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

Any QuestionsAny Questions

The EndThe End