What is considered a medical emergency

You might have read the phrase “in the case of an emergency” in our Benefit Guide or on our website, referring to conditions under which benefits will be available to you, when a co-payment might be waved, or what to do for Scheme administrative processes like obtaining an authorisation.

If you or a loved one gets hurt or you have a health concern, it might feel like the biggest medical emergency in your life. And it might even be the biggest emergency that you ever had. But is it considered a medical emergency in terms of the Scheme Rules, which are bound to the definition of ‘emergency medical conditions” in the Medical Schemes Act? Consider this scenario - a small child falls off a bicycle, causing her to badly scrape her face, which starts bleeding and swelling. This does sound like an emergency to many. Or if you are elderly, go for a walk and are attacked by a dog - this is traumatic and you might need to go to a doctor immediately. Both cases, while requiring urgent care, may not be considered a ‘medical emergency’ according to the Act.

The Medical Schemes Act 131 of 1998 defines an “emergency medical condition” as “the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a body organ or part, or would place the person’s life in serious jeopardy”.

 
This means that the following factors must be present before an emergency can be concluded:
1. This onset of your health condition must be sudden and unexpected. It can’t be a concern you had for weeks, or as a result of another condition which might cause you pain that one could expect.
3. The health condition must require immediate treatment (medical or surgical). If you don’t get treatment right away, but wait for next week, it would not be an emergency.
4. If not immediately treated, one of three things would result: serious impairment to a bodily function – in other words long-term consequences, serious dysfunction of a body part or organ – for example resulting in a damaged heart or lung, or death.

Our two scenarios above may meet none, some or all of the above criteria, depending on the severity of the injuries. In some cases only the diagnosis can clarify if your case is a medical emergency. This would be the case if, for example, you rush to the hospital, suspecting that you are having a heart attack. After examining you however, the doctor confirms that your pain is thankfully only caused by heartburn. At the point of doubt you would have to, of course, seek medical advice immediately. The outcome of the event will however determine whether your treatment qualifies as an emergency or not. This is the reason why it is so important to know your facts, your benefits and where to go in which situation.

MediBrief articles are not a substitute for professional medical advice, diagnosis or treatment. Seek the advice of a qualified healthcare provider if you believe that you might be suffering from a medical condition.