Region Four Emergency Medical Services

Subject: Emergency Medical Services Diversion Policy

1.0 Purpose

1.1 To promote optimal patient care through the coordinated efforts of hospital administration and the emergency medical services in determining patient destination during periods when hospital administrators feel their facility is temporarily incapable of providing optimal care to any further patients.

2.0 Objectives

2.1 To facilitate transportation of patients by emergency medical services in Region Four to the most accessible medical facility, which is staffed, equipped, and prepared to administer appropriate emergency care to meet the patients needs.

2.2 To provide a mechanism for receiving hospitals in Region Four to divert patients away from emergency departments that are temporarily not staffed, equipped, or prepared to care for additional patients.

2.3 To ensure that involved emergency medical services are not unreasonably removed from their area of primary response when transporting a patient to a medical facility.

2.4 To identify the specific circumstances, which will be recognized by emergency medical services as appropriate for ambulance diversion.

2.5 To define the responsibility of the emergency medical service personnel in response to such a request.

2.6 To indicate the types of emergency medical service response which will be governed by this policy.

2.7 To identify circumstances when diversion shall not apply or may be disregarded.

2.8 To identify mechanisms for the initiation and termination of diversion.

3.0 Definitions

3.1 Advanced Life Support Unit: An ambulance staffed by one or more certified paramedics operating in the capacity of an advanced life support pre-hospital care provider.

3.2 Basic Life Support Unit: An ambulance staffed by certified EMT’s and/or paramedics, not operating in the capacity of an advanced life support pre-hospital care provider.

3.3 Hospital Administration: Senior hospital administrative personnel, not assigned to patient care duties in the emergency department, who is responsible for hospital operations at the time of the diversion or his/her designee

3.4 Appropriate Facility: A hospital facility recognized to have staffing, equipment and services to care for the patient’s immediate medical needs.

3.5 Ambulance Diversion Request Categories:

A) Emergency Department Situation

When the hospital emergency resources (beds, equipment, and/or appropriately trained personnel) are fully committed and or are not available for additional incoming critical or seriously ill ambulance patients and acceptance of any additional patients requiring advanced life support would seriously jeopardize the care of other patients in the emergency department.

B) ICU/CCU Situation

When the hospitals intensive care/cardiac care resources are fully committed and are not available for additional patients requiring intensive care.

C) Psychiatric Patient Saturation

When the hospital emergency and/or inpatient psychiatric resources are fully committed and the facility cannot accept any further acute psychiatric patients. Patients who have intentionally overdosed are considered to need psychiatric evaluation.

D) Internal Disaster

When the hospital cannot receive any more patients due to a physical plant breakdown (e.g. fire, bomb threat, power outage, etc.). For situations in which a hospital has advanced knowledge that it will need diversion for internal disasters, the hospital shall notify area 911 centers and surrounding hospitals via the Internet at (www.gaems.net) of their situation. If it is a scheduled event for maintenance the hospital should make these required notifications in advance.

E) Trauma Saturation

When trauma resources are fully committed and the facility cannot accept additional seriously injured patients because the staff is encumbered with trauma patients in the OR, ED or CT.

4.0 Scope

4.1 This policy and procedure will apply to all emergency medical services operating in or transporting to Region Four.

5.0 Responsibilities

5.1 EMS Directors/Fire Chiefs will be accountable for the overall management and administration of this policy.

5.2 EMS Medical Directors will be responsible for all medical aspects of this policy.

6.0 Procedures

6.1 Hospitals are considered “open” unless the area 911 center has been notified via the Internet at (www.gaems.net) by an on-duty hospital administrator of a condition, which necessitates an ambulance diversion situation as noted in section 3.5 of this policy.

6.2 All hospitals in Region Four will notify their area 911 centers when a diversion status is deemed necessary and when it is no longer necessary via the Internet at (www.gaems.net).

6.3 Hospitals that are on diversion must update area 911 centers via the Internet at (www.gaems.net) of their status prior to the deadline of this four-hour period. Hospitals failing to update their status will automatically be changed to an “open” status unless a hospital administrator extends the diversion.

6.4 When a 911 center is notified of a diversion request they will notify their emergency medical service providers and others departments in accordance with their standard operating procedures of the diversion.

6.5 When the diversion request in no longer necessary the on-duty hospital administrator will terminate the diversion request. The 911 center will then notify their emergency medical service providers and other departments in occurrence with their standard operating procedure.

6.6 In the event Internet access is not possible due to (weather, server problems, provider problems, connection failures…) then 911 centers must be notified by phone of a hospitals diversion status (see attached 911 center phone list)

7.0 Compliance

7.1 The emergency medical services of Region Four will comply with diversion requests unless:

A) The informed EMS unit estimates that it cannot reach an “open” and appropriate medical facility within a reasonable time/distance of the incident location. If there are no “open” facilities within this area, the EMS unit will transport to the closest most appropriate facility regardless of their diversion status (exception: internal disaster). (Reasonable time/distance will be established by the emergency medical services Medical Director).

B) The patient’s condition is life threatening or other wise subject to rapid significant deterioration and there is clear indication that, an extended transport time/distance may be detrimental to the patient’s outcome.

C) The patient’s rights will be violated and the patient does not agree to be transported to an alternate hospital. (see State of Georgia Rules and Regulations 290-5-30-.05 section K “Destination of Pre-Hospital Patients”)

Approved: 03/08/01

Revised: 06/06/01

William T. Ayers, M.D. Billy R. Watson, EMT/P

Region Four EMS Region Four EMS

Medical Adviser Coordinator