When it is the emergency room, not the clinic.

Weeklies run corrections in a box on page two. This desk runs one correction, on every page, every week, because the thing it corrects never stops being true: a chiropractic clinic is not an emergency room, and a website that sends you to a clinic is obligated to say when it should send you somewhere else.

The list

Chest pain, a sudden severe headache, weakness or numbness on one side, trouble speaking, a loss of bowel or bladder control, or a head injury with vomiting or worsening confusion is an emergency room trip right now, not a call to a clinic.

To that list, for head injuries specifically, add: a headache that is getting worse rather than better, repeated vomiting, increasing drowsiness or confusion, a seizure, unequal pupils, or slurred speech. For the spine, add: numbness or weakness that is spreading rather than settling, or loss of feeling in the saddle area. For anything, add: you are frightened and cannot say why. The ER would rather see you than not.

Why the list is on every page

Because the desk's one column is "get examined at the clinic this week," and advice like that is dangerous without a fence around it. The fence is this page. The two audiences are different: the clinic is for the strained neck that files late, the low back that will not bend for shoes, the concussion in its rehab phase after the ER has ruled out anything dangerous. The emergency room is for tonight.

We would rather a reader go to the ER for a headache that turns out to be a strained neck than go to a clinic for a headache that turns out to be something else. The cost of the first mistake is a long wait. The cost of the second is not something this desk is willing to be part of.

Stiffer versus worse

The hardest judgment call after a crash is the difference between expected and alarming. Expected: a neck that is stiffer on day two than day one, an ache between the shoulders, a headache at the base of the skull that is uncomfortable and steady. That is the lag, and the explainer covers it. Alarming: anything that is escalating, anything that is spreading, anything on the list above. Stiffer goes to the clinic this week. Worse goes to the ER tonight.

When you genuinely cannot tell, call someone who can. That may be an ER, a nurse line through your insurer or health system, or, during business hours, the clinic itself, which will tell you if what you are describing is not a clinic problem.

After the emergency room

The ER's job is to rule out the dangerous thing and stabilize you. It is not built to manage the six weeks after, and its discharge paperwork usually says so: follow up with a provider. That follow-up is where the injury clinic lives. Bring the ER paperwork, the imaging report if you were given one, and the discharge instructions to the first visit. Missouri Injury Clinic's published lanes are auto injuries, TBI and concussion rehab after acute injury, and sports injuries, and "after acute injury" is the phrase to notice. The clinic is the step after.

The call, when it is the clinic

Missouri Injury Clinic, three rooms, all closed 12 to 2 daily. South County (314) 530-5480, Hazelwood (314) 627-1411, O'Fallon (636) 280-0990. Say car crash, give the date, mention the head if the head is involved, take the earliest opening. The service desk page has the rest. This page is educational and is not medical advice; when in doubt, the emergency room is the answer, and the desk will never be annoyed that you went.