Painful Miscarriage?!

Patient: Hello. I was not sure if I was pregnant because I had technically not “missed” my period. Instead I started a week early. As soon as the bleeding started, the pain did as well. I have been in excrusiating pain since last night. I have had heavy bleeding with some flesh like substance in it, severe pain in my lower back and pelvic region. Severe cramping. I have also felt very weak and sick. I am not even sure if I was pregnant but based on all the web research, it seems that I may be suffering from a miscarraige. How do I know for sure? Im not sure how much of this pain I can handle. No medical insurance. How do I know if its serious enough to go to Emergency Room? Please Help!!!

Doctor: