How do you know when you're sick enough to need an ambulance? Katy Guest consults the emergency experts

The latest advertising campaign by the British Heart Foundation is trying to cure the nation's stiff upper lip. Its posters show a man's chest being squeezed by a belt of pain, and the advice: "a chest pain is your body saying call 999". According to the BHF, heart attack victims wait a breathtaking 90 minutes before deciding to call an ambulance, and those minutes are crucial.

But it is not just heart attacks that are ignored. According to Dr Adrian Reyes-Hughes, a clinical director at NHS Direct, too many people worry about being a nuisance. "Sometimes people, particularly older people, don't want to disturb the hospital," he says. So when should you swallow your pride and dial 999? The Independent's Dr Fred Kavalier; the BHF's director of prevention and care, Mike Knapton; and NHS Direct's Dr Adrian Reyes-Hughes offer some advice.

Severe chest pain

Chest pain indicating a heart attack is often described as a crushing pain accompanied by a general feeling of being unwell, says Mike Knapton. It usually spreads to the jaw or the left arm, but don't wait for that to happen. Richard Diment, chief executive of the Ambulance Service Association, says: "We would rather attend a false alarm than arrive too late." In some ethnic minorities, heart attacks feel more like indigestion - so call 999 to be safe.

Deep wounds

Sometimes a stab wound is obvious - other times it can be difficult to see. If a victim has been stabbed with a long knife or knitting needle the wound may be small, but they may be bleeding internally. They may be cold, clammy and grey and become confused.

A sudden and severe headache

A headache that comes on "like a thunderclap", particularly at the back of the head, can indicate a stroke or similar condition. Often the victim is still able to call an ambulance for himself, but may soon become confused. A subarachnoid haemorrhage, similar to a stroke, feels like being hit on the back of the head with a baseball bat.

Severe allergic reaction

Reactions that follow eating or touching certain substances, such as peanuts or shellfish, can indicate a serious allergy. Symptoms can include difficulty breathing and swelling of the mouth. The victim often turns bright red.

Severe burns and scalds

Often the severity of a burn or scald is evident from the intensity of the pain. The victim can go into shock and will look cold, clammy and sweaty. Often they will feel sick and become confused. A severe burn is indicated by swelling, and does not have to cover a large area to be a danger.

Heavy blood loss

It is often difficult to know how much blood a person has lost, says Dr Reyes-Hughes. "A little goes a long way." But if an accident victim has blood coming through his clothes, or there is blood on the ground, call an ambulance.

Broken bones

Broken bones do not always puncture the skin, but often the pain is bad enough to know that an ambulance is necessary. Sometimes the break will cause a lump to form under the skin.


A high temperature, drowsiness and a purplish rash, particularly in a baby, are warning signs of meningitis and mean an ambulance is needed. If meningitis is suspected and there is no rash, use your common sense - is the person's level of consciousness decreasing? A rash does not always indicate meningitis. Try pressing it hard with a clear glass - if it is purplish and does not disappear it is likely to indicate meningitis.


If a person cannot be roused, he is probably unconscious. Even if you think he's drunk, says Dr Reyes-Hughes, you should call an ambulance - he might deteriorate further. Unconsciousness is also indicative of other conditions, such as diabetic coma, overdose, stroke and head injury.

Suspected stroke

The victim often experiences a sudden, severe headache and may become confused. Their emotional status could change and they may appear miserable or drunk. Speech becomes slurred and movement may be lost down one side, making the limbs floppy. There may be a sudden or gradual loss of consciousness.

A baby or adult turning blue

"If somebody has actually stopped breathing it is obviously a much more acute emergency," says Dr Fred Kavalier, "but turning blue is a good sign it's time to call an ambulance." Turning blue indicates that a person has stopped breathing or is having difficulty breathing, possibly because they are having a severe asthma attack.

Difficulty breathing

Asthma can be a killer. An asthmatic who is not responding to their inhaler, and whose breathing is getting worse, should call an ambulance. "Generally, if breathing difficulties are making it impossible to speak and are not getting any better after five or 10 minutes, call 999," says Dr Kavalier.