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US emergency room procedures

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I have a character who is attacked by a creature of some sort, badly scratched and bitten.  His friends take him to the emergency room of a local hospital and say it was a feral dog that attacked him.  The doctor who treats him is naturally concerned about rabies. 

The questions:

If the cuts are bad but not life threatening, is It conceivable that he would be stitched up and sent home within a few hours?

In the case of an older teen (right now I'm thinking 17, but could make it 18 if necessary), would the hospital have to inform the parents of the treatment (assuming they already have family health insurance on file)?  Would they let him leave with his friends if the parents were unreachable at that time?

Would the hospital insist on following up or would that be the responsibility of the patient?  E.g., rabies shots are supposed to be given in a series.  Would someone from the hospital call the boy or his parents to make sure he comes in for the next shot?  Could he simply not go and get away with it or would it be more difficult than that?

Just want to make sure I don't include accidental plot holes! 
#1 - July 17, 2010, 07:30 AM
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oooh, I can't help you Megan but I have to say I'm already very intrigued just by the minimal notes you've given about that scene!  :yup
#2 - July 17, 2010, 08:22 AM
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I'm not sure about most of your questions ... but I think the Animal Control authorities would also be called.

If the bites weren't life threatening he'd probably be in the E.R. for hours before being seen especially if it's a weekend night ... because stabbings and auto accident victims will come first (disclaimer: my emergency room care has always taken place at a military hospital which also served as a trauma center for the nearby civilian community.)

I don't know about reporting .. that could vary from state to state. An older teenager could sign as the patient .. but have to give the parent's insurance information. I'm thinking that the kid may not want to do this. I wouldn't think the hospital would have the information on file already ... unless the kid has been treated there frequently. Usually those forms have to be turned in every time. But I'm not positive how civilian hospitals work .....  I just can't imagine the insurance paperwork already being on file.

#3 - July 17, 2010, 09:12 AM
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If you change it to be in Canada, all he would have to do is give his insurance number.  I'm not sure about the reporting or rules about contacting parents, but he could be seen without much delay as long as he knows his insurance #.

In the US, I don't think it's that easy.  Once when I was a kid, my grandparents were taking care of me and I was really ill so they took me to the ER.  The people in the ER wouldn't see me until they had confirmation from a parent that they were allowed to do so.  I couldn't get in touch with my mom (who is my sole guardian), so I had to call my dad and then they gave me treatment.  Although...if you do want to have something like that in your plot, you could have your character call someone who pretends to be a parent.  In my situation, they did nothing to verify that the man on the other end of the line was really my father (and they didn't pay attention to the fact that he's not my legal guardian at all).  So, that might be something.

hope that helped a little!
#4 - July 17, 2010, 09:18 AM

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Most of my knowledge comes from my years of working on the tv show ER so take it for what it's worth but yes I believe parents must be reached before any treatment unless the child is near death in which case the doctor is allowed to make decisions. Unless is a very small hospital that only really treats locals I doubt they would rely on insurance being on file. As far as I know, you must always show proof because it mightve changed. That said, it's illegal to refuse to treat someone who doesn't have insurance.

If they say it was an animal attack and he's given a rabies shot I'm pretty sure that animal control has to be contacted as well as whoever it is that keeps track of infectious diseases but not positive about the disease part. With a minor, they would want him to stay until a parent arrived to take him home and to receive instruction on follow up shots, etc. I think you could get around some of this if he was 18, but the billing and insurance would still be issues (although I don't think you'd need to go into detail about it). Also I agree that if his injuries were minor and the hospital a busy one, he would likely wait several hours to be treated. Is maybe a med center an option? They tend to have less people waiting. Just a thought.
#5 - July 17, 2010, 09:57 AM
« Last Edit: July 17, 2010, 10:00 AM by valeriek »
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Yeah .. that's right I forgot about that .. insurance could change .. because still in the United States people have private health insurance under a zillion different providers. If you change jobs or lose your job, your insurance will change or your employer might switch carriers or something.  And if it's non life threatening .. the kid might be turned away without proof of insurance .. unless the kid happened to be carrying enough cash or a credit card to pay for the care outright. That's another angle you can take ... the kid just says he's uninsured and he can pay .. or he can offer to pay in installments or something.

A med center or minor emergency clinic is like a 24 hour doctor's office ... or at least a later than usual hours .. and it's walk in .. no appointment needed.

#6 - July 17, 2010, 10:07 AM
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I can't comment on much of this, but I will agree that ER visits for non-life threatening conditions can be hours.  And, yes, no matter where you go -- ER, doctor's office for a routine visit -- they ALWAYS ask about any changes in insurance (I can't tell you how many times I've been to the pediatrician with different kids over the course of the week, same receptionist who knows us well, and she always checks that.  They have to.)
#7 - July 17, 2010, 10:15 AM

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Yes, waiting in ER can take HOURS!! It just depends on how busy they are and how much more urgent the other patients' cases are.

Just a side note on rabies shots: they have changed them from the 26-shot series in the stomach or whatever it used to be. Now it's just one or two, and not in the stomach. So that's something to check on as well. (I don't know if sarah_create is on, but I know she knows something about current ones.) Just in case that affects your story...
#8 - July 17, 2010, 10:53 AM

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Thanks for the replies, all!  Sounds like I may have to figure out a way for them not to go to the hospital to make things work (even in Canada, the animal control involvement could become an issue).
#9 - July 17, 2010, 05:19 PM
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I'm just confirming what you've already been told, but from personal experience. Several years ago I was attacked by a feral cat and had to get the series of rabies shots; I had my first in the ER. The Board of Health was definitely involved in contacting me for follow up, and the ER doctor reported it to them.  The only way to avoid getting the entire series of shots is if the animal is captured and killed so they can test its brain stem for signs of rabies infection, or if it's quarantined for several days and doesn't die from rabies, you can skip the last couple shots. (We had captured the cat so we were able to quarantine it, at least.) If the animal isn't captured, I think you'd be strongly encouraged to get all the shots with all appropriate follow-up. I remember some strongly worded and scary handouts!

And that is probably more than anyone needed to know!
#10 - July 17, 2010, 06:25 PM

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I did get a couple stitches at 17 without my parents being around. They were called (no answer), but it was a small town hospital and it was near midnight. I'm not sure how rabies shots/health dept./animal control would effect that? But I imagine it's possible if the injuries aren't serious and no adults can be reached. Anyway, even if the hospital says to stay, it's not like they put you in handcuffs. I smell a good sneak-out scene...lol.
#11 - July 17, 2010, 08:03 PM
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Check out HIPPA and the state laws wehre your story is set

it may be the other way around - that the hospital / clinic would not be allowed to inform the parents even if they called...depending...

Also if you want to save the hours of wait time, consider having your MC's friends take him to an ambulatory care clinic...and it would help speed things along if he had his insurance card in his wallet!!!

(and from what you posted....it sounds exciting!)
#12 - July 19, 2010, 02:37 PM
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Back in 1998 here in NY, we had a bit of a run in with a bat.  Everybody in the family except me had to have rabies series.  The local public health agency was notified and that was where we had to go to get the shots.  The shots were set up on a doubling scheme.  I looked up my kids immunizations and found that there were 5 shots given.  After you got the first one the next was 2 days later, then four days after that shot was the next, then one week after that and finally two weeks after that.

My husband was unlucky enough to have another run in later, maybe a year or two afterward.  Because he had already been through the series, he only had to have one booster.  This might work for what you are trying to accomplish with your MC if you can come up with a reason why he had to have them before.

With the bat there were no animal control issues like there might be with a dog.  Because we were concerned for our kids, we didn't skip the shots, so I can't say what would happen if you did.  (There was a terrible tale going around at the time about a local young girl that had been near a bat but nobody thought she had contact, so they didn't get the shots.  She died of rabies later.  Scary!!  :ahh )
#13 - July 23, 2010, 07:27 PM

I have a character who is attacked by a creature of some sort, badly scratched and bitten.  His friends take him to the emergency room of a local hospital and say it was a feral dog that attacked him.  The doctor who treats him is naturally concerned about rabies. 

Could he simply not go and get away with it or would it be more difficult than that?
Rabies shots are given as a series. They hurt a lot!!  (I was given a couple shots "in advance" because of some foreign countries I've lived in and the high risk because I would be in places where rabies was very common. Getting some of the shots in advance basically buys time, but more shots are still needed if exposed/bit/scratched.)

As to if he could get away with not going in: I think it would depend on the hospital or clinic if they would follow up and make sure the kid got the shots. I suspect he could get away without getting the follow up shots, if the setting was set up that way. Which could create some interesting plot points.

Good luck with your story.
#14 - July 30, 2010, 10:55 PM
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