What happens at A&E?
If you self-harm and need immediate medical assistance, your nearest Accident and Emergency (A&E) department is the first place to go to. TheSite.org finds out what happens when you get there.
Each year, around 25,000 admissions to hospitals in England and Wales are made by young people who have self-harmed. All hospitals now have guidelines in place for dealing with young people who self-harm in order to make the environment as supportive and comfortable as possible. This means that when you arrive you should be given the same amount of respect, care and compassion as any patient.
Knowing when to go
If you need medical attention it's crucial to get yourself checked out. You can tend to some minor wounds yourself, but if you've hurt yourself badly, call an ambulance or make your way to the nearest hospital.
"If you've taken an overdose you should always go to the emergency department," says Dr Katie Muscroft, who works in A&E. "If you've cut yourself superficially (not fully penetrated the top layer of skin) give your wound a good clean with soapy water. If it's very deep, you feel it might need stitches, or is bleeding excessively, go directly to A&E."
Not every hospital has an A&E department; some hospitals have minor injury units that can deal with cuts and bruises, but usually wouldn't treat someone who came in by ambulance. You can find your nearest A&E department on the NHS website.
The primary aim of A&E is to ensure your physical injuries are dealt with as soon as possible. When you arrive, a 'triage' assessment will be made to determine how critical your physical injuries and state of mind are. These are categorised as 'minor' or 'major', with the most life-threatening prioritised. You'll either be directed to a bed or asked to wait in the waiting area.
The two most common forms of self-injury at A&E are cutting and overdosing - also referred to as 'self-poisoning'. Each case will be different, but the most likely emergency procedure for these is as follows:
If a professional can help from the start, you can get the help you need as soon as possible.
- The doctor will ask what has happened, what you cut yourself with; when, where and why you did this.
- You will be asked if you have a history of mental illness. As the physical injury is only one part of the emergency, this needs to be known so you can be suitably cared for.
- Your wounds will be cleaned and the doctor will look to see how deep the cuts are. If the wound isn't very deep and there doesn't seem to be any nerve or muscle damage, it can be closed with paper stitches or medical glue.
- If the wound is particularly deep, a local anaesthetic to numb the area can be given.
- If there is damage to the nerves and muscles, you may be referred to a specialist, such as an orthopaedic surgeon or plastic surgeon. They may perform an operation, which is usually done the same or following day.
Self-poisoning and overdosing
Sometimes ambulance staff may need to give you treatment before you reach the emergency department. Depending on individual circumstances:
- The doctor will need to know what you've taken, when you've taken it and how much.
- Within an hour of taking the overdose you may be given a drink of 'activated charcoal' - a black, unpleasant-tasting drink that prevents the stomach from absorbing the poison.
- Blood tests will be taken and paracetamol levels checked. It will depend on the amounts taken as to when you may be treated. If there's evidence to suggest a very large overdose, treatment will start immediately, otherwise they will wait to find out the levels.
- A drip treatment may be given to you via a cannula (a plastic tube inserted into a vein in your arm) and may need to remain in place for up to 24 hours.
- For some overdoses, you may just need observation in the hospital, sometimes for up to 12 hours.
Talking to the doctor
Going to A&E may be the very first time someone else has seen the effects of your self-harm. There are several options the doctor can take before discharging you, but the most important thing is that they feel you aren't at risk of seriously harming yourself.
An important part of this process is assessing your mental and emotional state. This assessment may be done by a duty psychiatrist or psychiatric nurse. You should try and be honest about your feelings, including whether you have any suicidal thoughts.
"You should talk to someone about why you felt the need to cut yourself, and if you want any help," says Dr Muscroft. "If a professional can help from the start, you can get the help you need as soon as possible."
Unfortunately, A&E doctors don't always have the time they would like to chat to a patient, and not every hospital has a social worker or Community Psychiatric Nurse (CPN) for you to talk to either, but things are slowly improving. If this is the case, the hospital should try to make sure that you will be put in touch with someone who does have time to talk to you.
Written by Chris Chapman and Dr Katie Muscroft
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