It's 4 a.m., and you're pretty tired. You've been running nonstop for the past seven hours, confronting the advanced clinical challenges of a lady with a migraine who couldn't decide if she wanted to go to the hospital, an 18-year-old kid with constipation, a drunk who really was just drunk, a guy who had paid the price for provoking a bar fight, and a wedding planner who woke up with a strange rash he wanted you to see. Now you're on your way to the private residence of a 78-year-old man who's called 9-1-1 because he can't pee.

     You arrive to find Larry Findall, the gentleman described, seated on the edge of his bed in his pajamas, pale and diaphoretic and obviously in pain. He's alone in the home. His only history is osteoarthritis and a 15-year-old diagnosis of benign prostatic hyperplasia (BPH). He says he became totally unable to void urine for the first time in his life about six hours ago. Every attempt feels like he's peeing razor blades. He's ashamed to have bothered you, but he just couldn't wait any longer for help. He's shivering and afebrile. There are no other complaints, and you note no discharges. He takes no meds, has an allergy to Demerol and is afraid to drive after dark. He's lost his credit cards, he's on Medicaid, he doesn't have the cash for a cab ride, and he's asking you to please "help him out."

     Q. These are the kinds of calls we run every shift, while the units around us are handling cardiac alerts and trauma calls. We've begged our administrators to organize a training program for the public to teach them what an emergency is, but they have better things to do. How can we convince them their inaction is wasting emergency resources?

     A. I hear you talking—truly. Sometimes you find yourself running call after call that no one could possibly define as an emergency, and yet there you are. It happens to EMS crews all over the world, and it happens in EDs as well. Several American EMS systems tried your solution in the mid-1980s and learned that—like it or not—people pretty much define their own emergencies. Always have. Always will. But don't let your guard down too much or you'll miss some emergencies whose owners (like Mr. Findall) really need you to understand what's happening to them.

     Q. Right, like being unable to urinate is an emergency. What are we going to do for this guy anyway? Take him to the hospital? He could get that much service from his next-door neighbor.