diversion so what are the rules? mbemsc pre-hospital systems coordination committee december 2004
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DiversionDiversionSo what are the rules?So what are the rules?
MBEMSC Pre-Hospital Systems Coordination MBEMSC Pre-Hospital Systems Coordination CommitteeCommittee
December 2004
PurposePurpose
The purpose of this program is to give The purpose of this program is to give the pre-hospital provider a practical the pre-hospital provider a practical
overview of Diversion, and the overview of Diversion, and the Internet Based Diversion system.Internet Based Diversion system.
What is Diversion?What is Diversion?
• Essentially an Emergency Essentially an Emergency Department is full and is re-Department is full and is re-directing ambulances from their directing ambulances from their ED ED
Why divert ambulances?Why divert ambulances?
•ED’s divert ambulances for ED’s divert ambulances for only two reasons.only two reasons.– Internal Disaster Internal Disaster – ED SaturationED Saturation
Most Common ReasonMost Common Reason
ED SaturationED Saturation
What causes ED Saturation?What causes ED Saturation?
Boarding of patients in the EDBoarding of patients in the ED
What does this mean to the What does this mean to the EMTEMT
• Honor Diversion Status Honor Diversion Status – Allows an ED to clear Boarding patients Allows an ED to clear Boarding patients
out quickerout quicker– Allows patients being transported by the Allows patients being transported by the
EMT to be seen sooner at other ED’sEMT to be seen sooner at other ED’s
Is There An ExceptionIs There An Exception
• There are several:There are several:– Trauma Center patientsTrauma Center patients– Immediate life threatening situationsImmediate life threatening situations– Complex medical history related to Complex medical history related to
eventevent– Recently dischargedRecently discharged
Who’s on Diversion?Who’s on Diversion?
• How does the EMT know when an ED How does the EMT know when an ED is on Diversion?is on Diversion?
• Does the CMED tell all ambulances Does the CMED tell all ambulances which hospitals are on diversion?which hospitals are on diversion?
What will I see?What will I see?
• If a provider service accesses the Internet If a provider service accesses the Internet Based Diversion System what will they see?Based Diversion System what will they see?
Hospital City Status Region Last Updated Updated By
BOSTON MED CTR-HARRISON A BOSTON Diversion 04 12/13/2004 10:36:40 AM Ulrich
B.I.D. Needham (Glover) NEEDHAM Open 04 11/8/2004 7:42:56 PM C-MED; Auto Open
BETH ISRAEL DEACONESS BOSTON Open 04 12/11/2004 4:30:30 PM auto
BOSTON MED CTR-EAST NEWTO BOSTON Open 04 12/5/2004 3:09:52 AM Auto Open/Timed Out
BRIGHAM AND WOMENS BOSTON Open 04 12/11/2004 3:28:57 AM C-MED
CAMBRIDGE HOSPITAL CAMBRIDGE Open 04 12/10/2004 7:03:47 PM cmed4
CARITAS NORWOOD HOSPITAL NORWOOD Open 04 12/12/2004 3:12:56 PM Operations
CARNEY HOSPITAL BOSTON Open 04 11/29/2004 3:20:17 PM cmed timed out
CHILDRENS HOSPITAL BOSTON Open 04 9/28/2004 3:17:38 PM auto open
EMERSON HOSPITAL CONCORD Open 04 10/28/2004 11:32:59 AM staff
FAULKNER HOSPITAL BOSTON Open 04 12/8/2004 5:01:45 PM cmed
LAHEY CLINIC BURLINGTON Open 04 12/12/2004 12:37:28 AM CMED
MASS GENERAL HOSPITAL BOSTON Open 04 12/11/2004 8:22:01 PM cmed
Website is UnavailableWebsite is Unavailable
• Local computer/internet problemsLocal computer/internet problems– Contact another local dispatch center Contact another local dispatch center
that has accessthat has access
• Webpage Server downWebpage Server down– Contact ED directlyContact ED directly– Contact CMED on ED statusContact CMED on ED status
Practical ApplicationPractical Application
• You are transporting a patient that You are transporting a patient that insists in being transported to a local insists in being transported to a local facility that is currently on diversionfacility that is currently on diversion– The patient does not meet any of the The patient does not meet any of the
exception criteria defined in the diversion exception criteria defined in the diversion rulesrules
– If not transported to the hospital of choice If not transported to the hospital of choice the patient refuses to be transported at allthe patient refuses to be transported at all
How should this incident be handled?How should this incident be handled?
Practical Application I cont…Practical Application I cont…
• Every effort should be made by the Every effort should be made by the ambulance crew to inform the patient ambulance crew to inform the patient of the potential risks of being of the potential risks of being transported to a facility that is on transported to a facility that is on diversiondiversion
• Every effort should be made by the Every effort should be made by the ambulance crew to notify the receiving ambulance crew to notify the receiving facility in advance of arrivalfacility in advance of arrival– The circumstances of transport should be The circumstances of transport should be
explained to the facilityexplained to the facility
Practical Application IIPractical Application II
• Your have assessed your patient and Your have assessed your patient and have begun transporting your patient have begun transporting your patient to hospital A.to hospital A.
• The hospitals diversion status changes The hospitals diversion status changes while enroute to the hospital from open while enroute to the hospital from open to on diversionto on diversion
What should be done?What should be done?
Practical Application II Practical Application II cont…cont…
• Every effort should be made by the Every effort should be made by the ambulance crew to notify the receiving ambulance crew to notify the receiving facility in advance of arrivalfacility in advance of arrival– The circumstances of transport should be The circumstances of transport should be
explained to the facilityexplained to the facility
• Upon arrival at the hospital the ambulance Upon arrival at the hospital the ambulance crew should explain:crew should explain:– Hospital was open at the time of transportHospital was open at the time of transport– Family was already committed to bringing patient Family was already committed to bringing patient
to the facilityto the facility– Every effort was made in advance to notify the EDEvery effort was made in advance to notify the ED
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