All the new advice lines and out of hours services can be confusing when you need to seek medical help in a hurry and the practice is closed. A review of our patients' recent attendances at Royal Berks A&E suggests that some people could have been more appropriately seen elsewhere. So what is available?

NHS Direct (tel 0845 46 47): 24 hr telephone helpline staffed by experienced nurses. Usually a good place to start for advice about whether to seek further help

999 : Serious emergencies or trauma only. A paramedic will normally attend within 10-15 minutes. Only use in absolute emergencies.

GP out of hours service (tel: 0845 345 8995): evenings and 24hrs/day at weekends. For the problems that you would normally see your GP about  during the week. Staffed by GPs, nurses and paramedics. Full time base in Abingdon, part time surgeries held at Townlands Hospital, Henley. Phone first and you will be given advice or an appointment.

Minor injuries unit, Townlands Hospital Henley. 0800-2000, seven days a week. For injuries and trauma. The experienced nurses deal with injuries, cuts, burns etc and can carry out stitching. This is a great service and a good way of avoiding the long waits at Royal Berks A&E.

Royal Berks Hospital Accident and Emergency. 24hrs/day. For serious emergencies or trauma. Good for major problems or accidents. Anyone attending with a minor problem can expect to wait several hours and those attending with a problem that is not a medical emergency or trauma may not see the most appropriate doctor.
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Why our own section of advice on emergencies?  

You may well be wondering - Of course we know you would be unlikely to rush to your PC if you had an accident or emergency to deal with.

What we hope, rather, is that you will read through this section carefully and so be informed about best ways to cope with situations that can be alarming as well as serious.  You will then be better prepared for such an eventuality.

You may also wish to print out these pages and have them ready as a handy guide for times of crisis.

EMERGENCIES - Recognition & Aid

Anaphylactic (allergic) shock 
Bleeding (severe) 
Broken limb
Electric shock 
Emergency contraception
Emergency dental treatment
Head injury
Heart attack 
Stroke

Anaphylactic shock

Anaphylactic shock is a life-threatening allergic reaction. Usually, but by no means always, it is a reaction to something to which the victim is known to be allergic e.g. nuts, wasp sting. The initial symptoms are: chest tightness, difficulty in swallowing, sweating and looking pale. These are followed by breathing difficulties and possible collapse.

Anaphylactic shock demands immediate action and speedy injection of adrenaline (epinephrine).

Those known to be at risk should always carry an EPIPEN - a device to enable easy self-injection of the required dose of adrenaline (available on prescription). Inject first, then Call for Help 999

Bleeding (severe)

If blood is gushing from a wound, urgent action is needed. Apply direct pressure to the wound with the hand. If you know or suspect something (e.g. glass) is in the wound, press round it.

If other injuries allow, lay the patient down and raise the injured limb/area. 

Even less serious head injuries often bleed profusely. Apply pressure round the wound.

Note  Nosebleeds are rarely serious: head forward, pinch nose firmly and continuously for 15 - 20 minutes and apply cold compress, if available, to the forehead

Broken limb

Obvious fractures need to be taken directly to the Accident & Emergency Department at the Royal Berkshire Hospital.

Suspected fractures (e.g. ankles or wrists) could be assessed by the nurses/doctors in our treatment room between 9-00 a.m. and 6-00 p.m.

After 6-00 p.m. the Minor Injuries Unit at Townlands Hospital, Henley is very helpful for cuts and bruises.

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Electric shock

Do not touch the victim until the power has been switched off.

If it cannot be switched off, try to break the victim's contact with something non-conducting. Make sure you are standing on something dry and use, say, a long-handled brush.

Once the source of the shock has been removed, begin resuscitation. 

Emergency contraception

Every now and again couples make a mistake with contraception or don't use it when they should have. Emergency contraception using a pill is available free from the health centre providing the female partner sees a doctor or nurse as soon as possible but certainly within 72 hours of unprotected sex. There is no need to tell the receptionist what the appointment is for, just let them know that you need to be seen today.

There is an alternative method that involves fitting a coil or intra-uterine device and is effective within five days of unprotected sex. The important thing is to come and get advice as soon as possible.

The service is available for anyone who thinks that they might be at risk of an unwanted pregnancy, whatever their age. We suggest that those under 16 who are sexually active discuss contraception with their parents but we will not tell anyone, including parents.

Emergency contraception can also be purchased form local pharmacies by those over 16 for approximately £20 and is available free from the Accident and Emergency dept at the Royal Berks Hospital and from the Family Planning Clinic in Craven Road, Reading.

Head injury

Any head injury which causes the victim to have even a short temporary loss of consciousness (say 5-10 seconds) needs to be seen at the Accident and Emergency Department.

Most people have a headache, look pale and feel sick and not with it. This is concussion and should last only about 3-4 hours.

If you are worried or if any of the following symptoms develop, then call the Health Centre for advice on (0118) 972 2188:

• double vision

• severe headache

• confusion/speech disturbance

• vomiting

• neck stiffness

Heart Attack

The pain of a heart attack usually comes on suddenly, but is not always severe. It typically lasts for 30 minutes or more and is not relieved by rest or GTN spray.

The pain is usually a pressure in the centre of the chest which may pass down the left arm, up to the neck, into the jaw and giving a feeling of weakness. 

There may also be

• shortness of breath

• cold sweat

• nausea and/or vomiting

• unconsciousness

For further information:

British Heart Foundation

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• Sudden weakness or numbness of the face, arm or leg on one side of the body.

• Sudden difficulty speaking or understanding speech.

• Sudden blurring or loss of vision - particularly in one eye. 

The latest treatments work best when given within the first few hours and early intervention cuts the risk of further, more serious strokes.

If these symptoms last for less than 24 hours, then this is called a 'Transient Ischaemic Attack' or TIA. They are more common than strokes but need to be treated. Ring the Health Centre on 0118 972 2188 and ask the advice of the on-duty doctor.

For further information

The Stroke Association, Stroke House, Whitecross Street, London EC1Y 8JJ
Tel: (0171) 566 0300

If you are certain you don't need immediate help, phone (0118) 972 2188, day or night. Outside working hours you will be transferred automatically to the doctor on duty who will be one of the doctors from Sonning Common or from another local practice with which we have reciprocal arrangements. You may be invited to attend a local out-of-hours medical centre.

Alternatively you may attend the Minor Injuries Unit at Townlands Hospital, Henley which is open 24-hours a day.

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© 2002 Sonning Common Health Centre