emergency room visits for

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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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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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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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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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

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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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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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Preliminary Findings from Drug-Related Emergency Department Visits, 2021. An analysis of 2021 preliminary data presents (1) nationally representative weighted estimates for the top five drugs in drug-related ED visits, (2) the assessment of monthly trends and drugs involved in polysubstance ED visits in a subset of sentinel hospitals, and (3) the identification of drugs new to DAWN’s Drug Reference Vocabulary.

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3 Fireworks-Related Injuries That Land People In The Emergency Room

N othing says Fourth of July like fireworks. The technicolor explosives are every kid’s favorite part of the celebration — and many adults’ favorite, too. They’re mesmerizing to watch from a safe distance, but pose a serious danger if you stand too close or misuse them. 

According to the Consumer Product Safety Commission , 9,700 people were sent to emergency rooms in the U.S. due to injuries sustained from fireworks in 2023, and eight people died. The number of fireworks-related injuries has risen overall between 2008 and 2023, and peaked in 2020, when the pandemic caused the cancellations of many public professional fireworks displays. 

The most injured body parts in 2023 were hands and fingers (35%), the head, face and ears (22%) and eyes (19%), according to the CPSC. The age groups most likely to be seen in the ER for fireworks injuries were teens ages 15-19 and children ages 5-9. 

We spoke to two doctors about the most common injuries they see caused by fireworks and how to prevent them.

The CPSC report found that 42% of ER visits for firework-related injuries involved burns.

“Burns typically are on the hands or the face,” Dr. Nick Poulos , trauma director and chief of pediatric surgery at Nemours Children’s Hospital in Orlando, told HuffPost. 

“Burn injuries are usually flash injuriesand are usually not terribly severe,” he said, although that doesn’t mean they aren’t painful. If your child gets a burn that doesn’t seem severe, Poulos recommends cooling it off with cold water. 

“Then, if the if the pain is persistent, that would be the time to head to the emergency room.”

Blast injuries

Blast injuries, which involve tissue damage, “can be very severe and debilitating,” Poulos said. 

“Explosives get much more dangerous the more compact they are pressed,” he said. So if a child holds on tightly to a firework that then explodes, “the tissue can’t get away very fast, and so it makes the exposure much worse.”

Blast injuries will require a trip to the emergency room. 

But not all types of fireworks are capable of causing them. Sparklers “don’t have any explosive component,” Poulos said. They’re on the end of a stick, giving you a buffer, and “the amount of gunpowder is much, much smaller,” he added. 

While any kind of firework can cause injury, kids are less likely to get hurt by sparklers. The CPSC report says there were about 700 injuries caused by sparklers brought to the ER in 2023, out of the 9,700 total injuries. Bottle rockets caused another 800 injuries. Other kinds of explosive firewords were responsible for the remaining majority of the injuries. Any kind of projectile, or a firework that shoots into the air, can injure either the person igniting it or a spectator. 

Eye injuries 

Eye injuries are a major concern when it comes to fireworks, as they can cause vision damage — sometimes permanently.

Eye injuries vary in their severity, Dr. Brian Boxer Wachler , a Los Angeles-based ophthalmologist, told HuffPost. But any significant injury to the eye requires medical attention.

A common, less-serious injury involves damage to the outer portion of the eye called the cornea. Boxer Wechler said that even a minor abrasion or scratch can still cause a lot of discomfort.

“Even though it’s really small, there’s so many nerves, it’s just incredibly painful,” he said of the cornea. While these injuries often heal within a couple of days, it’s important to see a specialist because of the possibility of infection and scarring. The impact of scarring can range from “a little vision distortion to a really high degree of vision impairment, depending on the scar,” Boxer Wechler said. 

In more serious injuries, a firework penetrates the cornea and damages deeper layers of the eye.

“That can cause a cataract, it can cause a retina detachment. And those could be really high degrees of vision impairment, or even blindness, possibly,” Boxer Wechler said. Depending on the severity of the injury, he said, treatment might involve a “Band-Aid-type contact lens,” antibiotic drops, steroids or even surgery. 

Boxer Wechler noted that all of these injuries can be prevented by using protective eye wear. 

If you plan to use fireworks, here’s what you should know

The doctors recommended the following safety precautions when using fireworks with children in order to prevent injury. 

• Supervision by an adult who is not drinking . Poulos said that kids who are ready to be left alone in the house are likely ready to use fireworks with supervision, around ages 12 or 13. “Every child lighting a firework should have adult supervision,” Boxer Wachler said. Calling alcohol and fireworks “a bad mix,” Poulos said it’s important that the supervising adult remain sober. 
• Protective eyewear.  “The most protective types of lenses are polycarbonate lenses,” Boxer Wechler said. “Some material that’s shatterproof.” Think of the safety goggles you wore in chemistry class. If you don’t have these on hand, a pair of sunglasses is a decent second option, even though they are not shatterproof. While it’s uncommon to see people wearing protective eyewear when lighting fireworks, Boxer Wechler noted that it used to be rare to find seatbelts in cars, and a change in norms is always possible. 
• A safe distance.  With any fireworks that explode in the sky, “everybody ought to be back at least 50 feet away from where this is going off, because the risk is also for the audience as well as the person lighting it,” Poulos said. He added that a person should never hold this type of firework in their hand, but use a smoldering stick, or “punk,” that will give you some distance. The firework “needs to be in a stable position, and it needs to be lit with one of those punks, so that you are nowhere near the firework when it actually takes off,” Poulos said. To avoid starting a fire, he added, fireworks should be set off on an asphalt or cement surface, and not aimed toward anyone’s home or a wooded area. 
• A bucket of water or garden hose.  Sparklers can be dropped into a bucket of water to be extinguished. Water should be immediately available in case anything catches flame. If a firework doesn’t light or go off correctly, do not handle it or attempt to light it again. 
• 6 Of The Most Dangerous Kids’ Activities, According To ER Physicians
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• Forget 'Stranger Danger.' Here's What We Should Really Teach Kids To Keep Them Safe.

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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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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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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 allows emergency abortions in Idaho for now

WASHINGTON — The Supreme Court on Thursday sidestepped a ruling on whether Idaho's strict abortion law conflicts with a federal law that requires stabilizing care for emergency room patients, including pregnant women suffering complications who may require abortions.

The court dismissed an appeal brought by Idaho officials, meaning a lower court ruling that allows doctors in the state to perform abortions in emergency situations remains in effect for now.

The decision, which leaves the legal question unresolved and has no impact in any other state, was widely expected after the Supreme Court inadvertently posted a copy online Wednesday.

The court could take up the issue in a later case.

Attorney General Merrick Garland said in a statement the Justice Department will continue to push its interpretation of the federal law in the ongoing litigation.

"Today's order means that, while we continue to litigate our case, women in Idaho will once again have access to the emergency care guaranteed to them under federal law," he said.

Justice Ketanji Brown Jackson, who objected to the court’s failing to decide the case, read her dissenting opinion from the bench, a step justices generally take only when they are particularly disgruntled with the outcome.

"There is simply no good reason not to resolve this conflict now," she wrote.

Conservative Justice Samuel Alito agreed on that point in a dissenting opinion joined by Justice Clarence Thomas and, mostly, Justice Neil Gorsuch.

Alito indicated he would rule against the Biden administration, which argues that federal law requires an abortion when a woman is suffering from various health complications that are not necessarily immediately life-threatening, notwithstanding Idaho's strict ban.

"Here, no one who has any respect for statutory language can plausibly say that the government's interpretation is unambiguously correct," he wrote.

A five-justice bloc of conservative and liberal justices, however, voted against deciding the case.

Conservative Justice Amy Coney Barrett wrote that the "shape of these cases has substantially shifted" since the court agreed to hear the two linked appeals from the state and elected officials.

Liberal Justice Elena Kagan said Idaho's arguments "have never justified ... our early consideration of this dispute."

The legal question is of importance not just in Idaho, but also in other states that have enacted similar bans that abortion-rights advocates say clash with the federal law because they do not include broad exceptions for the health of the woman.

But the court's failure to issue a ruling means confusion remains about whether the federal law trumps the state bans. In Idaho, the state's appeal of the lower court ruling will continue.

The litigation could get even more complicated if former President Donald Trump wins the election, as his administration could change its legal position and argue that the federal law does not conflict with state abortion laws.

The federal government said a handful of states would be affected if the court had issued a full ruling, while abortion opponents said a win for the Biden administration could affect up to 22 states that have restricted abortion.

The Idaho abortion ban was enacted in 2020, with a provision stating it would go into effect if the Supreme Court overturned Roe v. Wade, the 1973 ruling that found women had a constitutional right to terminate pregnancies.

The legislation, known as the Defense of Life Act,  went into effect  in 2022 when the Supreme Court  rolled back  Roe.

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.

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

The government and abortion rights groups cited as examples women whose water breaks early in a pregnancy, putting them at risk of sepsis or hemorrhage.

The federal law applies to health care providers that receive federal funding under the Medicare program.

The Idaho law includes an exception if an abortion is necessary to protect the life of the pregnant woman, although the scope of the exception was heavily contested in the litigation.

The Supreme Court in January allowed Idaho to enforce the provisions while it agreed to hear oral arguments in the case. Other provisions of the ban are already in effect and are not affected by the court's latest decision.

In blocking parts of the state law that conflict with federal law, U.S. District Court Judge B. Lynn Winmill described the state’s actions as putting doctors “on the horns of a dilemma.”

The 9th U.S. Circuit Court of Appeals, based in San Francisco, briefly put Winmill’s ruling on hold in September, but it subsequently allowed it to go back into effect, prompting the state officials to turn to the Supreme Court.

The emergency room dispute is one of two abortion cases the Supreme Court considered this term, both of which arose in the aftermath of the 2022 decision to overturn Roe. In the other, the court rejected a challenge by anti-abortion doctors to the Food and Drug Administration’s lifting of restrictions on mifepristone, the drug most commonly used for medication abortions.

Lawrence Hurley covers the Supreme Court for NBC News.

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Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021

Weekly / June 18, 2021 / 70(24);888–894

On June 11, 2021, this report was posted online as an MMWR Early Release.

Ellen Yard, PhD 1 ; Lakshmi Radhakrishnan, MPH 2 ; Michael F. Ballesteros, PhD 1 ; Michael Sheppard, MS 2 ; Abigail Gates, MSPH 2 ; Zachary Stein, MPH 2 ; Kathleen Hartnett, PhD 2 ; Aaron Kite-Powell, MS 2 ; Loren Rodgers, PhD 2 ; Jennifer Adjemian, PhD 2 ; Daniel C. Ehlman, ScD 1 ,2 ; Kristin Holland, PhD 1 ; Nimi Idaikkadar, MPH 1 ; Asha Ivey-Stephenson, PhD 1 ; Pedro Martinez, MPH 1 ; Royal Law, PhD 1 ; Deborah M. Stone, ScD 1 ( View author affiliations )

What is already known about this topic?

During 2020, the proportion of mental health–related emergency department (ED) visits among adolescents aged 12–17 years increased 31% compared with that during 2019.

What is added by this report?

In May 2020, during the COVID-19 pandemic, ED visits for suspected suicide attempts began to increase among adolescents aged 12–17 years, especially girls. During February 21–March 20, 2021, suspected suicide attempt ED visits were 50.6% higher among girls aged 12–17 years than during the same period in 2019; among boys aged 12–17 years, suspected suicide attempt ED visits increased 3.7%.

What are the implications for public health practice?

Suicide prevention requires a comprehensive approach that is adapted during times of infrastructure disruption, involves multisectoral partnerships and implements evidence-based strategies to address the range of factors influencing suicide risk.

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Beginning in March 2020, the COVID-19 pandemic and response, which included physical distancing and stay-at-home orders, disrupted daily life in the United States. Compared with the rate in 2019, a 31% increase in the proportion of mental health–related emergency department (ED) visits occurred among adolescents aged 12–17 years in 2020 ( 1 ). In June 2020, 25% of surveyed adults aged 18–24 years reported experiencing suicidal ideation related to the pandemic in the past 30 days ( 2 ). More recent patterns of ED visits for suspected suicide attempts among these age groups are unclear. Using data from the National Syndromic Surveillance Program (NSSP),* CDC examined trends in ED visits for suspected suicide attempts † during January 1, 2019–May 15, 2021, among persons aged 12–25 years, by sex, and at three distinct phases of the COVID-19 pandemic. Compared with the corresponding period in 2019, persons aged 12–25 years made fewer ED visits for suspected suicide attempts during March 29–April 25, 2020. However, by early May 2020, ED visit counts for suspected suicide attempts began increasing among adolescents aged 12–17 years, especially among girls. During July 26–August 22, 2020, the mean weekly number of ED visits for suspected suicide attempts among girls aged 12–17 years was 26.2% higher than during the same period a year earlier; during February 21–March 20, 2021, mean weekly ED visit counts for suspected suicide attempts were 50.6% higher among girls aged 12–17 years compared with the same period in 2019. Suicide prevention measures focused on young persons call for a comprehensive approach, that is adapted during times of infrastructure disruption, involving multisectoral partnerships (e.g., public health, mental health, schools, and families) and implementation of evidence-based strategies ( 3 ) that address the range of factors influencing suicide risk.

CDC examined NSSP ED visit data, which include approximately 71% of the nation’s EDs in 49 states (all except Hawaii) and the District of Columbia. ED visits for suspected suicide attempts were identified by using a combination of chief complaint terms and administrative discharge diagnosis codes. ED visits for suspected suicide attempts include visits for suicide attempts, as well as some nonsuicidal self-harm visits ( 4 ). Suspected suicide attempts were identified by querying an NSSP syndrome definition developed by CDC in partnership with state and local health departments (Supplementary Table, https://stacks.cdc.gov/view/cdc/106694 ). All analyses were restricted to EDs that reported consistently throughout the study period (January 1, 2019–May 15, 2021) and had at least one visit for suspected suicide attempts; 41% of those that reported consistently had one or more visits for suspected suicide attempts. § Weekly counts and rates (mean number of ED visits for suspected suicide attempts/mean total number of ED visits) x 100,000) analyzed by age group (12–17 and 18–25 years) and sex were plotted across the entire study period, and analyzed for three distinct periods: spring 2020 (March 29–April 25, 2020; calendar year weeks 14–17); summer 2020 (July 26–August 22, 2020; weeks 31–34); and winter 2021 (February 21–March 20, 2021; weeks 8–11) and compared with their corresponding reference periods in 2019. ¶ These time frames were selected as representative of distinct periods throughout the pandemic. Percent change and visit ratios (rate of ED visits for suspected suicide attempts during surveillance period/rate of ED visits for suspected suicide attempts during reference period) with 95% confidence intervals (CIs) were calculated to compare suspected suicide attempt ED visit rates by pandemic period and sex; CIs that excluded 1.0 were considered statistically significant. NSSP race and ethnicity data were not available at the national level for this analysis at the time it was conducted. All analyses were conducted using R software (version 4.0.5; R Foundation). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.**

Among adolescents aged 12–17 years, the number of weekly ED visits for suspected suicide attempts decreased during spring 2020 compared with that during 2019 ( Figure 1 ) (Table). ED visits for suspected suicide attempts subsequently increased for both sexes. Among adolescents aged 12–17 years, mean weekly number of ED visits for suspected suicide attempts were 22.3% higher during summer 2020 and 39.1% higher during winter 2021 than during the corresponding periods in 2019, with a more pronounced increase among females. During winter 2021, ED visits for suspected suicide attempts were 50.6% higher among females compared with the same period in 2019; among males, such ED visits increased 3.7%. Among adolescents aged 12–17 years, the rate of ED visits for suspected suicide attempts also increased as the pandemic progressed (Supplementary Figure 1, https://stacks.cdc.gov/view/cdc/106695 ). Compared with the rate during the corresponding period in 2019, the rate of ED visits for suspected suicide attempts was 2.4 times as high during spring 2020, 1.7 times as high during summer 2020, and 2.1 times as high during winter 2021 ( Table ). This increase was driven largely by suspected suicide attempt visits among females.

Among men and women aged 18–25 years, a 16.8% drop in the number of ED visits for suspected suicide attempts occurred during spring 2020 compared with the 2019 reference period ( Figure 2 ) (Table). Although ED visits for suspected suicide attempts subsequently increased, they remained consistent with 2019 counts (Figure 2). However, the ED visit rate for suspected suicide attempts among adults aged 18–25 years was higher throughout the pandemic compared with that during 2019 (Supplementary Figure 2, https://stacks.cdc.gov/view/cdc/106696 ). Compared with the rate in 2019, the rate was 1.6 times as high during spring 2020, 1.1 times as high during summer 2020, and 1.3 times as high during winter 2021 (Table).

This report expands upon previous work highlighting increases in ED visits for suspected suicide attempts earlier in the pandemic among all persons ( 5 ) and suggests that these trends persisted among young persons as the pandemic progressed. Compared with the corresponding period in 2019, persons aged 12–25 years made fewer ED visits for suspected suicide attempts during March 29–April 25, 2020, the period that followed the declaration of the COVID-19 pandemic as a national emergency and a concurrent 42% decrease in the total number of U.S. ED visits ( 6 ). However, ED visits for suspected suicide attempts increased among adolescent girls aged 12–17 years during summer 2020 and remained elevated throughout the remaining study period; the mean weekly number of these visits was 26.2% higher during summer 2020 and 50.6% higher during winter 2021 compared with the corresponding periods in 2019. The number of ED visits for suspected suicide attempts remained stable among adolescent boys aged 12–17 years and among all adults aged 18–25 years compared with the corresponding periods in 2019, although rates of ED visits for suspected suicide attempts increased.

The difference in suspected suicide attempts by sex and the increase in suspected suicide attempts among young persons, especially adolescent females, is consistent with past research: self-reported suicide attempts are consistently higher among adolescent females than among males ( 7 ), and research before the COVID-19 pandemic indicated that young females had both higher and increasing rates of ED visits for suicide attempts compared with males ( 8 ). However, the findings from this study suggest more severe distress among young females than has been identified in previous reports during the pandemic ( 1 , 2 ), reinforcing the need for increased attention to, and prevention for, this population. Importantly, although this report found increases in ED visits for suspected suicide attempts among adolescent females during 2020 and early 2021, this does not mean that suicide deaths have increased. Provisional mortality data found an overall decrease in the age-adjusted suicide rate from quarter 3 (July–September) of 2019 to quarter 3 of 2020. The suicide rate among young persons aged 15–24 years during this same period saw no significant change ( 9 ). Future analyses should further examine these provisional rates by age, sex, race, ethnicity, and geographic setting.

Some researchers have cautioned about a potential increase in suicides during the COVID-19 pandemic on account of increases in suicide risk factors; however, this study was not designed to identify the risk factors leading to increases in suspected suicide attempts ( 10 ). Young persons might represent a group at high risk because they might have been particularly affected by mitigation measures, such as physical distancing (including a lack of connectedness to schools, teachers, and peers); barriers to mental health treatment; increases in substance use; and anxiety about family health and economic problems, which are all risk factors for suicide. In addition, average ED visit rates for mental health concerns and suspected child abuse and neglect, risk factors for suicide attempts, also increased in 2020 compared with 2019 ( 5 ), potentially contributing to increases in suspected suicide attempts. Conversely, by spending more time at home together with young persons, adults might have become more aware of suicidal thoughts and behaviors, and thus been more likely to take their children to the ED.

The findings in this report are subject to at least nine limitations. First, these data are not nationally representative. Second, facility participation varies within and across states; however, data were only analyzed from facilities that reported consistently over the study period, thus minimizing the impact of reporting fluctuations on resultant trends. Third, differences in availability, coding practices, and reporting of chief complaints and discharge diagnoses from facilities might influence results returned by the syndrome definition. Fourth, distinguishing initial visits from follow-up visits for the same event was not possible, so the number of ED visits for suspected suicide attempts might be lower than presented. Fifth, NSSP race and ethnicity data were not available at the national level for this analysis at the time it was conducted, so analyses of differences among racial/ethnic groups was not possible. Sixth, these data likely underrepresent the true prevalence of suspected suicide attempts because persons with less severe injuries might be less likely to seek emergency care during the pandemic when many persons avoided medical settings to reduce the risk for contracting COVID-19. Seventh, the suspected suicide attempt syndrome definition excludes some, but not all, visits for nonsuicidal self-harm. Eighth, the sharp decline in all ED visits during the pandemic likely affected the number and proportion of visits for suspected suicide attempts ( 6 ). Finally, this analysis was not designed to determine whether a causal link existed between these trends and the COVID-19 pandemic.

Suicide can be prevented through a comprehensive approach that supports persons from becoming suicidal as well as persons who are at increased risk for suicide. †† Such an approach involves multisectoral partnerships (e.g., public health, mental health, schools, and families) and implementation of evidence-based strategies to address the range of factors influencing suicide attempts, which is a leading risk factor for suicide ( 3 ). Strategies specific to young persons include preventing and mitigating adverse childhood experiences, strengthening economic supports for families, limiting access to lethal means (e.g., safe storage of medications and firearms), training community and school staff members and others to learn the signs of suicide risk and how to respond, improving access and delivery of evidence-based care, increasing young persons’ social connectedness and coping skills, and following safe messaging by the media and in schools after a suicide ( 3 ). Widely implementing these comprehensive prevention strategies across the United States, including adapting these strategies during times of infrastructure disruption, such as during the pandemic, can contribute to healthy development and prevent suicide among young persons.

Corresponding author: Ellen Yard, [email protected] .

1 National Center for Injury Prevention and Control, CDC; 2 Center for Surveillance, Epidemiology, and Laboratory Services, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* NSSP is a collaborative program among CDC, federal partners, local and state health departments, and academic and private sector partners to support the collection and analysis of electronic health data from EDs, urgent and ambulatory care centers, inpatient health care facilities, and laboratories.

† Analysis was limited to ED encounters. As of March 31, 2021, a total of 3,722 EDs covering 49 states (all except Hawaii) and the District of Columbia contributed data to the platform daily, including data from 71% of all nonfederal EDs in the United States.

§ To limit the impact of data quality on trends, all analyses were restricted to facilities with a coefficient of variation <30 throughout the analysis period January 2019–May 2021 so that only consistently reporting facilities were included. Of all the EDs that met the data quality criteria, 41% had visits and thus were included in the analysis.

¶ Percent change in visits per week during each surveillance period was calculated as the difference in total visits between the surveillance period and the reference period, divided by the total visits during the reference period, times 100%. ([ED visits for suspected suicide attempts during surveillance period–ED visits for suspected suicide attempts during reference period]/ED visits for suspected suicide attempts during reference period*100%).

** 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

†† https://www.cdc.gov/suicide/programs/csp/index.html

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FIGURE 1 . Numbers of weekly emergency department visits* for suspected suicide attempts † among adolescents aged 12–17 years, by sex — National Syndromic Surveillance Program, United States, January 1, 2019–May 15, 2021

Abbreviations: ED = emergency department; NSSP = National Syndromic Surveillance Program.

* ED visits for suspected suicide attempts were identified by querying an NSSP syndrome definition developed by CDC in partnership with state and local health departments ( https://stacks.cdc.gov/view/cdc/106694 ). NSSP ED visit data include approximately 71% of the nation’s EDs in 49 states (all except Hawaii) and the District of Columbia.

† Visits for suspected suicide attempts include visits for suicide attempts, as well as nonsuicidal self-harm.

Abbreviations : CI = confidence interval; ED = emergency department; N/A = not applicable. * Percent change in visits per week during each surveillance period was calculated as the difference in total visits between the surveillance period and the reference period, divided by the total visits during the reference period, times 100%. ([ED visits for suspected suicide attempts during surveillance period–ED visits for suspected suicide attempts during reference period]/ED visits for suspected suicide attempts during reference period*100%). † Rate of ED visits for suspected suicide attempts = (mean number of ED visits for suspected suicide attempts/mean total number of ED visits) x 100,000. § Visit ratios for suspected suicide attempt visits = (rate of ED visits for suspected suicide attempts during the surveillance period/rate of ED visits for suspected suicide attempts during reference period). Ratios >1 indicate a higher rate of ED visits for suspected suicide attempts during the surveillance period than during the reference period. Reference periods are as follows: for weeks 14–17, 2020 (March 29–April 25, 2020, Spring 2020): weeks 14–17, 2019 (March 21–April 27, 2019); for weeks 31–34, 2020 (July 26–August 22, 2020, Summer 2020): weeks 31–34, 2019 (July 28–August 24, 2019); for weeks 8–11, 2021 (February 21–March 20, 2021, Winter 2021): weeks 8–11, 2019 (February 17–March 16, 2019). ¶ ED visits for suspected suicide attempts were defined using NSSP’s syndrome definition based on a combination of chief complaint terms and administrative discharge diagnosis codes. ** NSSP is a collaborative program among CDC, local and state health departments, and academic and private sector partners supporting the collection and analysis of electronic health data. Results in this analysis are limited to only ED encounters. As of March 31, 2021, 71% of all nonfederal EDs in the United States. (3,722) covering 49 states (all except Hawaii) and the District of Columbia contribute data to the platform daily. Of all the EDs that met the data quality criteria, 41% observed visits for suspected suicide attempts and thus were included in the analysis. †† Female to male visit ratios = (proportion of ED visits for suspected suicide attempts during surveillance period for females/proportion of ED visits for suspected suicide attempts during surveillance period for males). Ratios >1 indicate a higher proportion of suspected suicide attempt–related ED visits during the surveillance period for females compared with males. §§ Data are shown only for the surveillance periods (spring 2020: March 29–April 25, 2020; summer 2020: July 26–August 22, 2020; and winter 2021: February 21–March 20, 2021). Thus, the date range is different from that in the figures, which depict the entire study period (January 1, 2019–May 15, 2021).

FIGURE 2 . Numbers of weekly emergency department visits* for suspected suicide attempts † among adults aged 18–25 years, by sex — National Syndromic Surveillance Program, United States, January 1, 2019–May 15, 2021

Suggested citation for this article: Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep 2021;70:888–894. DOI: http://dx.doi.org/10.15585/mmwr.mm7024e1 .

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