Ambulances are diverted from emergency rooms in the U.S. at the rate of one a minute, according to the Institute of Medicine at the National Academy of Sciences. It also says that the system is over­burdened and underfinanced. Frederick Blum, M.D., past president of the American College of Emergency Physicians, agrees. “The emergency-care system is stretch­ed to the breaking point,” he says.

Improving emergency care will require government and industry help, including strong guidelines to reduce ambulance diversions and crowding. Since ERs treat the sickest the quickest, noncritical patients don’t seem to be the problem. The worst logjams occur when patients must wait to be moved from the ER to hospital beds.

Here’s what you need to know when you need emergency care:

Go--quickly. If you think you’re having a medical emergency, you probably are, experts say. Get to an ER fast if you have severe physical trauma, sudden chest pain, serious blood loss, a possible broken bone, a sudden inability to use a limb, loss of vision, or an “explosive” headache.

Know the alternatives. Conditions that rarely, if ever, warrant emergency care include mild respiratory infections, minor aches and sprains, scrapes and bruises, and prescription refills. ER charges can run hundreds of dollars or more, and insurers might not pay if the problem isn’t a true emergency. If your doctor isn’t available, seek an urgent- or immediate-care center, such as MinuteClinic and RediClinic, which are open after-hours and on weekends.

Don’t drive yourself. Dial 911 for an ambulance. You can request that it take you to a hospital known for handling your type of emergency--cardiac, stroke, or trauma, for example. But if your condition is grave, it’s generally best to let the paramedics take you to the nearest ER that they consider equipped to handle your problem and that is accepting patients. You can transfer to a different facility later.

Rally the troops. The contacts listed under “ICE” (in case of emergency) in your cell phone should be able to provide your vital medical information and act as your advocate. Family and friends can help ensure that you get the best care possible by asking doctors and nurses about testing and treatment options.

Follow up. Before you leave the ER, get your diagnosis, follow-up instructions, and the names of the doctors who treated you. Within a week, ask the hospital for a copy of the emergency-room report, which should include any notes taken by doctors and nurses, and your lab results. Also ask for an itemized bill, and dispute any discrepancies.