Triage and special situations

01 — When to call 911, when to go to the ER, when to treat at home

The decision framework is about time and resource urgency, not just severity.

Calling 911 means activating paramedic-level care with equipment that a car does not have. Going to the ER yourself means faster personal transport but no care en route. Home treatment means the injury or illness is unlikely to worsen significantly without medical intervention. When in doubt, 911 is the conservative and often correct choice — 911 dispatchers are trained to help you assess the situation.

One consistent rule: if you are uncertain which category the situation belongs in, call 911 or Poison Control (1-800-222-1222) for guidance. Dispatchers are trained to help you triage over the phone.

02 — Dental emergency: knocked-out tooth

Time is the critical variable. The tooth must reach a dentist within one hour for the best chance of reimplantation success.

When a permanent tooth is knocked out (avulsed), how you handle it in the first minutes determines whether it can be saved. Handle the tooth only by the crown — the white part you can see. Do not touch the root. Periodontal ligament cells on the root surface are what allow reimplantation to succeed; contaminating or drying them significantly reduces the odds.

• If the tooth is dirty, rinse it gently with clean water or saline for about 10 seconds. Do not scrub it. Do not use soap, alcohol, or antiseptic wipes.
• If possible and the person is conscious, attempt to reinsert the tooth into its socket. Hold it by the crown, orient it correctly, and press it gently into place. Have the person bite down on gauze or a clean cloth to keep it in position. This is the best option.
• If reimplantation is not possible immediately, store the tooth in one of the media below and transport to a dentist or ER immediately.
• Call a dentist or ER now. Do not wait to see if it gets better.

Storage media ranked best to acceptable (AHA/Red Cross 2024 guidelines):

1. Hanks' Balanced Salt Solution — sold as Save-A-Tooth or similar products; highest rate of reimplantation success; best option if available
2. Oral rehydration solution (Pedialyte or equivalent) — good cell viability
3. Cling wrap/plastic wrap — keep the tooth moist and protected; better than leaving it dry
4. Cold whole milk — widely available and acceptable
5. The person's own saliva — held in the cheek, if the person is conscious and can cooperate safely

Note: these guidelines apply to permanent (adult) teeth only. Baby teeth are not reimplanted — doing so can interfere with the developing permanent tooth beneath.

03 — Eye foreign object

Do not rub. Do not try to remove embedded objects. Flush small particles; protect and seek care for anything larger.

The eye has strong self-cleaning mechanisms — blinking and tearing can clear most small particles of dust, sand, and eyelashes on their own. Rubbing the eye forces the particle into the cornea and can cause abrasions. The first response to any small particle in the eye is to blink several times and let the eye produce tears naturally.

If blinking does not clear the particle, flush the eye with clean lukewarm water. Tilt the head so the affected eye is lower than the other and flush from the inner corner outward using an eyecup, clean drinking glass, or a gentle stream from a tap or shower. Remove contact lenses before or during flushing if possible.

For chemical splashes: begin flushing with clean lukewarm water immediately and continue for at least 15 to 20 minutes. Keep the affected eye lower than the other while flushing. Call Poison Control (1-800-222-1222) for guidance on the specific chemical, and seek emergency eye care. Take the chemical container or note the substance name.

04 — Mental health crisis

Recognizing a mental health crisis is a first aid skill. Knowing the right number to call is part of having the skill.

A mental health crisis can include severe anxiety, panic attacks, psychotic episodes, acute depression, and suicidal ideation. First aiders are not expected to diagnose or treat these conditions, but they can recognize warning signs and take appropriate action to connect the person with help.

Warning signs that someone may be in a mental health crisis include: talking about wanting to die or to hurt themselves or others; expressing feelings of hopelessness or having no reason to live; suddenly giving away prized possessions; withdrawing from people and activities; dramatic and sudden changes in mood or behavior; talking about being a burden to others; increased use of substances; inability to carry out basic daily tasks.

If someone expresses suicidal thoughts, take it seriously and stay with them. Ask directly if they are thinking about suicide — asking does not plant the idea and can open the conversation. Listen without judgment. Remove or help them get away from potential means of self-harm if it is safe to do so. Call 988 together or encourage them to call. If there is immediate danger to themselves or others, call 911.

Do not promise to keep suicidal thoughts secret. Do not leave the person alone if they are at immediate risk. Do not argue about whether their feelings are valid. Do not minimize what they are going through.