have a lower deductible than the ER, “and if you’re paying out of pocket, urgent cares can be cheaper than an emergency department typically,” Cassell says.

Cost of Urgent Care vs. ER

On the cost front, San Miguel says there are a few factors to be aware of, particularly if funds are an issue.

“Urgent cares are like any other outpatient health care office – they can require payment up front and decline to see patients who are unable to pay,” San Miguel explains.

Emergency departments, however, are compelled by federal law – the Emergency Medical Treatment & Labor Act, which was enacted in 1986 – to see patients and assess them for “life- or limb-threatening illness and injuries regardless of their ability to pay,” he says.

While this means that the ER must see you, they can “decline to treat non-life-threatening problems once they determine that they are non-life-threatening,” San Miguel adds.

You won’t be charged a fee upfront to be seen in the emergency room, but the hospital can and will bill you after you’ve been discharged.

When you accept treatment at the emergency department, “you’re still ultimately accepting responsibility for the bill ,” San Miguel points out. “And because of the nature of providing a 24-hour service that is prepared to handle any emergency, the cost of care in the ED is much higher than the cost in an urgent care.”

If you find yourself in a situation where you’ve received emergency care but are unable to pay, you should call the billing office as soon as possible to talk about your options.

“Often the bill will be reduced and you’ll be placed on a reasonable payment plan,” San Miguel says.

For any non-urgent or ongoing health concerns, visit with your primary care provider, Amin adds.

“It’s always better to have longstanding issues taken care of in a calm and collected manner during normal business hours,” he explains.

How Long Is the Wait at an ER?

Before you arrive, consider that you could be in for a long wait, depending on the type of problem you’re having and the situation inside the ER.

“We don’t operate on a first-come, first-served basis. It’s based on how sick you are,” Cassell explains.

For instance, he says, patients with more severe illnesses, such as a suspected heart attack or stroke , will take precedence over less severe problems, such as a sprain or an earache .

Even though you may walk in and find an empty waiting room and assume you’ll be seen quickly, there could be all sorts of activity going on behind the scenes. Especially in larger ERs, ambulances may be arriving with sick patients or the ER may already be very busy with sicker patients. You will get the same triage if you come by ambulance or walk in to the ER.

So rest assured that if you are very sick, you will get brought back immediately if you walk into ER. Similarly, if you take an ambulance for broken toe, it wont get you in sooner. You will likely be placed in waiting room if ER full.

San Miguel adds, “The best thing you can do is to let the triage/registration team know if there has been a change in your symptoms while you are waiting. For instance, if your chest pain is getting worse or if you are now having trouble breathing, this should prompt the team to reassess you and make sure you are triaged appropriately.”

What Should You Do While You're Waiting to Be Seen?

While you’re waiting, Amin recommends considering what the provider will ask you, such as:

• When did symptoms start?
• How long have they been going on for? Have they changed in severity or frequency?
• Are symptoms related to a health issue you’re being treated for?
• What triggered your visit to the ER today?

You should also bring a list of your medications, health conditions and history, such as chronic conditions and previous surgeries. It's also a good idea to have the names of the providers on your care team, including your primary care doctor and any specialist. Having this information at the ready is especially helpful if you’re headed to an ER that’s outside of the health system you typically use.

“It’s immensely valuable if patients are able to provide us with an accurate history of their medical problems and current medications,” San Miguel notes. “Unfortunately, not all electronic health systems communicate with each other, and in the middle of the night, it can be impossible to request records from another hospital.”

What Happens When You See an ER Provider

When you are brought in to see a provider, the initial aim of the interaction is to assess what’s going on and make sure you’re stabilized.

For some patients, a "big point of frustration is the need to tell their symptoms to more than one person," San Miguel says. "It seems like we’re quite unorganized and not communicating with each other, but in reality, we just know that the patients themselves are the best source of information about their own symptoms.”

As the physician, San Miguel always reads the notes that come from the initial intake, “but I want to confirm the details directly with you.”

While you will receive some care on the spot, most of your treatment will take place elsewhere, Cassel adds.

“With the exception of putting in stitches to fix a cut, the emergency department is not in and of itself a definitive care spot. Definitive care takes place outside of the ED,” he says.

This means that once the care team determines what’s going on and what care you need, you’ll either be admitted to the hospital for more intensive treatment or sent home with care instructions and a plan for additional follow-up if necessary.

For example, if you are having a heart attack , you’ll be admitted to an inpatient unit in the hospital for more testing and stabilization. If you’ve come in for an earache, you’ll probably be given a prescription and sent home. You'll then use those medications and recover with instructions to follow up with your primary care provider as soon as they can see you.

Lee underscores that “emergency and urgent care is not complete care. It is an acute intervention that addresses specific issues that often require further attention in the ambulatory office setting.”

Lastly, remember that the providers you’re working with are doing their best to look after you in a timely, helpful fashion. The ER staff understand you have been waiting, but they have no control over how many patients show up at once. If a surge of patients show up in an hour, the ER doesn't have the ability to suddenly bring on more staff. This happens more frequently than people realize.

Cassell says that the people who staff the emergency department are there “because we love it. We are task-focused, and we’re often very busy going from place to place, but we really do care.”

Keep in mind that the ER is not generally a calm place and the patient experience will be different from what you might get if you’re admitted in the hospital.

What to Pack in Your Hospital Bag

The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our  editorial guidelines .

Amin is chief medical officer of L.A. Care Health Plan, the largest publicly operated health plan in the U.S.

Cassell is patient care administrator, emergency services, with Orlando Health in Florida.

Lee is medical director of the Emergency Care Center at Providence St. Joseph Hospital in Orange, California.

San Miguel is clinical assistant professor of emergency medicine with the Ohio State University Wexner Medical Center in Columbus.

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Important Information You Should Know About the ER

The emergency room (ER) is the first—and sometimes only—place many Americans go for their healthcare. These days it’s often referred to as the emergency department. The ER has become an entry point for patients of all types, but it may not be the right place for some patients to go.

If you’ve gone to the ER when somewhere else might have been a better choice, you’re not alone. Since the ER might not be exactly what you thought it was.

Here are a few things everybody should know about the ER:

The ER Is for Emergencies

Despite the fact that everyone in the ER waiting room seems to have the sniffles and a cough, the ER is really supposed to be for emergencies, hence the name. The whole system is built around the idea that at any minute a heart attack patient could come through those sliding doors; not to mention a shooting victim, a stroke patient, or a woman having a baby right now .

If a bus full of hemophiliacs careens off the interstate and sends 30 bleeding victims to the ER, the staff would have to push aside those poor coughing souls in the waiting room to make room for honest-to-goodness emergencies. It happens—not the bus full of hemophiliacs, per se, but real emergencies regularly displace all those folks who waited until Friday afternoon or Saturday to try to get medical care for a week-old sore throat.

Not First-Come, First-Served

The ER can be a convenient way to get medical care—or maybe your only way—but that doesn’t mean they’ll see folks in the order they come through the door. It doesn’t really matter if you’re the first person in the waiting room. If everyone coming in after you have more of a need for medical care than you do, you’ll have to wait.

It’s common today for ER staff to see the direst emergencies first as well as quickly taking care of people who are least sick. That means the people with moderate medical needs end up waiting for the longest. Some ER systems are doing more to reduce the wait, including a huge change in the order folks are getting seen.

The Doctor Knows a Little About a Lot

Emergency physicians are the medical equivalent of a Jack-of-all-Trades. As an ER doc, you never know what’s coming through the ambulance bay at any given moment. You have to be equally as competent with massive chest trauma as you are with urinary tract infections. If the injury or illness is life-threatening, you’d better know how to get things stabilized and where to go for help after that.

ER doctors are like any other craftsmen: they get really good at doing what they do most. An emergency physician can run circles around any other type of doctor—including a cardiologist—when treating a cardiac arrest . They can stitch wounds in one room and decompress collapsed lungs in another. ER docs can prescribe antibiotics for the 25 or so most common infections by memory.

What an ER doc is not good for is taking care of—or even recognizing—rare diseases and conditions. You don’t go to an emergency doc hoping she’ll diagnose multiple sclerosis or cancer. It happens sometimes or, more to the point, they sometimes will identify a problem and send you to a specialist.

Most importantly, ER docs do spot-check medicine. They take snapshots of a person’s medical history and make quick decisions about what to do. ER docs aren’t in a good position to notice trends or do long-term medicine. Most of these doctors chose this path specifically because at the end of the day they want to pack up and go home. They’re here to save your life—or treat your cough—and move on to the next patient.

The Waiting Room Is a Hotbed of Germs

In case you didn’t notice, there are some sick folks sitting in there. They cough on each other and sneeze all over the place. It’s not like an obstetrician’s office, where everyone is mostly healthy and just coming in for a monthly check-up.

Not only that, but the cleaning crew doesn’t get much time in the waiting room. Around the country, ER’s are filling up throughout the day leaving little opportunity for the chairs, floors, and walls to get a good scrubbing. If you weren’t sick when you walk into an ER waiting room, you might be before you leave it.

It’s Not Always the Best Option

As you may have noticed, I’m not exactly selling the ER for your garden variety sniffle. The ER is a wonderful innovation and they save thousands of lives every year, but as a starting point for minor illness, the ER leaves a lot to be desired.

If you think you have an emergency , by all means, call an ambulance or get yourself to the emergency room. You never want to go to a doctor’s office for chest pain or sudden weakness on one side. Those are the types of things an emergency doc is well prepared to handle. On the other hand, seeing ten different ER physicians for the same complaint on ten different occasions is not likely to help you diagnose what’s wrong.

Try to save the ER for emergencies, you’ll be healthier in the long run.

By Rod Brouhard, EMT-P Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.

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When to use the emergency room - adult

Whenever an illness or injury occurs, you need to decide how serious it is and how soon to get medical care. This will help you choose whether it is best to:

• Call your health care provider
• Go to an urgent care clinic
• Go to an emergency department right away

It pays to think about the right place to go. Treatment in an emergency department can cost 2 to 3 times more than the same care in your provider's office. In addition, your health insurance may require you to pay a higher copayment for care in an emergency department. Think about this and the other issues listed below when deciding.

Signs of an Emergency

How quickly do you need care? If a person or unborn baby could die or be permanently disabled, it is an emergency.

Call 911 or the local emergency number to have the emergency team come to you right away if you cannot wait, such as for:

• Stopped breathing
• Head injury with passing out, fainting, or confusion
• Injury to neck or spine, particularly if there is loss of feeling or inability to move
• Electric shock or lightning strike
• Severe burn
• Severe chest pain or pressure
• Seizure that lasted more than 1 minute or from which the person does not rapidly awaken

Go to an emergency department or call 911 or the local emergency number for help for problems such as:

• Trouble breathing
• Passing out, fainting
• Pain in the arm or jaw
• Unusual or bad headache, particularly if it started suddenly
• Suddenly not able to speak, see, walk, or move
• Suddenly weak or drooping on one side of the body
• Dizziness or weakness that does not go away
• Inhaled smoke or poisonous fumes
• Sudden confusion
• Heavy bleeding
• Possible broken bone, loss of movement, particularly if the bone is pushing through the skin
• Serious burn
• Coughing or throwing up blood
• Severe pain anywhere on the body
• Severe allergic reaction with trouble breathing, swelling, hives
• High fever with headache and stiff neck
• High fever that does not get better with medicine
• Throwing up or loose stools that does not stop
• Poisoning or overdose of drug or alcohol

If you are thinking about hurting yourself or others, call or text 988 or chat 988lifeline.org . You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

When to go to an Urgent Care Clinic

When you have a problem, do not wait too long to get medical care. If your problem is not life threatening or risking disability, but you are concerned and you cannot see your provider soon enough, go to an urgent care clinic.

The kinds of problems an urgent care clinic can deal with include:

• Common mild illnesses, such as colds, the flu, earaches, sore throats, migraines, low-grade fevers, and limited rashes
• Minor injuries, such as sprains, back pain, minor cuts and burns, minor broken bones, or minor eye injuries

If you are not Sure, Talk to Someone

If you are not sure what to do, and you don't have one of the serious conditions listed above, call your provider. If the office is not open, your phone call may be forwarded to someone. Describe your symptoms to the provider who answers your call, and find out what you should do.

Your provider or health insurance company may also offer a nurse telephone advice hotline. Call this number and tell the nurse your symptoms for advice on what to do.

Prepare now

Before you have a medical problem, learn what your choices are. Check the website of your health insurance company. Put these telephone numbers in the memory of your phone:

• Your provider
• The closest emergency department
• Nurse telephone advice line
• Urgent care clinic
• Walk-in clinic

American Academy of Urgent Care Medicine website. What is urgent care medicine. aaucm.org/what-is-urgent-care-medicine/ . Accessed July 25, 2022.

American College of Emergency Physicians website. Emergency care, urgent care - what's the difference? www.acep.org/globalassets/sites/acep/media/advocacy/value-of-em/urgent-emergent-care.pdf . Updated April 2007. Accessed July 25, 2022.

Findlay S. When you should go to an urgent care or walk-in health clinic: knowing your options in advance can help you get the right care and save money. www.consumerreports.org/health-clinics/urgent-care-or-walk-in-health-clinic . Updated May 4, 2018. Accessed July 25, 2022.

Review Date 7/25/2022

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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6 Tips for Getting the Most Out of Your Emergency Room Visit, From an ER Doctor

By Esther Choo, M.D., M.P.H.

As an emergency medicine physician, being in the emergency room (ER) is my comfort zone. But I’ve also experienced the ER as a worried spouse and mother, so I know it can be a mysterious, frightening, and frustrating place for most people. Because life is so unpredictable, it’s a safe bet that you or a loved one will find yourself in an ER at some point. With that in mind, I’ve assembled a number of tips to maximize the likelihood that your next trip there goes smoothly and that you get the best care possible.

To supplement my own opinions on this topic, I polled an online group I’m part of called EM Docs, which is made up of more than 15,000 emergency physicians from around the country. They’re the doctors I go to when I have a tough case or when I need to brainstorm ways to improve the care we give.

The following six tips are what we came up with, so keep them in mind next time you or a loved one find yourselves in the ER.

Having a full understanding of your medical history helps us doctors provide care that fits your needs. If you have the option, seek emergency treatment at a hospital where you’ve previously received care, since it will already have your records. Even in the age of electronic medical records, hospitals may not have direct access to information about visits that occurred outside their own system. You may have a long-time auto mechanic who knows the quirks of your car. Similarly, if you’ve had an operation or other specialty treatment, your previous doctors who’ve been “under the hood” have a familiarity with your case, and that may be quite important to your care.

Obviously in an emergency, going to your regular hospital isn’t always possible. So, at a minimum, always bring with you a list of your medical issues , medications (including dosages), allergies , and names of the doctors who provide you with routine care. Having this information printed out on a single card that you carry in your wallet will make sure you’re prepared for any unexpected hospital visit.

There’s no way around it: Waiting is part of the emergency care experience. Emergency medicine doctors are the least patient people on the planet ( trust me , we hate waiting even more than you do). Unfortunately, the system is designed to keep each doctor and nurse maximally busy, and too often, the sheer number of patients (and the really dire cases) take a lot of our time and push us beyond comfortable capacity. We’re simply unable to get to everyone quickly. I’m optimistic that advances in hospital flow (like figuring out better predictive models to help us identify surges in patient volume ahead of time and respond to them quickly) will minimize these waits eventually. In the meantime, there are some ways to make good use of your time in the waiting room:

• Notify your primary care physician about your emergency visit, and arrange a follow up appointment for after your ER treatment.
• Think through all of your symptoms, and how you can relay them to the nurses and physicians succinctly and completely.
• If you can’t recall your medications or allergies, it’s a good time to call home or your pharmacy to make sure you have a complete list.
• In some cases, we may ask about your end of life wishes . If you don’t have this paperwork, think about who might have it.
• Make some phone calls to work out logistics ahead of time: Who can give you a ride home if you receive medications that make you too groggy to drive home? Who can feed your cat or pick up your kid in case the visit takes longer than you anticipated or you need to be admitted? Is there someone who can come spend some time in the ER with you to help relay information to the doctors and nurses, and be a second set of ears about test results and the care plan?
• If you’re really upset about the wait and want someone to know about it, write an email to the hospital administration while you’re waiting. That way, you have filed a complaint, and can use your face time with the doctors and nurses focusing on what brought you to the hospital.

We understand you’re feeling awful, and have probably been waiting for too long while feeling that way. If you’re grumpy by the time you see us, we get it. In fact, we’re braced to face much worse—angry, intoxicated, and even violent patients. But the longer the wait, the more likely the doctors and nurses have been running their tails off without a chance to attend to their own basic biologic needs (e.g., eating and peeing). So when we’re met with patience and respect, it is so awesome. It allows the staff to use all their emotional energy focusing on the most pressing problem at hand: your health.

Emergency training gives us a certain approach that’s fairly routine and focused on making sure you, well, don’t die. However, the things that are foremost on our minds may not align with the actual concerns you have. I’ll give you an example: I once cared for a young man with acute, severe knee pain who’d been in the ER for three hours. I evaluated him for a host of things that would require immediate treatment and hospitalization. The workup did not reveal anything concerning and I decided that it was just muscular inflammation from a recent strenuous workout. I gave him instructions for taking care of the injury, said goodbye, and was leaving the room when he said, with a little embarrassment, “So, doctor, just to be sure…it’s not cancer?”

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It turns out the patient had a nephew who died from bone cancer and he’d linked his mysterious knee pain to that diagnosis, which is what brought him to the ER in the middle of the night. He didn’t mention it when he arrived or during my initial evaluation, and it was such an unlikely diagnosis that it didn’t make it onto my list of suspects. Once he mentioned it, I was able to sit down with him and go over all the reasons I did not think that it was cancer , to his great relief.

So don’t be embarrassed to express your fears up front, even if you think they sound crazy or weird. Trust me, we’ve heard stranger things, and it helps us to know what’s motivating your visit to us. That way we can address your biggest concerns up front.

ER doctors are very good at certain things, like recognizing when people are vitally sick with life- or limb-threatening conditions, staying cool when people are in the process of dying, and stabilizing severely injured patients. We are, admittedly, not so good at other things. We may not hand you a tidy diagnosis. At the end of your visit, we may tell you a list of things we are pretty sure you don’t have, rather than telling you what you do have. The longer your symptoms have been going on, the more likely it is that it is not something common or straightforward, so the less likely it is that we will be able to crack the puzzle during your ER visit.

Also, we can’t just run any test at any time. I wish we could! We’re always on the lookout for when we need to get special tests, like MRIs , but we generally can only get them in a handful of truly dire situations. The everyday tools of the emergency physician are the simple stuff: listening to your symptoms, reviewing your vital signs, and doing a physical examination. After that, we may advise that you receive some immediate testing.

But as often as not, we may feel that you need no further testing at all, at least not during your ER visit. While we do admit some patients who are too sick to manage at home, or who need an immediate therapy or a procedure that can only happen in the hospital, the majority of patients get discharged home with an initial course of treatment (e.g., pain medications or antibiotics) and are advised to follow up with a primary care physician. For those without primary care, we’ll provide a list of local clinics and physicians so they can establish care.

Similarly, we don’t always have specialists on call who can come in at any time. Someone out there—someone who obviously doesn’t work in an ER—created the myth that you can walk into any emergency department and get a plastic surgeon to sew up a simple facial laceration. That’s not how it works. Part of our job is to determine which conditions require a specialist, and which we can manage by ourselves. Often, the answer is that the emergency doc can handle it—and if we can’t, we’ll give you the next steps to get the care you need.

Oh, and we don’t pull teeth.

In almost any ER, we'll ask patients to rate their pain on a scale of 1 to 10. There’s a common misperception about the pain scale; namely, that you need to use the very top of the scale in order to be taken seriously. Almost every shift, someone tells me their pain is “a 12” on a scale of 1 to 10. Ten, to be clear, represents the worst pain possible in human experience; a 10 means a baby is exiting your uterus or a knife has been lodged in your back. Please don’t give us a 10 unless one of these conditions is present.

The pain scale is something we use in conjunction with your physical exam, vital signs, and other clinical data, to characterize your pain, guide your workup, and track the trajectory of your pain and your response to treatment. It's not used as a device to blow you off or to be stingy treating your pain. We never say, “Oh, just a 8? It must be nothing.” Eight is very bad. So is six and in fact, so is four—this is a pain scale, after all, not a fun scale. Picking the right number helps us get an accurate sense of what you are experiencing.

Many people do not have a good understanding of the instructions they are given when they are discharged from the ER. You may be very eager to get home after a long stretch there, and you may feel tired, groggy, and not fully recovered from whatever landed you in the ER in the first place. However, make sure you receive the printed-out discharge instructions, that someone (a nurse or doctor) goes over them with you carefully, and that it all makes sense to you. If you have a friend or family member with you, they should also listen in, as they may be able to help you remember some of the details of your care plan later.

The instructions should include, in general: the doctor’s impression about what may have caused your symptoms; suggested treatments for your symptoms; who to follow up with and when; and what kinds of symptoms should bring you back to the ER, rather than waiting for outpatient follow-up. If you're prescribed medications, make sure you understand what each one is for, how long you should take them, if they are to be taken on a set schedule, or if you only take them as needed. Ensure you receive the physical prescription or that it's faxed to your pharmacy. If you're told to follow up with a specialist, ask if you need to call for the appointment or if that clinic will be calling you. A few extra minutes making sure you understand the plan before you leave the hospital may give you peace of mind later.

We work in a system with some inherent limitations that doesn’t always conform to people’s hopes and expectations, and I can’t promise it’ll be as smooth or as quick as you would like. But I promise we’ll do our best to work with you and make sure you get the care you need, especially if you follow these guidelines straight from emergency doctors.

Esther Choo, M.D., M.P.H, is currently an associate professor in the Department of Emergency Medicine at Oregon Health and Science University.

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Emergency Room Visit: When to Go, What to Expect, Wait Times, and Cost

Knowing when and why to go for an emergency room visit can help you plan for care in the event of a medical emergency.

How much does it cost to go to an emergency room?

Emergency Room (ER) costs can vary greatly depending on what type of medical care you need. How much you pay for the visit depends on your health insurance plan. Most health plans may require you to pay something out-of-pocket for an emergency room visit. A visit to the ER may cost more if you have a High-Deductible Health Plan (HDHP) and you have not met your plan’s annual deductible. HDHP's typically offer lower monthly premiums and higher deductibles than traditional health plans. Your plan will start paying for eligible medical expenses once you’ve met the plan’s annual deductible. Here are some tips to pay less out of pocket .

When should I go to an emergency room?

Emergency rooms are often very busy because many people don’t know what type of care they need, so they immediately go to the ER when they are sick or hurt. You should make an emergency room visit for any condition that’s considered life-threatening.

Life-threatening conditions include, but are not limited to, things like a serious allergic reaction, trouble breathing or speaking, disorientation, a loss of consciousness, or any physical trauma.

If you need to be treated for problems that are considered non-life threatening, such as an earache, fever and flu symptoms, minor animal bites, mild asthma, or a mild urinary tract infection, consider seeing your doctor or visiting an urgent care center or convenience care clinic.

What is the cost of an emergency room visit without insurance?

Emergency room costs with or without health insurance can be very high. If you have health insurance, review your plan documents for details on the costs associated with your plan, including your plan deductible, coinsurance, and copay requirements.

If you don’t have insurance, you may be required to pay the full cost of your treatment, which can vary by facility and the type of treatment required. Always plan ahead for sudden sickness, injury, or other medical needs, so you know where to go and how much it could cost. If you need medical care, but it’s not life-threatening you may not have to go to the ER—there are other more affordable options:

• Urgent care center: Staffed by doctors, nurses, and other medical staff who can treat things like earaches, urinary tract infections, minor cuts, nausea, vomiting, etc. Wait times may be shorter and using an urgent care center could save you hundreds of dollars when compared to an ER.
• Convenience care clinic: Walk-in clinics are typically located in a pharmacy (CVS, Walgreens, etc.) or supermarket/retail store (Target, Walmart, etc.). These clinics are staffed with physician assistants and nurse practitioners who can provide care for minor cold, fever, flu, rashes and bruises, head lice, allergies, sinus/ear infections, urinary tract infections, even flu and shingles shots. No appointments are needed, wait times are usually minimal, and a convenience care clinic costs much less than an ER.

Plan ahead for when you need medical care. You may not need an emergency room visit and the bill that could come with it.

What are common emergency room wait times?

Emergency room wait times vary according to hospital and location. Patients in the ER are seen based on how serious their condition is. This means that the patients with life-threatening conditions are treated first, and those with non-life threatening conditions have to wait.

To help reduce ER wait times, health care facilities encourage you to plan ahead for care, so when you’re sick or hurt, you know if the ER is right for your medical condition.

An emergency room visit can take up time and money if your problem is not life-threatening. Consider other care options, such as an urgent care center, convenience care clinic, your doctor, or a virtual doctor visit (video chat/telehealth)—all of which could be faster and save you money out of your own pocket if the medical problem is non-life threatening.

If you have health insurance, be sure to check your plan documents to see what types of care options are eligible for coverage under your plan, including whether or not you need to stay in your plan’s network.

Is taking an ambulance to the emergency room free?

An ambulance ride is not free, but your insurance may cover some of the costs for the ride, as well as the emergency room visit. Check your plan benefits to see what out-of-pocket expenses you are responsible for when it comes to an ambulance ride and a visit to the ER.

Plan ahead for times you may need immediate medical care. Review the details of your health plan so you know the costs for an ER visit should you ever need it. Know when it’s best to go to the emergency room and when going somewhere else, like an urgent care center, convenience care clinic, your doctor, or even a virtual doctor visit (video chat/telehealth), is the right option that may save you time and money.

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How Much Does an ER Visit Cost? Free Local Cost Calculator 

It’s true that you can’t plan for a medical emergency, but that doesn’t mean you have to be surprised when it’s time to pay your hospital bill. In 2021, the U.S. government enacted price transparency rules for hospitals in order to demystify health care costs. That means it should be easier to get answers to questions like how much an ER visit costs.

While the question seems pretty straightforward, the answer is more complicated. Your cost will vary based on factors such as if you’re insured, whether you’ve met your deductible, the type of plan you have, and what your plan covers. 

There is a lot to consider. This guide will take you through specific scenarios and answer questions about insurance plans, deductibles, co-payments, and discuss scenarios such as how much it costs if you go to the ER when it isn’t an emergency. 

You’ll learn a few industry secrets too. Did you know that if you don’t have insurance you might see a higher bill? According to the Wall Street Journal , it’s common for hospitals to charge uninsured and self-pay patients higher rates than insured patients for the same services. So, where can you go if you can’t afford to go to the ER?

Keep reading for all this plus real-life examples and cost-saving tips.

How Much Does an ER Visit Cost Without Insurance?

Everything is more expensive in the ER. According to UnitedHealth, a trip to the emergency department can cost 12 times more than a typical doctor’s office visit. The average ER visit is $2,200, and doesn’t include procedures or medications. 

If you want to get a better idea of what an ER visit will cost in your area, check out our medical price comparison tool that analyzes data from thousands of hospitals.

Compare Procedure Costs Near You

Other out-of-pocket expenses you may incur include bills from third parties. A growing number of emergency departments in the United States have become business entities separate from the hospital. So, third-party providers may bill you too, like:

• EMS services, like an ambulance or helicopter 
• ER physicians
• Attending physician
• Consulting physicians
• Advanced practice nurses (CRNA, NP)
• Physician assistants (PA)
• Physical therapists (PT)

And if your insurance company fails to pay, you may have to pay these expenses out-of-pocket.

How Much Does an ER Visit Cost With Insurance? 

The easiest way to estimate out-of-pocket expenses for an ER visit (or any other health care service) is to read your insurance policy. You’ll want to look for information around these terms:

• Deductible: The amount you have to pay out-of-pocket before your insurance kicks in . 
• Copay: A set fee you pay upfront before a covered medical service or procedure. 
• Coinsurance: The percentage you pay for a service or a procedure once you’ve met the deductible.
• Out-of-pocket maximum: The most you will pay for covered services in a rolling year. Once met, your insurance company will pay 100% of covered expenses for the rest of the year. 

Closely related to out-of-pocket expenses like deductibles and co-insurance are premiums. A premium is the monthly fee you (or your sponsor) pay to the insurance company for coverage. If you pay a higher premium, you’ll have a lower deductible and fewer out-of-pocket costs whenever you use your insurance to pay for services such as a visit to the ER. The opposite is also true — high deductible health plans (HDHP) offer lower monthly payments but much higher deductibles. 

Sample ER Visit Cost

Using a few examples from plans available on the Marketplace on Healthcare.gov (current as of November 2021), here’s how this might play out in real life:

Rob is a young, healthy, single guy. He knows he needs health insurance but he feels reasonably sure that the only time he’d ever use it is in case of an emergency. Here’s the plan he chooses:

Plan: Blue Cross/Blue Shield Bronze Monthly premium: $394 Deductible: $7,000 Out-of-pocket maximum: $7,000 ER coverage: 100% after meeting the deductible

Rob does the math and considers the worst case scenario. If he does go to the ER, he’ll pay full price if he hasn’t yet met his deductible. But since both his deductible and his maximum out-of-pocket are the same, $7,000 is the most he’ll have to pay before his insurance kicks in at 100%.

Now imagine that Rob gets married and is about to start a family. He might need a different insurance plan to account for more hospital bills, doctors appointments, and inevitable emergency room visits.

Since Rob knows he’ll be using his insurance more often, he picks a plan with a lower deductible that covers more things. 

Plan: Bright HealthCare Gold Monthly premium: $643 Deductible: $0 Out-of-pocket maximum: $6,500 ER coverage: $500 Vision: $0 Generic prescription: $0 Primary care: $0 Specialist: $40

This time Rob goes with a zero deductible plan with a higher monthly premium. It’s more out-of-pocket each month, but since his plan covers doctor’s visits, prescription drugs, and vision, he feels more prepared as his lifestyle shifts into family mode. 

If he has to go to the ER for any reason, all he’ll pay is $500 and his insurance pays the rest. And worse case scenario, the most he’ll pay out-of-pocket in a year is $6,500. 

How Much Does an ER Visit Cost if You Have Medicare?

Medicare Part A only covers an emergency room visit if you’re admitted to the hospital. Medicare Part B covers 100% of most ER costs for most injuries, or if you become suddenly ill. Unlike private insurance and insurance purchased on the Affordable Care Act (ACA) Marketplace, Medicare rarely covers ER visits that happen while you’re outside of the United States.

To learn more, read: How to Use the Healthcare Marketplace to Buy Insurance

How Much Does an ER Visit Cost for Non-Emergencies?

When you have a sick child but lack insurance, haven’t met your deductible, or if you’re between paychecks, just knowing you can go to the ER without being hassled for money feels like such a relief. ER staff won’t demand payment upfront, and they usually don’t ask about insurance or assess your ability to pay until after discharge.

There are other reasons, too. You might be tempted to go to the ER for situations that are less than emergent because emergency departments provide easy access to health services 24/7, including holidays and the odd hours when your primary care physician isn’t available. If you’re one of the 61 million Americans who are uninsured or underinsured , you might go to the ER because you don’t know where else to go.

What you may not understand is the cost of an ER visit without insurance can total thousands of dollars. Consumers with ER bills that get sent to collections face some of the most aggressive debt collection practices of any industry. Collection accounts and charge-offs could affect your credit score for the better part of a decade.

Did you know that charges begin racking up as soon as you give the clerk your name and Social Security number? There are tons of horror stories out there about people receiving medical bills after waiting, some for many hours, and leaving without treatment. 

4 ER Alternatives Ranked by Level of Care

First and foremost, if you’re experiencing a medical emergency, call 911 or go to the closest emergency room. Do not rely on this or any other website for advice or communication. 

If you’re not sure whether your condition warrants immediate, high-level emergency care, you can always call your local ER and ask to speak to their triage nurse. They can quickly assess how urgent the situation is. 

If you are looking for a lower-cost alternative to the ER, this list provides a few options. Each option is ranked by their ability to provide you with a certain level of care from emergent care to the lowest level, which is similar to the routine care you would receive at a doctor’s office. 

1. Charitable Hospitals  

There are around 1,400 charity hospitals , clinics, and pharmacies dedicated to serving low-income families, including the uninsured. Most charitable, not-for-profit medical centers provide emergency room services, making it a good option if you’re uninsured and worried about accruing substantial medical debt. 

ERs at charitable hospitals provide the same type of medical care for conditions like trauma, broken bones, and life-threatening issues like chest pain and difficulty breathing. The major difference is the price tag. Emergency room fees at a charity hospital are usually flexible and almost always based on your income. 

2. Urgent Care Centers

Urgent care centers are free-standing facilities designed to treat patients with serious but not life-threatening conditions. Also called “doc in a box,” these ambulatory care centers are a good choice for treating stable but chronic health issues, fever, urinary tract infections, back pain, abdominal pain, and moderately high blood pressure, to name a few. 

Urgent care clinics usually have a medical doctor on-site. Some clinics offer point-of-care diagnostic tests like ultrasound and X-rays, as well as basic lab work. The average cost for an urgent care visit is around $180, according to UnitedHealth.

3. Retail Health Clinics

You may have noticed small retail health clinics (RHC) popping up in national drugstore chains like CVS, Walgreens, and in big-box stores like Target and Walmart. The Little Clinic is an example of an RHC that offers walk-in health care services at 190 supermarkets across the United States. 

RHCs help low-acuity patients with minor medical problems like sore throat, cough, flu-like symptoms, and other conditions normally treated in a doctor’s office. If you think you’ll need lab tests or other procedures, an RHC may not be the best choice. Data from UnitedHealth puts the average cost for an RHC visit at $100.

4. Telehealth Visits

Telehealth, in some form, has been around for decades. Until recently, it was mostly used to provide access to care for patients living in the most remote or rural areas. Since 2020, telehealth visits over the phone, via chat, or through videoconferencing have become a legitimate and extremely cost-effective alternative to in-person office visits. 

Telehealth is perfect for some types of mental health therapies, follow-up appointments, and triage. For self-pay, a telehealth visit only costs around $50, according to UnitedHealth.

Tips for Taking Control of Your Health Care

• Don’t procrastinate. Delaying the care you need for too long will end up costing you more in the end. 
• Switch your focus from reactive care to proactive care. Figuring out how to pay for an ER visit is a lot harder (and costlier) than preventing an ER visit in the first place. Data show that preventive health care measures lead to fewer illnesses and better outcomes.
• Plan for the unknown. It’s inevitable that at some point in your life you’ll need health care. Start a savings account fund or better yet, enroll in a health savings account (HSA). If you’re employed (even part-time) you already qualify for an HSA. A contribution of just $9 a paycheck could add up to $468 tax-free dollars for you to spend on health care every year. Unlike the use-it-or-lose-it savings plans of the past, modern plans don’t expire. You can use HSA dollars to pay for out-of-pocket costs like copayments, deductibles, and for services that your health insurance may not cover, like dental and vision services. 
• Advocate for yourself. There is nothing more empowering than taking charge of your health. Shop around for services and compare prices on procedures to make sure you’re getting the best prices possible.
• If you are uninsured or doing self-pay, negotiate your bill and ask for a cash discount. 

Estimate the Cost of the ER Before You Need It

It’s stressful to think about money when you’re facing an emergency. Research the costs of your nearest ER before you actually need to go with Compare.com’s procedure cost comparison tool . 

All you have to do is enter your ZIP code and you’ll immediately see out-of-pocket costs for ER visits at your local emergency rooms. It works for other medical services too, like MRIs, routine screenings, outpatient procedures, and more. Find the treatment you need at a price you can afford.

Disclaimer: Compare.com does not offer medical advice and is in no way a substitute for any medical advice received from health professionals. Compare.com is unable to offer any advice on any medical procedure you may need.

Nick Versaw leads Compare.com's editorial department, where he and his team specialize in crafting helpful, easy-to-understand content about car insurance and other related topics. With nearly a decade of experience writing and editing insurance and personal finance articles, his work has helped readers discover substantial savings on necessary expenses, including insurance, transportation, health care, and more.

As an award-winning writer, Nick has seen his work published in countless renowned publications, such as the Washington Post, Los Angeles Times, and U.S. News & World Report. He graduated with Latin honors from Virginia Commonwealth University, where he earned his Bachelor's Degree in Digital Journalism.

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Top 20 most common emergency department diagnoses

Apr 21st, 2023

Hospital emergency departments are on the front lines of healthcare, equipped with the specialists and resources necessary to provide critical care to patients facing sudden illness or severe injury.

As well-equipped as these facilities are, however, most patients seeking care in emergency departments do so for non-emergency medical events.

Every medical encounter in an emergency department/emergency room (ER) produces data that can help hospital leaders and providers understand the needs of their patients. We’ve analyzed these data to examine how patients use hospital emergency departments.

Check out the list below to see the most common diagnoses and ICD-10 codes from ER visits in the U.S.

Most common ER diagnoses

Fig. 1 HospitalView Data from the Definitive Healthcare Atlas All-Payor Claims product for calendar year 2022. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Accessed May 2023.

What causes the most emergency room visits?

Essential (primary) hypertension was the most common reason for ER visits in 2022, with 3.0% of total diagnoses. Hypertension is a common disease that increases the risk of heart attack, stroke, renal failure, and even death.

Chronic conditions like hypertension that have traditionally been managed in primary care settings are increasingly being evaluated and treated in the ER. The rise in ER visits related to hypertension may be due to a growing shortage of primary care providers , limited access to healthcare services, or a rising prevalence of chronic conditions.

Exposure to COVID-19 was the second-most common reason for ER visits. Coronavirus exposure prompted 2.1% of total trips to the emergency department in 2022.

Other long-term (current) drug therapy took the number three spot on our list, with 1.4% of total diagnoses. Other long-term drug therapy is a catch-all code when a patient is taking or has taken a medication on a long-term basis. It captures the use of injectable diabetic drugs, immunosuppressants, steroids, and other drugs.

How ERs serve rural patients

Patients living in rural areas of the U.S. often use care facilities and ERs differently than urban patients. There are likely to be fewer urgent care facilities in regions with a low population density, leaving patients to rely on hospital emergency departments for unexpected care.

Unfortunately, this often includes chronic care management . If patients do not have regular access to specialists, they are more likely to bring themselves and their family members to the nearest hospital emergency department for rapid treatment of their symptoms.

Rural patients are also more likely to be uninsured , further restricting the care they can access. However, even those with insurance may have difficulty finding covered providers within a reasonable distance of their homes, preventing them from seeking care outside their local ER.

According to a 2019 study from the University of New Mexico, rural emergency department visits rose from 16.7 million to 28.4 million between 2005 and 2016—a difference of more than 70%. In the same period, urban hospital visits grew by just under 19%.

Even in urban areas, emergency departments are often overcrowded, with some patients waiting upwards of two hours. In many cases, these extended wait times are due to patients seeking treatment for non-life-threatening issues (as seen in the table above) such as chronic pain, sprains, fractures, and other ailments better suited to urgent care centers.

Addressing long ER wait times

Avoidable emergency room visits can lead to the delay of medication administration and other treatments for patients in imminent danger from more serious injuries. Often, patients simply aren’t sure what constitutes an emergency department visit rather than a trip to urgent care —some patients may not even be aware there is a difference between the two care centers.

To reduce wait times and improve care outcomes, some hospital ERs are employing telehealth software. Patients are assessed by an NP or PA upon arrival for stability, and lower-risk patients are eligible to consult with an in-network physician at another location.

New York Presbyterian Weill Cornell Medical Center (NYPWC) launched a telehealth service in July 2016. Within one year, emergency department wait times plummeted from an average of 150 minutes to 18 minutes , according to Definitive Healthcare data. This program was considered such a success that NYPWC expanded it by launching the Hauser Institute for Health Innovation in 2019.

Get the data behind the trends

Looking to sell to providers in an outpatient setting? You’ll need data, analytics, and expertise to identify the best opportunities in this rapidly shifting market.

With healthcare commercial intelligence from the Definitive Healthcare platform, you’ll get access to the information and insights necessary to find the providers who can benefit from your business and tailor your messaging to their unique needs. Start a free trial today and get the latest data on hospitals, physicians, and other healthcare providers.

About the Author

Definitive healthcare.

This blog was written by a former contributor at Definitive Healthcare. At Definitive Healthcare, our passion is to transform data, analytics and expertise into healthcare…

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Bill Of The Month

It’s called an urgent care emergency center — but which is it.

Renuka Rayasam

Emily Siner

In severe pain and uncertain of its cause, Tieqiao Zhang of Dallas says he didn’t want to wait for an appointment with his regular doctor, but he also wasn’t sure if he needed emergency care. He visited a clinic on the campus of Dallas’ largest public hospital — and was charged 10 times what he expected. Laura Buckman/KFF Health News hide caption

One evening last December, Tieqiao Zhang felt severe stomach pain.

After it subsided later that night, he thought it might be food poisoning. When the pain returned the next morning, Zhang realized the source of his pain might not be as “simple as bad food.”

He didn’t want to wait for an appointment with his regular doctor, but he also wasn’t sure if the pain warranted emergency care, he said.

Zhang, 50, opted to visit Parkland Health’s Urgent Care Emergency Center, a clinic near his home in Dallas where he’d been treated in the past. It’s on the campus of Parkland, the city’s largest public hospital, which has a separate emergency room.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it !

He believed the clinic was an urgent care center, he said.

A CAT scan revealed that Zhang had a kidney stone. A physician told him it would pass naturally within a few days, and Zhang was sent home with a prescription for painkillers, he said.

Five days later, Zhang’s stomach pain worsened. Worried and unable to get an immediate appointment with a urologist, Zhang once again visited the Urgent Care Emergency Center and again was advised to wait and see, he said.

Two weeks later, Zhang passed the kidney stone.

Then the bills came.

The patient: Tieqiao Zhang, 50, who is insured by BlueCross and BlueShield of Texas through his employer.

Medical services: Two diagnostic visits, including lab tests and CAT scans.

Service provider: Parkland Health & Hospital System. The hospital is part of the Dallas County Hospital District.

Total bills: The in-network hospital charged $19,543 for the two visits. BlueCross and BlueShield of Texas paid $13,070.96. Zhang owed $1,000 to Parkland — a $500 emergency room copay for each of his two visits.

What gives: Parkland’s Urgent Care Emergency Center is what’s called a freestanding emergency department .

The number of freestanding emergency rooms in the United States grew tenfold from 2001 to 2016 , drawing attention for sending patients eye-popping bills. Most states allow them to operate, either by regulation or lack thereof . Some states, including Texas, have taken steps to regulate the centers, such as requiring posted notices identifying the facility as a freestanding emergency department.

Urgent care centers are a more familiar option for many patients. Research shows that, on average, urgent care visits can be about 10 times cheaper than a low-acuity — or less severe — visit to an ER.

But the difference between an urgent care clinic and a freestanding emergency room can be tough to discern.

Generally, to bill as an emergency department, facilities must meet specific requirements, such as maintaining certain staff, not refusing patients and remaining open around the clock.

The freestanding emergency department at Parkland is 40 yards away from its main emergency room and operates under the same license, according to Michael Malaise, the spokesperson for Parkland Health. It is closed nights and Sundays.

(Parkland’s president and chief executive officer, Frederick Cerise, is a member of KFF’s board of trustees. KFF Health News is an editorially independent program of KFF.)

The hospital is “very transparent” about the center’s status as an emergency room, Malaise told KFF Health News in a statement.

Malaise provided photographs of posted notices stating, “This facility is a freestanding emergency medical care facility,” and warning that patients would be charged emergency room fees and could also be charged a facility fee. He said the notices were posted in the exam rooms, lobby and halls at the time of Zhang’s visits.

Zhang’s health plan required a $500 emergency room copay for each of the two visits for his kidney stone.

When Zhang visited the center in 2021 for a different health issue, he was charged only $30, his plan’s copay for urgent care, he said. (A review of his insurance documents showed Parkland also used emergency department billing codes then. BCBS of Texas did not respond to questions about that visit.)

One reason, “I went to the urgent care instead of emergency room, although they are just next door, is the copayment,” he said.

The list of services that Parkland’s freestanding emergency room offers resembles that of urgent care centers — including, for some centers, diagnosing a kidney stone, said Ateev Mehrotra, a health care policy professor at Harvard Medical School.

Having choices leaves patients on their own to decipher not only the severity of their ailment, but also what type of facility they are visiting all while dealing with a health concern. Self-triage is “a very difficult thing,” Mehrotra said.

Zhang said he did not recall seeing posted notices identifying the center as a freestanding emergency department during his visits, nor did the front desk staff mention a $500 copay. Plus, he knew Parkland also had an emergency room, and that was not the building he visited, he said.

The name is “misleading,” Zhang said. “It’s like being tricked.”

Parkland opened the center in 2015 to reduce the number of patients in its main emergency room, which is the busiest in the country , Malaise said. He added that the Urgent Care Emergency Center, which is staffed with emergency room providers, is “an extension of our main emergency room and is clearly marked in multiple places as such.”

Malaise first told KFF Health News that the facility isn’t a freestanding ER, noting that it is located in a hospital building on the campus. Days later, he said the center is “held out to the public as a freestanding emergency medical care facility within the definition provided by Texas law.”

The Urgent Care Emergency Center name is intended to prevent first responders and others facing life-threatening emergencies from visiting the center rather than the main emergency room, Malaise said.

“If you have ideas for a better name, certainly you can send that along for us to consider,” he said.

Putting the term “urgent” in the clinic’s name while charging emergency room prices is “disingenuous,” said Benjamin Ukert, an assistant professor of health economics and policy at Texas A&M University.

When Ukert reviewed Zhang’s bills at the request of KFF Health News, he said his first reaction was, “Wow, I am glad that he only got charged $500; it could have been way worse” — for instance, if the facility had been out-of-network.

The resolution: Zhang said he paid $400 of the $1,000 he owes in total to avoid collections while he continues to dispute the amount.

Zhang said he first reached out to his insurer, thinking his bills were wrong, before he reached out to Parkland several times by phone and email. He said customer service representatives told him that, for billing purposes, Parkland doesn’t differentiate its Urgent Care Emergency Clinic from its emergency department.

BlueCross and BlueShield of Texas did not respond to KFF Health News when asked for comment.

Zhang said he also reached out to a county commissioner’s office in Dallas, which never responded, and to the Texas Department of Health, which said it doesn’t have jurisdiction over billing matters. He said staff for his state representative, Morgan Meyer, contacted the hospital on his behalf, but later told him the hospital would not change his bill.

As of mid-May, his balance stood at $600, or $300 for each visit.

The takeaway: Lawmakers in Texas and around the country have tried to increase price transparency at freestanding emergency rooms, including by requiring them to hand out disclosures about billing practices.

But experts said the burden still falls disproportionately on patients to navigate the growing menu of options for care.

It’s up to the patient to walk into the right building, said Mehrotra, the Harvard professor. It doesn’t help that most providers are opaque about their billing practices, he said.

Mehrotra said that some freestanding emergency departments in Texas use confusing names like “complete care,” which mask the facilities’ capabilities and billing structure.

Ukert said states could do more to untangle the confusion patients face at such centers, like banning the use of the term “urgent care” to describe facilities that bill like emergency departments.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.  

Emmarie Huetteman of KFF Health News edited the digital story, and Taunya English of KFF Health News edited the audio story. NPR's Will Stone edited the audio and digital story.

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• medical bill

June 21, 2024

Emergency Room Visits Surge as Record-Breaking Heat Scorches Northeast

With a heat dome baking the eastern U.S., emergency departments in New England and the Midwest have seen a spike in heat-related cases

By Chelsea Harvey , Ariel Wittenberg & E&E News

People try to stay cool in Newark, New Jersey as residents of New Jersey and much of the Northeast experience the seasons first heat wave.

Spencer Platt/Getty Images

CLIMATEWIRE | The Northeast U.S. is sweltering under its first major heat wave of 2024. Temperature records are toppling, emergency room visits are rising and experts say climate change likely bears some responsibility for the searing weather.

The town of Caribou, Maine, on the Canadian border tied its all-time record high of 96 degrees Fahrenheit on Wednesday. It also tied its all time maximum evening temperature with a low of 71 degrees. Across Maine, daily record highs were tied or broken in Houlton, Millinocket and Bangor.

Mount Washington in New Hampshire set a new daily heat record on Wednesday at 70 degrees. And Burlington, Vermont, saw its hottest low temperature on record for the month of June when the heat on Wednesday failed to drop below 80 degrees.

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Temperatures were higher overall in some parts of the Northeast than in South Florida with highs in the upper 90s. Some areas in the Northeast this week have seen the heat index, a metric combining both heat and humidity, climb into the 100s.

And it’s not over yet — the heat wave is expected to drag on into the weekend, likely overturning more records in the coming days.

It’s yet another reminder of the accelerating impacts of climate change, which is worsening extreme weather events and threatening human health around the world. Heat waves are happening more frequently, growing more intense and lasting longer as global temperatures rise. With it, the number of heat-related illnesses and deaths is climbing too.

The current event is the result of a phenomenon known as a heat dome, a persistent high-pressure system in the atmosphere that traps hot air beneath it like the lid on a pot. The ongoing heat wave is remarkable not only for its scorching temperatures — it’s also an unusually early and long-lasting event. The hottest temperatures across most of the country typically occur in July.

These conditions have clear links to global warming, according to the climate research and communication nonprofit Climate Central. Global warming has made the temperatures across parts of the Northeast and Midwest this week several times more likely to occur compared with a world in which human-caused climate change didn’t exist.

That’s according to the organization’s Climate Shift Index , a scientific tool that evaluates the influence of global warming on temperatures around the world. According to the index, temperatures on Thursday across much of the Northeast and Midwest were made at least twice as likely by climate change, while large swaths of West Virginia, Ohio and Indiana saw temperatures that were made three or four times more likely.

Meanwhile, parts of eastern Canada, including Nova Scotia, saw temperatures at least five times more likely to occur because of climate change.

Cooling centers have opened across the Northeast to provide respite from the blistering heat. Even so, emergency room visits for heat-related illnesses have surged this week across New England and the Midwest, according to data from the Centers for Disease Control and Prevention.

On Monday, just 57 out of every 100,000 emergency department visits in New England were due to heat-related illnesses. By Tuesday, that number had jumped to 469 of every 100,000.

Similarly, the proportion of heat-related emergency department visits nearly doubled in the Midwest between Sunday and Tuesday, when 545 per 100,000 visits were for heat illnesses. Numbers were so high in the Midwest and New England regions that the CDC’s Heat Health Tracker website included a special icon in the regions to designate “that extremely high rates of heat-related illness were detected.”

As of Thursday, CDC and the National Weather Service advised that vast swaths of Ohio, Illinois, New York and New England were seeing “major” or “extreme” health risks from the heat wave, meaning that everyone in the area could be vulnerable to high temperatures. The agencies told people that “staying cool on these days likely requires staying inside with air conditioning if possible.”

“We are seeing people who are impacted acutely by heat, and dealing with people who have been exposed to heat for a few days, and the stress of heat on their body is leading to dehydration, heat exhaustion and other things that can make their underlying conditions worse,” said Caleb Dresser, an emergency physician at Beth Israel Hospital in Boston.

Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2024. E&E News provides essential news for energy and environment professionals.

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New York heat wave causes surge in heat-related ER visits, health department says

As a severe heat wave grips New York state this week, hospitals are reporting a significant increase in heat-related illnesses and emergency room visits spiking to alarming levels.

What You Need To Know

New york hospitals report a 500 to 600% increase in heat-related emergency room visits this week, depending on the day the very young, elderly and those with pre-existing conditions are most susceptible  certain medications, including antihistamines and blood pressure drugs, can increase vulnerability to heat  stay in air-conditioned spaces, drink plenty of water and avoid strenuous outdoor activities during peak heat hours authorites urge residents to check on elderly neighbors and those with chronic health conditions during the heat wave.

Dr. Matthew Stupple, an emergency medicine physician, noted the correlation between rising temperatures and patient influx.

"As the temperature and humidity rise, we certainly see an increased number of patients with heat-related illnesses," Stupple said. "It affects a spectrum of people, with the very young, the elderly and those with pre-existing medical conditions being particularly susceptible."

According to the Centers for Disease Control and Prevention's Heat and Health Tracker, New York is currently at high risk for heat-related illnesses. The state's Department of Health reports that heat-related emergency room visits this week, depending on the day, were 500 to 600% higher than the average June day.

There were 95 heat-related illness visits to state emergency departments outside New York City on Tuesday, 134 on Wednesday and 105 on Thursday, according to state health department.

While severe cases like heat stroke are rare, the extreme temperatures can exacerbate existing health conditions. Stupple warned that certain medications can increase vulnerability to heat-related illnesses.

"Antihistamines, some anti-psychotic medications and common blood pressure medicines can impair the body's ability to regulate temperature," he explained.

Health officials are urging residents to stay in air-conditioned spaces, drink plenty of water and avoid strenuous outdoor activities during peak heat hours. They also recommend wearing light, loose-fitting clothing and taking frequent breaks if outdoor activities are unavoidable.

Stupple emphasized the importance of avoiding alcohol, which he says plays a significant role in heat-related illnesses seen in the emergency department.

As the heat wave continues, authorities stress the importance of checking on elderly neighbors and those with chronic health conditions, who are at higher risk during extreme weather events.

Heat Wave Much of U.S. Bakes as Some Cities Break Temperature Records

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For much of the nation, no relief from the heat is expected this weekend.

On the first weekend of summer, a brutal heat wave took hold for a sixth consecutive day, continuing to scorch large swaths of the United States.

Several temperature records were broken on Saturday. In the Baltimore area, temperatures went up to 101 degrees, breaking the previous daily record of 100 in 1988. Nearby Dulles, Va., saw temperatures of 100 degrees, which broke the daily record of 99, also in 1988. Temperatures across portions of the Midwest and Ohio Valley climbed as well, while heat continued to build in the Southern Plains and the West.

In states like Ohio, Pennsylvania and Maryland, the humidity is making it feel hotter. By early Saturday afternoon, heat index values — a measure of how conditions feel with humidity taken into account — reached over 100 in places like Philadelphia and Tampa, Fla.

In New York City, officials and utility providers are bracing the city for the lingering heat, which is expected to reach a heat index of 103 degrees between Saturday and Sunday. Already, the city has recorded temperatures it hasn’t seen in almost two years, with Central Park hitting 94 degrees on Friday.

Elevated temperatures raise the risk of heat-related power outages, but power grids in New York and across the country so far have largely held up.

Still, hazardous conditions remain. In Manhattan and cities including Indianapolis and Cincinnati, residents faced the highest level of health risk from the heat, according to a gauge by the National Weather Service and the Centers for Disease Control and Prevention. Their measurement, called HeatRisk , rates the danger in an area on a scale from zero to 4 based on factors that include the duration of the heat and how unusual it is for this time of year.

C.D.C. data also showed that heat-related illnesses spiked this week in regions like the Northeast and the Midwest — areas that have been hit the hardest by the heat wave.

Though the heat wave will not fade over the weekend, conditions are expected to cool slightly on Monday. But even if they do, the country won’t be in the clear: Forecasters expect temperatures to still hover above average in the Mid-Atlantic States through the middle of next week.

— Kate Selig and Judson Jones

Heat index forecast for…

Heat-related illnesses spiked in some regions this week, c.d.c. data shows..

Heat-related emergency room visits spiked this week in regions of the United States that have been hit the hardest by the heat wave, according to data from the Centers for Disease Control and Prevention.

Across swaths of New England, the Midwest, the Rockies and the Mid-Atlantic States, there were “extremely high” rates of heat-related illnesses this week, the C.D.C.’s heat and health tracker showed, with data through Saturday.

The data used emergency room visits associated with the heat to determine the rise in heat-related illnesses, showing which areas had visits that exceeded the 95th percentile of what is typical. The numbers were based on a scale of per 100,000 visits.

In the Mid-Atlantic, including the Washington area and Philadelphia, the number of visits climbed from 290 on Monday, the first day of the heat wave, to 1,150 on Saturday. That was the highest rate anywhere in the country all week. On Saturday and Sunday, several temperature records were broken in Washington, Baltimore and Philadelphia.

Data also showed a spike in the region that includes Iowa and Missouri, with 1,077 visits on Saturday, up from 267 on Monday. On Saturday, the temperature in Kansas City, Mo., reached 95 degrees, 10 degrees above average for this time of year.

Earlier in the week, as New England states sweltered under record-breaking temperatures, the number of visits climbed from 57 per 100,000 on Monday, the first day of the heat wave, to 848 on Thursday.

The region is less acclimated to having high temperatures this time of year than others, and places like Boston and Hartford, Conn., had record temperatures . Caribou, Maine, reached 96 degrees this week, tying the highest temperature ever recorded there.

Much of the Midwest also had more heat-related emergency room visits than usual, with such trips reaching a peak of 632 visits on Wednesday. Chicago hit a record high of 97 degrees on Monday.

Areas around New York and New Jersey also saw a surge in heat-related medical issues this week, going up to 537 heat-related emergency room visits on Friday, from 141 on Monday. New York City reached daily temperatures it hadn’t experienced in almost two years, going up to 94 degrees in Central Park on Friday.

Deaths resulting from extreme heat have been on the rise in the country in the past few years. The C.D.C. recorded about 2,300 heat-related deaths in 2023, up from approximately 1,700 in 2022 and about 1,600 in 2021.

Global warming has been making heat waves hotter , more frequent and longer lasting. And the longer a heat wave, the more health risks people face because each additional day of extreme heat further strains the body.

Temperatures in New England fell on Friday, but the Mid-Atlantic continued to bake through Sunday. By Monday, cooler temperatures are expected along the populous Interstate 95 corridor on the East Coast, but the National Weather Service predicts intense — and potentially dangerous — heat for parts of the South and the Plains throughout the upcoming week.

— Kate Selig and Isabelle Taft

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The heat couldn’t stop a parade of mermaids on Coney Island.

Dolly McDermott and her mother, Patricia McDermott, were making their way along Surf Avenue on Coney Island shortly after noon on Saturday. They were trying to get to the registration table for Brooklyn’s annual Mermaid Parade, but it was slow going — spectators kept asking them to pose for pictures.

The daughter was wearing light-rimmed sunglasses, peach-colored frills, necklaces, bangles, and a foam seashell anchored to her back. Her mother struck a gothic contrast in black and white, with face paint and a full mermaid skeleton running the length of her outfit.

“One more! One more!” a photographer pleaded with them.

“It’s taken us half an hour to walk this far,” the younger Ms. McDermott, an artist and a self-styled “professional eccentric,” said. “Only because we look as good as we do,” her mother added.

The pair said they had been marching in Coney Island’s pageantry of aquatic weirdness for several years, and that they had not been deterred by a citywide heat advisory. The temperature was already 86 and climbing as costumed marchers and spectators assembled under a cloudless blue sky.

But the mood was upbeat as DJs on floats tested their speakers and marching bands tuned up near the staging area at Surf Avenue and West 21st Street.

On a side street, Elijah Thomas of Harlem stood under the shade of a tree with several of his bandmates from Honk NYC!, a nonprofit that promotes brass and percussive street music and participates regularly in the parade.

Mr. Thomas, 24, spoke about the inspiration that the Mermaid Parade, founded in 1983, drew from the street marching culture of Mardi Gras in New Orleans. A repeat performer at the Mermaid Parade, Mr. Thomas said he had come for “the pageantry, the community music making and the parading.”

Nearby on Surf Avenue, Dmitry Brill — better known as DJ Dmitry of the pop group Deee-Lite — did a soundcheck with his laptop mounted on a small float. The float was adorned with the name of a Berlin, Germany-based band he is producing, Nauti Siren, whose members were using their first turn at the parade to roll out a new single entitled, aptly enough, “Mermaid of the Year.”

Brill, 60, said this was his first time officially participating in the parade, though he attended it once as a spectator in the late 1980s.

Another first-time marcher, Leah King, wore a gold tiara, a bikini top and an eight-legged octopus skirt in the style of Ursula, the queenly villainess from Disney’s “The Little Mermaid.” She wielded a gold-tipped trident as she, too, stopped repeatedly for photographs.

“I’m a cosplayer,” Ms. King, 40, said. “I was made for this. The mermaid is my alter ego.”

The parade kicked off with this year’s official King Neptune and Mermaid Queen — New York husband and wife artists Joe Coleman and Whitney Ward — riding in an electric tricycle under a canopy trimmed with gold. Mermaids, ship captains, pirates and people dressed as various forms of marine life trailed behind, followed by musical floats and bands playing techno and pop hits.

The procession rolled east along Surf Avenue past rows of cheering spectators, past the original Nathan’s hot dog emporium, and toward its eventual turn onto the Boardwalk, and on to its end point at the towering metal Parachute Jump, one of Coney Island’s most recognizable landmarks.

Jenni Bowman, 42, of Brooklyn, watched with friends behind barricade fencing from under the shade of a four-pole party tent.

Ms. Bowman said she comes to the parade for its offbeat celebration of “ocean mythology,” as well as for its artistry. “It’s an art parade,” she said. “The people of New York City are incredible. This is a representation of their artistry and their love for this community.”

Acknowledging the weather, Bowman added, “My friends and I bought a tent to stay in the shade because we want to be hydrated and safe.”

As it happened, the weather eased as the afternoon wore on and a light cloud cover helped keep the temperature below 90 degrees.

— Sean Piccoli

Thousands of Michigan residents weather days without power during the heat wave.

As storms battered southeast Michigan this week, Lindsey Brenz heard trees crashing and saw bright flashes of lightning through her windows. Then, she heard a pop and the monotone drone of what she suspected was a power surge.

“I thought, ‘Oh gosh, this is not going to be good,’” she said.

Ms. Brenz, 32, was one of 69,000 customers who lost power Wednesday night after powerful storms downed trees and toppled power lines — compounding the effects of an intense heat wave that has scorched the Midwest and other areas of the country.

Three days after the outage, about 7,000 customers are still without power, according to DTE Energy, a Detroit-based utilities company that serves the area. Detroit has suffered temperatures in the 90s since the heat wave began on Monday. The heat index, a measure of how conditions feel with humidity factored in, reached 95 degrees on Saturday afternoon.

Ms. Brenz’s biggest concern was keeping herself and her cat, Bubba, safe from the sweltering conditions during the outage. She closed her windows, drew the blinds and refrained from showering to keep her house in Berkley cool.

“It was the little things I had to be aware of to keep me and my cat safe,” said Ms. Brenz, who works for a nonprofit.

Deb Dworkin, a 52-year-old human resources manager, lives in a bungalow in Berkley. She said her upstairs bedroom got “crazy hot” during the outage. She slept on her couch for two days, using a battery-powered travel fan and a neck towel filled with ice cubes.

“I probably looked ridiculous,” she said.

Michael Reiterman, a 25-year-old assistant financial planner who lives in New Baltimore, tried similar remedies in his home, including shutting the blinds to keep out the heat. But his ultimate solution was to shuttle between his home, which had outages intermittently, and his fiancée’s house, which maintained power through the week.

The country has so far been spared widespread blackouts amid the heat wave, which heightened demand for electricity and put pressure on the grid’s infrastructure. Experts say that’s a promising sign that the grid will be able to handle intense heat waves later in the summer.

But the difficulties faced by the Michigan residents demonstrate the risks of power outages that coincide with heat waves — regardless of whether the outages are caused directly by the heat.

To help mitigate those risks, DTE Energy is planning to invest about $9 billion over the next five years to “harden” the grid to weather the effects of climate change, said Brian Calka, vice president of the company’s distribution operations business unit.

“The weather patterns that we’re seeing right now are fundamentally different from what we’ve seen in recent memory,” he said. “It’s a call to action.”

Sophia Lada contributed reporting.

— Kate Selig

In the Mid-Atlantic and Ohio Valley, some residents are undeterred by the heat.

The heat wave has been especially brutal in the Ohio Valley and the Mid-Atlantic States on Saturday. Yet that did not stop some resilient locals from attending an air show, hanging out at an African American heritage festival or going on hourslong bike rides.

In Dayton, Ohio, the heat index surged well into the 90s, but tens of thousands of people braved the stifling weather to attend the CenterPoint Energy Dayton Air Show, a beloved tradition in the city. Attendees navigated through bumper-to-bumper traffic and a long, hot walk onto the grounds, carrying coolers and lawn chairs.

Dozens of airplanes were parked on the tarmac, and air show regulars sat under their wings for a bit of relief from the blistering sun. “They know to hide under a plane wing for a while,” said Martin Kelly, 61, referring to his four grandchildren who had staked out a shady spot under a KC-135R refueling plane.

Preparations were made for the heat, such as bringing in city buses to serve as mobile cooling shelters, according to the show director. But 109 attendees were treated for heat-related ailments, and 12 were transported off grounds.

Some 400 miles away, in Baltimore, thousands of locals at the AFRAM Music Festival — one of the largest of its kind on the East Coast — came to celebrate African American culture. They carried tents and backpacks filled with bottled water to guard against the sun and rising temperatures.

Baltimore was even more sweltering, with a temperature of 101 and a heat index of 106 on Saturday afternoon. But still, organizers of the festival — which features activities like African drumming, mask making and music entertainment by Busta Rhymes and Big Daddy Kane, among others — were expecting some 300,000 people to attend over the weekend.

Aja Wilkinson, 24, a recent graduate of Morgan State University, was at the festival for the first time. “Even though it’s so hot, I wanted to be here for the community of it all,” she said while hopping on a cooling bus.

In Philadelphia, where the heat index shot up to 105, a group of five bicyclists were determined to go on a 60-mile ride from Valley Forge, Pa., which took about five hours. The riders, aged 52 to 69, dismissed any concerns that they might be crazy to ride in the heat.

“We’ve done 100 miles in this kind of weather,” said John Ditterle, 62. “It’s much worse in the cold.”

Still, some were struggling to cope with the unusually early heat wave. Temperatures in Philadelphia, for instance, don’t usually reach the 90s until mid-July or August, according to Derrick Fleming, a 53-year-old chef.

“It’s too sudden,” he said.

— Kevin Williams ,  Donna M. Owens and Jon Hurdle Kevin Williams reported from Dayton, Ohio, Donna M. Owens from Baltimore, and Jon Hurdle from Philadelphia.

The concrete jungle helps the sizzling heat feel even hotter.

There’s a reason heat waves feel hotter in New York City: Concrete. And here in the city, we have a lot of it.

Our buildings, roads and sidewalks absorb the heat from the sun and then release it, a process known as the “ urban heat island effect .”

A 2023 study on the phenomenon reported that New York City, followed by Newark, had the highest urban heat island, or U.H.I., index average of about 8.5 degrees. This means that if the temperature is 90 degrees, it feels more like 98.5. Other cities with high U.H.I. numbers include Miami, Seattle, New Orleans, Detroit and Chicago, all of which have averages of around 8 degrees.

When the National Weather Service releases heat index predictions, which factor humidity with temperature readings, it takes into account the urban heat island component, said Dominic Ramunni, a meteorologist at the weather service. “The value is baked into our computer model,” he said.

“Baked” is the operative word this weekend for those in New York and Newark, who are looking at a heat index of right around 100 through Sunday.

But there is a way for cities to mitigate against the heat: By incorporating more green spaces into our urban landscapes, said Amy Chester, the managing director of Rebuild by Design , a resiliency nonprofit.

“All the ways we make our cities beautiful also have the added benefit of cooling our air during heat waves, cleaning our air, absorbing rainwater to reduce flooding, raising the value of our homes and providing better health and mental health outcomes,” she said.

Trees provide shade, which lowers ambient temperatures, while green roofs, like the 6.75-acre one atop the Javits Center in Midtown, or the green terraces of Via Verde, an affordable housing development in the South Bronx, lower indoor temperatures, Ms. Chester said.

A glance at a heat map posted by the United States Geological Survey shows that temperatures in Central Park, for example, can be roughly five degrees cooler than more developed areas.

Case in point: Friday’s temperature in Central Park, a monitoring site for the National Weather Service, reached 94 degrees. At La Guardia Airport, another site with plenty of concrete and hardly any green, the high temperature was 97 degrees.

Temperatures in the city will hover in the 90s into the weekend, though potential rain could provide some relief. The Metropolitan Transportation Authority, which operates the city’s subway and buses, announced Friday that it would be on the lookout through the weekend for possible service disruptions linked to the heat.

— Hilary Howard

A ride in a chemical-sniffing van shows how heat amps up pollution.

Two vans loaded with precision instruments trundled along the streets of New York and New Jersey in the heat earlier this week, sniffing for toxic chemicals in the air.

They detected spikes in methane, a potent greenhouse gas, most likely from leaks, or from natural-gas-burning buses. They found plumes of nitrous oxide, possibly from wastewater. And all along the ride, they logged elevated levels of ozone, the main ingredient of smog, as well as cancer-causing formaldehyde — both of which form readily in hot weather.

The bottom line: The streets are dotted with pollution hot spots. And the heat makes pollution worse.

“If you want a chemical reaction to go faster, you add heat,” said Peter DeCarlo, an atmospheric air pollution researcher at Johns Hopkins University who’s leading an effort to use the vans to measure emissions along Louisiana’s petrochemicals corridor. “On hotter days, it’s the same idea,” he said.

Air pollution surges when temperatures rise, adding to the harms wrought by global warming. It’s one reason cities and counties across the Eastern United States hit by a heat wave this week have been issuing air pollution alerts.

The past three days, New York City has warned that ozone in the city is at levels “unhealthy for sensitive groups.” Detroit and Chicago have also issued air quality alerts this week. Drivers in Ohio, Michigan, Kentucky and Indiana have been urged to avoid refueling before 8 p.m., and to car pool or refrain from driving as much as possible, to cut down on fumes.

The bad air has to do with atmospheric chemistry, Prof. DeCarlo said, while his van navigated the South Bronx, East Harlem and Midtown with two New York Times journalists along for the ride. Pollution from burning fossil fuels reacts with heat and sunlight, forming ground-level ozone. Higher temperatures turbocharge that process.

Formaldehyde emissions, which can come from sources as diverse as wildfires and household products, also rise with higher temperatures. “The same chemistry that generates high levels of ozone also produces additional hazardous air pollutants, such as formaldehyde,” Prof. DeCarlo said.

Local hot spots can sometimes be seen. For instance, on some blocks in Manhattan, formaldehyde levels were double the surrounding areas, possibly from particularly dirty combustion caused by faulty equipment nearby.

The heat-pollution nexus is a growing concern worldwide. Health harms from extreme heat aren’t the only outcome of record-breaking temperatures. Air pollution also spikes when the temperatures rise, the World Meteorological Organization said in a report last year.

“Climate change and air quality cannot be treated separately,” Petteri Taalas, the weather organization’s secretary-general, said at the time. “They go hand in hand and must be tackled together to break this vicious cycle.”

Breathing elevated levels of formaldehyde and ozone has been linked to problems like respiratory irritation and inflammation, reduced lung function, and difficulties preventing and controlling asthma attacks. Exposure is particularly concerning in people with lung diseases like asthma or chronic bronchitis, said Keeve Nachman, an environmental-health and risk-assessment researcher at Johns Hopkins and a co-lead on the mobile monitoring effort.

By coincidence this week, as New York was getting struck by the heat wave, the research team had its pollution-sniffing vans in the city to demonstrate their technology.

Prof. Nachman said that while formaldehyde was carcinogenic to humans, cancers would be expected primarily from longer-term exposures, not from temporary increases.

It’s also important to recognize that chemical exposures don’t happen one at a time, and that we’re constantly exposed to groups of chemicals that may act together to harm our health, he said. “Hot days can create situations where people are breathing many harmful chemicals at the same time,” Prof. Nachman said. “Formaldehyde and ozone are perfect examples.”

One of the vans is set to return to Louisiana later this year to measure for as many as 45 pollutants from its petrochemicals industry, part of a project funded by Bloomberg Philanthropies’ Beyond Petrochemicals Campaign . In an initial peer-reviewed study published this month , the researchers found far higher emissions of ethylene oxide, a carcinogenic gas used in plastic production, than previously known.

Researchers piloting the van, a high-tech lab-on-wheels built by the environmental measurement tech company Aerodyne, can see pollution levels in real time, and even follow plumes to try to determine their source. “It’s a bit like a video game,” Prof. DeCarlo said. “And we’re able to measure everything all at once.”

Blacki Migliozzi contributed reporting.

— Hiroko Tabuchi

A short guide to understanding heat domes.

Hearing a “heat dome” is in the forecast might spur feelings of dread. But how does a heat dome actually work?

Here’s what to know about the weather phenomenon.

What is a heat dome?

A heat dome is a high pressure system way up in the atmosphere that helps create and encase heat, kind of like a lid on a pot that holds in steam.

Heat domes “on the order of 1,000 miles across” can form under high pressure weather systems, said Hosmay Lopez, an oceanographer and expert on extreme heat and climate change with the National Oceanic and Atmospheric Administration. They become anchored in place, building up heat, sometimes for weeks at a time.

The term “heat wave” describes a rise in temperature in the weather pattern, and the term “heat dome” refers to a high pressure system that traps heat. The terms are often used interchangeably.

How do heat domes form?

When a high pressure system moves into an area, it pushes warm air toward the ground. With the sinking air acting like a cap, the warm air can’t easily escape, and it continues to heat up the more it is compressed.

“You can actually repeat this process on a small scale,” said Greg Carbin, forecast operations chief at the National Weather Service’s Weather Prediction Center. “When you’re inflating a flat tire, as the air goes in and the pressure builds, the molecules move faster, they are closer together, and they heat up.”

This high atmospheric pressure is linked to the configuration of the jet streams, bands of speedy winds that form high in the atmosphere in areas where cold air and hot air meet. The jet streams tend to be narrow, wavy corridors of air that move west to east and migrate north to south. Sometimes jet streams can expand, becoming slower, or even stagnant, and heavier.

Can heat domes happen anywhere?

Yes, they can, but areas that are farther from water, have flatter topography and are south of where jet streams migrate in the summer are more prone to oppressive heat domes. In the United States, that area is the Central Plains.

The heat domes that have covered the Pacific Northwest in recent years still baffle meteorologists, Mr. Carbin said, because the mountainous topography of the region is the opposite of what is usually conducive to heat domes.

Heat domes are associated with climate change. In the 1970s, there was one heat wave for every cold wave. As climate change accelerates, “that ratio is more than two to one, and for some places, it’s three to one,” Dr. Lopez said.

Are heat domes dangerous?

Yes. Heat stress is the most common cause of weather-related deaths, according to the World Health Organization. Because heat domes are associated with stagnating air, they can also lead to reduced air quality, dryness and a greater chance of fire. “Those stains are very detrimental for human health, especially for the elderly and people with preconditions like cardiopulmonary illnesses,” Dr. Lopez said.

Read about staying safe in a heat wave here .

— Isabella Grullón Paz and Camille Baker

Supreme Court acknowledges accidentally posting Idaho abortion case document that may preview narrow Biden admin win

WASHINGTON — The Supreme Court acknowledged Wednesday that it inadvertently posted online a document related to a pending abortion case, which Bloomberg Law obtained before it was removed from the website.

Supreme Court spokeswoman Patricia McCabe confirmed that a document was “inadvertently and briefly uploaded” to the court website but added that the ruling “has not been released.”

Bloomberg also posted a copy of the document . NBC News could not independently verify the document. It is not known whether it was a draft decision, the actual decision or neither.

The court appears set to allow emergency room doctors in Idaho to perform abortions in certain situations, according to a copy of the decision, Bloomberg reported . The court is likely to dismiss the appeal brought by Idaho officials, Bloomberg said.

In doing so the court would allow a lower court ruling in favor of the Biden administration to go back into effect.

Justice Samuel Alito wrote a dissenting opinion joined by two other conservatives, Clarence Thomas and Neil Gorsuch, saying the court should not have dismissed the case.

The Supreme Court in January blocked the lower court ruling and allowed Idaho to enforce its abortion law in full while agreeing to hear oral arguments. Other provisions of the ban are already in effect and would not be affected by the ruling.

The case concerns whether a federal law that regulates emergency room treatment overrides Idaho's strict abortion ban. If the court dismisses the appeal, it would leave the legal question unresolved.

According to the document posted by Bloomberg, Justice Ketanji Brown Jackson wrote separately to say the court should have gone ahead and decided the bigger issue, which is likely to come up in another case in due course and would have an impact on other states with abortion restrictions similar to Idaho’s.

"Today’s decision is not a victory for pregnant patients in Idaho. It is delay,” she wrote, according to the document. “While this court dawdles and the country waits, pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires."

In a separate opinion, conservative Justice Amy Coney Barrett explained why she would vote to dismiss the case, saying the court had made a "miscalculation" in taking it up before an appeals court had a chance to weigh in. Part of the confusion was caused by both sides’ altering their legal arguments once the case got to the high court, she added.

Idaho’s law says anyone who performs an abortion is subject to criminal penalties, including up to five years in prison. Health care professionals found to have violated the law can lose their professional licenses.

The federal government sued, leading a federal judge in August 2022 to block the state from enforcing provisions concerning medical care that is required under the federal Emergency Medical Treatment and Labor Act.

The 1986 law mandates that patients receive appropriate emergency room care. The Biden administration argued that care should include abortions in certain situations when a woman’s health is imperiled even if death is not imminent.

The Supreme Court is due to issue rulings Thursday and Friday as it reaches the end of its current term. The abortion case is one of 12 argued cases yet to be decided.

Lawrence Hurley covers the Supreme Court for NBC News.

Last week’s heat wave brought a sharp spike in ER visits across New England

In a heatwave that spanned several states last week, New England experienced the highest rate of heat-related emergency department visits in the country, Centers for Disease Control and Prevention data show.

On Tuesday, Wednesday and Thursday, the region experienced temperatures of 90 degrees and above, posing a threat to public health. Rates of heat-related ER visits in New England topped those of every other region in the US on Wednesday and Thursday .

“That’s pretty excessive warmth for the Northeast and/or New England area. We don’t get heat waves often, especially in June,” said The Globe’s lead meteorologist, Ken Mahan.

The spike is likely a harbinger of our future, thanks in part to climate change. If global emissions continue to rise, temperatures in Massachusetts could climb by as much as 5 degrees annually by the middle of the century .

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Dr. Laurel O’Connor, an emergency physician at UMass Memorial Health in Worcester, has witnessed the increase in heat-related visits.

“Anecdotally, we’ve definitely seen a rise in both heat-related illnesses and conditions exacerbated by the heat,” O’Connor said. The spike in illnesses last week, she noted, is much sharper than what the emergency room experienced this time last year.

Patients’ symptoms, like many conditions, vary across a spectrum, said O’Connor.

On the more mild end, people have come to the emergency room fatigued and dehydrated. After medical professionals cool down and hydrate these patients, they are typically discharged.

On the more extreme end of the spectrum, patients come in with heat stroke that has triggered organ damage and neurological changes. These patients, who are often older and have underlying medical issues, are admitted to the hospital, where they receive more intense, prolonged care. The increase in these sorts of hospitalizations was more modest than visits for less severe heat-related illnesses, O’Connor noted.

While Dr. Katelyn Sullivan, an emergency medicine physician at Tufts Medical Center, also observed a spike in heat-related visits last week, she said the increase was not unexpected.

“It’s a pattern that we see pretty much every summer with the first big heat wave,” said Sullivan.

The first heat wave of the season, she explained, is especially challenging because most people have not had the time to prepare themselves and secure heat-mitigating appliances like air conditioners.

Both doctors said their respective emergency rooms prepared for these spikes as they would in any year. Part of this preparation, O’Connor said, is conducting community outreach and ensuring patients can access cooling resources.

Beyond injuries directly related to the heat, she worries about what she calls “heat-adjacent injuries”, such as heat-exhausted swimmers drowning.

“I think people just need generally to be cautious and aware of the fact that, even if they’re not having symptoms of heat injury, they have to be careful that they’re not predisposing [themselves] to other summer-related hazards,” said O’Connor.

As for the rest of the summer, there is a growing risk that above-average temperatures will persist, in part due to climate change and in part due to the meteorological transition from El Niño to La Niña —climate patterns that shift the jet stream, disrupting weather patterns — said Mahan.

“There are signals all over the place that are pointing towards a very warm summer,” said Mahan.

Helena Getahun-Hawkins can be reached at [email protected] .

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• Electrostal History and Art Museum

You can spend time exploring the galleries in Electrostal History and Art Museum in Elektrostal. Take in the museums while you're in the area.

• Cities near Elektrostal

• Places of interest
• Yuri Gagarin Cosmonaut Training Center
• Central Museum of the Air Forces at Monino
• Peter the Great Military Academy
• Bykovo Manor
• Balashikha Arena
• Ramenskii History and Art Museum
• Malenky Puppet Theater
• Balashikha Museum of History and Local Lore
• Pekhorka Park
• Saturn Stadium
• Orekhovo Zuevsky City Exhibition Hall
• Noginsk Museum and Exhibition Center