Emergency rooms across southwest Virginia

When you need emergency care in southwest Virginia, you want to know you are getting the best care as quickly as possible. That is what you receive when you choose a LewisGale Regional Health System ER. We offer ERs in our four full-service hospitals and Cave Spring ER, a freestanding ER.

If you are experiencing a medical emergency call 911 immediately. Patients can check our ER wait times online or by texting "ER" to 32222.

Our board-certified emergency medicine doctors and specially trained support staff stands ready 24 hours a day, 365 days a year to provide you with high-quality, compassionate care.

When should you go to the ER?

It's not always clear when you should go to the ER and when you should wait. But, knowing what to do could save your life in a medical emergency. The following symptom information may help you evaluate if your symptoms warrant a visit to the ER.

The flu virus is very common and does not normally require a visit to the ER. But, for the high-risk populations listed below, it can be very serious:

  • Infants
  • People 65 years old and older
  • Pregnant women
  • People with certain diseases, such as asthma or chronic obstructive pulmonary disease (COPD)
  • People with weakened or compromised immune systems

Signs that you should go to the ER with the flu include:

  • Trouble breathing
  • Vomiting that can’t be controlled, to the point of severe loss of body fluids (dehydration)
  • If you develop complications such as pneumonia
  • Still not sure? Consult our cold/flu/stomach flu symptoms chart for more information.

Stomach pain is the most common reason patients visit the ER. Everyone experiences stomach pain at some point. It can result from a variety of causes and occur in varying degrees of severity. So when is your pain serious enough to go to the emergency room?

You should seek immediate medical attention if your stomach pain is accompanied by any of the following symptoms:

  • Stomach is hard and/or tender to the touch
  • Persistent nausea or vomiting
  • Inability to eat without nausea or vomiting
  • Pain in your chest, neck or shoulder
  • Shortness of breath or dizziness
  • High fever
  • Irregular heartbeat
  • Dark or black stool
  • Vomit contains blood

Respiratory distress can be the result of chronic conditions, like asthma or emphysema, or something more serious, such as heart failure. Signs that you should seek emergency medical treatment include:

  • Breathing stops
  • Severe shortness of breath that affects your ability to function
  • Noisy, high-pitched and rapid wheezing
  • Coughing up blood
  • Inability to speak comfortably and sustain voice while at rest
  • Breathing difficulties when you lie flat
  • Breathlessness that doesn’t stop after 30 minutes of rest
  • Or if your trouble breathing is accompanied by any of the following symptoms:

    • Back or arm pain
    • Pain or tightness in chest
    • Extreme fatigue
    • Swelling in your feet and ankles
    • High fever, chills and cough

Call 911 right away if you have chest pain that is crushing or squeezing and comes with any of these symptoms:

  • Sweating
  • Shortness of breath
  • Nausea or vomiting
  • Pain that spreads from the chest to the neck, jaw or arms
  • Lightheadedness
  • Fast or irregular pulse
  • Signs of shock

Signs of a heart attack may show up in other ways in women, and may include:

  • Unusual fatigue
  • Shortness of breath
  • Nausea or vomiting
  • Dizziness or lightheadedness
  • Discomfort in your gut
  • Discomfort in the neck, shoulder or upper back

A concussion or any injury to the head can be very serious. If you have hit your head and have any of these symptoms, you should go to the ER:

  • Loss of consciousness, even briefly
  • Any period of amnesia or loss of memory of the event
  • Slurred speech
  • Feeling dazed or confused
  • Worsening or severe headache
  • Vomiting
  • Seizure

Most people will experience pain in their side or abdomen at some point in their lives, and it’s usually only temporary. However, severe side pain can be an indication of something serious.

If you have severe pain, especially in your lower right stomach, side or back, or if your pain is accompanied by any of the following symptoms, you should seek immediate medical treatment:

  • Fever
  • Dizziness
  • Persistent nausea or vomiting
  • Constipation
  • Diarrhea
  • Blood in the urine or pain during urination or have had a recent urinary tract infection (UTI)

Severe pain lasting only a few seconds may be nothing to worry about unless it’s reoccurring. If severe pain persists for more than a few minutes you should seek medical attention regardless of other symptoms.

Some common diagnoses may include:

  • Urological issues, such as a kidney infection, kidney stones or a bladder infection
  • Appendicitis
  • Ovarian cyst

Side pain can be an indication of a number of different medical conditions. If the pain is severe, it’s important to get it checked out by a medical professional.

If you aren’t sure whether you should come to the ER or wait for your doctor’s office to open, you can Consult-A-Nurse®, 24 hours a day, by phone at (877) 242-2362.

Advanced emergency care close to home

Our network of locations and emergency expertise make us the smart choice for ER care in southwest Virginia:

  • Multiple ER locations and short wait times
  • Fast Track ER for minor illnesses and injuries
  • All four of our health system hospitals are accredited Chest Pain Centers
  • Level III Trauma Center, available 24 hours a day, seven days a week
  • Board-certified physicians, nurses and clinical staff certified in emergency medicine and emergency nursing
  • Recognized for patient safety
  • Critical care and cardiac emergency bays to treat patients when every second counts
  • Comprehensive imaging services and laboratory testing on site
  • Emergency behavioral health care

Accredited Chest Pain Centers


All four of our full-service hospitals are Accredited Chest Pain Centers designated by the American College of Cardiology. This recognition acknowledges our superior efforts and results for incoming heart attack patients.

If you are admitted through one of our ERs for a heart attack, you can rest assured you will receive comprehensive inpatient cardiac care services.

Emergency stroke care

Stroke is a critical medical emergency where every second counts. It is vital to receive medical intervention within the first three hours of stroke onset to preserve brain cells and reduce the risk of long-term disability.

Our ERs partner with local emergency medical services (EMS) personnel to issue a stroke alert, which effectively begins stroke treatment before a patient even arrives at the ER.

Primary Stroke Center


LewisGale Medical Center is designated as a Primary Stroke Center by The Joint Commission in collaboration with the American Heart Association/American Stroke Association.

Mental health emergency care

A mental health emergency is a medical emergency. If you feel like you are a danger to yourself or others, seek treatment at your nearest ER.

Admission or referral for mental health care at all LewisGale Regional Health System facilities starts with an assessment through the ER at one of our four hospitals—in Salem, Alleghany, Montgomery and Pulaski—for patients who are in crisis.

For immediate evaluation, call LewisGale Regional Health System's assessment line at (800) 541-9992.

Pediatric-friendly emergency services

We know the littlest of patients need special care. To give you added peace of mind, we also use the specialized Artemis children's medication delivery system in all our locations.

FastTrack ER

LewisGale Regional Health System’s network of ERs in southwest Virginia offers a FastTrack ER option for patients. The FastTrack ER is designed to provide expedited medical care for patients coming to the ER with non-life-threatening conditions, but still require fast care from a medical professional. This is an ideal option for patients with less serious illnesses or injuries, such as flu-like symptoms or minor injuries and infections.

Unlike a walk-in clinic or an urgent care center, if your emergency becomes more serious, our FastTrack ER staff can quickly get you the care you need and even admit you to the hospital.

FastTrack ER services are available at:

  • LewisGale Medical Center from 11 a.m. - 11 p.m.
  • LewisGale Hospital Pulaski open 24 hours a day, seven days a week
  • LewisGale Hospital Montgomery open 24 hours a day, seven days a week

Our FastTrack ER is for minor illnesses and injuries that are not emergencies but require treatment within 24 hours. Use the ER entrance and check-in for our FastTrack ER.

If you or someone you know is experiencing an emergency, always call 911 first. If you would like to talk to a nurse about your symptoms or illness, you can Consult-A-Nurse® 24 hours a day by phone at (877) 242-2362.

What to expect at the ER

When you first get to the ER, a triage nurse will ask you about your symptoms and take some vital signs. Once you have seen a healthcare professional, a registration clerk will get information for your medical record and insurance. Whether or not you have insurance or can pay, you will be medically screened, evaluated and stabilized.

If you have a life-threatening illness or injury, you will be first to be treated in the ER, followed by seriously ill or unstable patients. All others will be seen in the order that they came to the ER. We strive to make your time in the waiting room as pleasant and as brief as possible.

What to bring with you to the ER:

  • List of medicines you take or the actual medicines
  • List of known medical allergies
  • A copy of results from any recent medical tests
  • List of recent medical procedures
  • Care preferences or restrictions
  • A responsible adult or phone number for someone to contact

Before you are sent home, ask any questions you may have about your care. Make sure you keep all your paperwork, discharge instructions and medicines if you receive any.

If you have a primary care provider listed in your medical record, we will give them a copy of your visit summary. Contact your primary care provider after you visit our ER. If you don’t have one, we can help you find a primary care physician.