Sometimes you may need medical treatment for a self-inflicted injury. If a cut is gaping (the edges don't stay together) or you can see fat or tissues underneath, if a burn is blistered and larger than the palm of your hand or charred and bigger than an inch (25 mm) in diameter or chemical, if you can't get bleeding to stop -- all of these conditions warrant immediate medical care. If you are showing symptoms of shock, you should phone an ambulance immediately.
If you are brought in by ambulance, you will immediately be taken to the treatment area.
If you walk in, you will first speak to a registration clerk. You can give the clerk your ER checklist and ask that she pass it on to the triage nurse. You'll be asked general questions about what's wrong and be asked to sign forms consenting to treatment. The clerk may also want to photocopy your insurance card. Then you'll be told to have a seat and wait until the triage nurse can see you. If the main waiting room is busy and you're freaked, you can ask the clerk about waiting somewhere quieter.
Triage just means sorting -- the triage nurse assesses people as they come in and decides which cases are most urgent. You will probably see him in a small room or cubicle. If he doesn't seem to have read your ER checklist, point it out to him. He'll ask you more specific questions about the injury and may ask you about any suicidal feelings you might have. He'll also take your pulse, blood pressure, and temperature and ask about your medical history. He may also briefly examine the injury. You can ask the triage nurse to have someone contact your therapist, if she's available. She can help ensure you get useful, appropriate treatment.
In most cases you'll then go back to the area in which you were waiting until a spot is open in the treatment area, but you might be taken to the treatment area instead. It may seem like you're having to wait an unfairly long time, but the emergency department usually see ambulance patients first, then calls other people back in order of the severity of their problem. When you finally do get called to the treatment area and your friend is up to it, it's okay to ask if he can come back with you.
The treatment area is usually a large open space with many beds. In some hospitals, each "bed" (really more like a gurney or examination table) is in a small treatment room; in others, the beds are divided by floor-to-ceiling curtains that can be closed all the way around the bed. The lights will probably be very bright. You'll be shown to a bed and may be asked to remove clothing, depending on what needs to be treated. If so, you'll be given a hospital gown to put on. The person who takes you to the bed should tell you where to put your things; if you need to hold on to your safe object it's usually okay to do that.
A medical assistant or a nurse will come in and go over what you've said so far. There will be more questions and a more detailed examination of the wound. At some point, a doctor will probably examine you and treat the wound. It may take quite a long time for you to be treated; be patient. Getting upset and demanding to see someone will only make things more difficult in the long run. Getting extremely upset may get you put in restraints or isolation. Practice deep breathing or other grounding, soothing exercises to help yourself stay as calm as you can. Focus on your safe object.
The person who treats the wound will probably ask you questions about the injury -- why you did it, whether it was a suicide attempt, maybe what was going on before it happened. Try to be as clear as you can -- the more they understand you, the more likely it is you'll get the treatment you need.
Unfortunately, some people in emergency care are ill-informed about self-harm. If someone is treating you roughly (stitches without numbing, rough cleaning of wounds, rude remarks), it's okay to ask to be seen by someone else. This is a time when it would be good to have a friend to advocate for you. It's also a good idea to have a sound bite to repeat to the person who's treating you badly, something like, "Yes, I hurt myself, but even though it's not an effective coping mechanism it's all I have right now. I'm trying to find others." You can also ask them to read the bill of rights for those who self-harm or this guide for emergency workers.
After your wound has been treated and bandaged, you may be given care instructions and sent home. On the other hand, you may be asked to talk to a social worker or psychiatrist before you can go. If you feel a psych evaluation isn't necessary, you can try explaining that. Some hospitals have policies they must adhere to, though.
This isn't as scary as it sounds. You may be taken to a quiet secluded room to wait for a social worker or psychiatrist; try to stay calm. The nurse escorting you will ask you if you have any dangerous tools with you and might go through your backpack or handbag to be sure. The evaluation may start with what's called a mental status examination -- some really simple questions (What day is it? Where are you? Who's president/prime minister?) designed to figure out if you're aware of reality. Then the person evaluating you will ask you some questions about why you hurt yourself -- what was going on just before, what were you feeling, maybe how else you might have coped.
You'll also be asked about your degree of suicidal intent; it's important to answer this honestly. The psych evaluation isn't a contest, and it's not necessarily about staying out of hospital. It's meant to be a collaborative effort in which you and the evaluator work together to get you the best treatment possible. It's okay to feel angry and scared, but venting your anger on the person doing the evaluation will only prolong the exam.
If you feel safe going home, it may help to come up with a safety plan -- what you will do if you get another urge. Your having and being able to explain a safety plan will make the person doing the evaluation more comfortable with letting you go home. In that case, you'll be given wound care and followup instructions and be allowed to leave.
If you're very upset, delusional, or suicidal, you may be asked to stay in hospital for a day or two. Someone will bring more paperwork for you to sign, and you will be escorted to the psychiatric ward. There you will talk with nurses or mental health aides about what brought you there. They'll also check your vital signs, assign you to a room, and explain how the ward works. You'll also have blood drawn for testing in the first hours you're there, and meet with a psychiatrist sometime during the first day to discuss what you can get from being hospitalized, to set concrete goals, and to work on a treatment plan that will enable you to meet those goals.
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Going to the emergency room for treatment may seem frightening, but if you prepare yourself and stay grounded you can get the treatment you need without too many problems. Sometimes, though, you may receive rough or painful treatment or may be spoken to rudely and sarcastically by the emergency department staff. If this happens, take note of the names of the abusive staff and ask to be treated by another provider. When things are calmer, you can file a formal complaint with the hospital.