This week I'm going to shamelessly steal the idea for my column from a health promotion brochure I received at work. One of the articles was titled, "When You Should Call 911." I'm sure most of you have a good idea of when to call 911 or take someone to the Emergency Room. This is by no means an exhaustive list - just a few basics.

The first thing to remember in any potential emergency is to limit the number of victims - this includes you. If you are at the scene of an accident, make certain the scene is safe before jumping in to help. This includes things like liquid or gaseous chemical spills, downed power lines, deep or fast water, etc. If possible, always activate 911 as quickly as possible, preferably before you attempt to help someone.

Two of the most common symptoms that require emergency care are chest pain and shortness of breath, often documented by medical personnel as "SOB." I once had a patient that was irate after reading his ER report and saw that the doctor had labeled him an "SOB."

Most people should be aware that chest or upper abdominal pain may be a warning sign of a heart attack. Unfortunately, tens of thousands of people each year ignore this symptom and end up having major heart damage or die from not taking it seriously. This is especially true of women who are more prone to disregard chest pain. Medical professionals have a saying: "time is muscle" - the longer you delay treatment of a heart attack, the more heart muscle you lose.

Chest pain in someone with known heart disease should prompt a call to 911. Chest pain that comes on with exertion, goes away with rest, does not go away at all, is associated with trouble breathing, or radiates into the neck, jaw or arm should also result in a trip to the ER. These folks, unless allergic, should also chew four baby aspirins (81mg) or an adult aspirin (325mg) - something every home first aid kit should contain.

Shortness of breath can also be a sign of a life-threatening emergency. There are many causes of SOB, but heart and lung disease are the most worrisome. Those who have known asthma or COPD (emphysema) who are having difficulty should be seen in the ER, especially if they have a history of previous visits to the ER or admissions to the hospital. A good rule of thumb is if a person can't talk or can only talk in short sentences, they should be seen emergently.

Trauma is another common emergency. The biggest concern other than trouble breathing or bleeding is injury to the brain or spinal cord. Any accident that involves a rapid force being applied to the head or neck (from being punched to wrecking a car or motorcycle) can result in brain and/or spinal cord injuries. These injuries may or may not result in unconsciousness. You should assume that any blunt force injury above the collarbones has caused a spinal injury, especially if the person has neck pain.

People suffering these injuries need to be handled by trained professionals if possible. If the person is having trouble breathing or is bleeding heavily, they may need to be moved out of necessity to attend to those problems. Otherwise, do not move them (even if face down) or allow them to walk around until help arrives.

Dr. John Roberts is a family physician. He is also one of the owners of The Paper of Montgomery County. Send him your question today by e-mail at