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Hospitals on "divert" status...


mrsmall

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Its not out of the ordinary to wait that long here ( Calgary, AB.) when its busy. Our city has a pop around 900,000. We have four hospitals, out of which one is a trauma centre, and one is the childrens.

We even have a new program set up with the health region called transfer of care paramedics. It involves one Paramedic, one EMT who sit in the hall their entire shift, they have five beds and look after low priority patients who would otherwise be waiting for hours with ems crews. They act as kind of a pre-emergency room bed.

ditto edmonton. except smaller population, 2 trauma centers (one which includes the children's)

only the 2 trauma centers have the emt/emt-p drop beds though, and only during peak hours. this is a brand new program, i hope it takes off. i dont end up in the city often, but when i do it would be nice to drop the pt that just needs his or foor checked on a bed, vs waiting 3+ hours for a bed.

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We have diversions here in Chicagom also. Some hospitals get a name for going on diversion to quickly. A hospital must call The Illinois Dept of Public Health prior to going on diversion. Two hospitals in close proximity with the same level of care cannot be on diversion at the same time. IE: Two level one trama centers cannot go on diverson. IDPH can deny diversions. CFD announces all diversions across radios and computers. Hospitals can also just have a certian area on diversion like Peds Trauma or OB/GYN.

How ever, no hospital can go on BLS diverson. The pT's just have to sit and wait. Im BLS so I dont care or pay attention to diversions and it really pisses off nurses and ER docs. Oh well.

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No real comment, but...Welcome usapride2004. Aways wondered about RI.

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Up here its condition red,green,yellow, black

red is up to a 4-6 hour wait for care

yellow is 2-4

green is open

black is closed for fire, flood, disaster in hospital

They "try" to divert at red and get mad when u go there, but legally cant, only way a hospital can tell us "no" is on BLACK.

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How are these people viewed by the rest of Calgary EMS?

Are they below average people who coulden't cut it? Or just the opposite?

The hallway Medics work for the Calgary Health Region (CHR). The CHR also takes care of the interfacility transfers in the region. The CHR employees are competent EMT's and Paramedics for the most part, and actually make a slightly better wage than we do.

Richard B. you are pretty much spot on when it comes to the duties of the hallway medics, and actually a lot of city medics take shifts in the hall on their days off.

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I have seen waiting times even in the rural area now up to 2 hours. Not unusual to see 3-4 hour waiting times for non-life threatening conditions.

If you think it is a problem now, prediction is within five years we will see double the wait and within 10 years fourfold.

Do you think we will have to change our thinking in EMS? As the classic line says.." hang on, it going to be a bumpy ride"...

R/r

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Here where I am from diversion means they dont accept anyone unless they are like coding or almost coding you have to go to another facality.

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I just called the section of the FDNY EMS/EMD that handles diversions, and before I continue, will mention 3 things, the first is, per the "diversion desk", what I am about to relate is in review, and might not be policy as early as tomorrow, the second is, this is per FDNY EMS/EMD policy, in conjunction with the State of New York policies, and might not be transferable to other jurisdictions, counties, states, provinces, or countries. The third is, the wording is my loose wording interpretations of policy for diversions

When a duly authorized hospital Officer of the Day feels that they need their ED temporarily closed, the ED must meet the following criteria, either singly, or in combinations.

There must be more patients waiting for admission than available beds in the hospital.

There must be more patients needing telemetry/monitoring than there are monitoring beds available.

There must be more patients waiting to be seen in the ED than the ED can, at that hour, reasonably handle.

At the discretion of either or both the EMD Tour Commander, or a Chief of EMS, a diversion for "Total" or "Critical Adult" will be authorized, for a period of 4 hours. After 4 hours, they can call back and make a fresh request. All diversions are canceled at the tour changes of Midnight, Eight AM, and Four PM.

If there is any question, an area "Conditions Car", usually a lieutenant at the nearest EMS station, will be sent to check out the situation, and report back to the EMD Tour Commander.

If several hospitals in a specified geographic area, referred to as a "pod", request a specific category diversion, the diversions will be accepted, but only up to a point. If and when that point is reached, all hospitals in the pod are reopened to the category, for what is called "Catchment". This means the field crews can, and will, bring patients in the category to the nearest hospital, despite the previous diversion request. Also, the "Conditions Car" will make periodic checks on the status of all the hospitals in the pod, even those not requesting diversions, and keep the Tour Commander updated.

All hospitals understand that a request for diversion is considered as a courtesy, and is not ironclad. Field crews understand that diversions don't hold if the patient they are treating is "in extremis", they will go to the nearest hospital anyway.

The categories are, but not limited to, "Total", "Adult Critical", "Pediatric Critical", "OB-Labor", Pediatric EDP", "Adult EDP", and "Trauma".

This might not be complete, but it is some food for discussion.

Now, my history lesson.

In the early 1980s, a crew from Brooklyn's Midwood Ambulance Service brought a patient to the Kings Highway Hospital.

Back then, you backed down a narrow driveway, rang a phone by the door to get them to buzz you in, and then, with the strecher halfway in the door, rang for the elevator to take you to the first floor, and either the ED, or be met by an admissions officer to tell you where the patient was going.

Kings Highway had earned a bad reputation, as, when a patient arrived at their doors, someone, usually a "Pops" type security officer, would advise the patient, or the ambulance crew, that the hospital was "closed".

When the Midwood crew got to the ED, that is just what happened. After advising the dispatcher of the situation, it was decided to move the patient, against the family's wishes (they wanted, and had paid for, transport to Kings Highway) to the Kings County Hospital. Highway was a "private" hospital, County was, and is, a municipal hospital run by the New York City Health and Hospitals Corporation.

During the transport, the patient went south, and CPR was started while enroute to KCH.

There was no good news, as the patient was pronounced shortly after arrival at the KCH ED.

Lawsuits abounded, but at least the Midwood crew was absolved of any blame (good for them, I had worked with both of them when I had worked at Midwood, and they were both good, caring EMTs). The family was also, apparently, well connected politically.

Then-State Senator Stavisky wrote a state law, requiring any patient presenting themselves, or being presented, for care at an ED, had to be checked by the original hospital's ED, to determine if the patient was stable enough to go to some other facility. A copy of such documentation would be included in the receiving hospital's chart on the patient, and attached to the ambulance call report.

Even this got abused, as seemingly anyone connected with a hospital would call up the local Ambulance Services, and tell them "We're on diversion".

The way that the City EMS, then still under HHC itself, responded to this, was, a list, updated monthly, was to be submitted to the EMS EMD, indicating which persons were authorized to request category diversions, and most of what I described above came into play.

Also, putting teeth into the rules, anyone basically "standing in the doorway, denying anyone requesting medical help from getting that help (again, my wording) could, and would, be personally fined upwards of $1,000, and the hospital itself risk really being closed by the NY State DoH.

One time I was running the Diversion Desk, I declined taking a request for diversion, as the caller clearly stated he was the security officer. I explained his name wasn't on the list of authorized persons to make such request. Would you believe he actually asked me what names were on the list? I was NOT born yesterday (perhaps the day before, but not yesterday), and told him the hospital administration had to make the call. The idiot actually called me back, not stating his name, but saying he was the on duty hospital administrator! "Sir, you WILL have the authorized administrator call me back, and IF that person's name is on my list, and if policy is followed, MAYBE the requested diversion will be authorized. If you call again, it will be considered as fraud, and you can be fined a minimum of $1,000!"

I hung up, turned to find my lieutenant standing behind me, smiling!

PS: The only 3 times I can recall when diversions were not accepted at all, on a citywide basis, were the 1993 truck-bombing of the World Trade Center ("What do you mean, no diversions? The WTC is in Manhattan, and we're Staten Island."), the 1995 Blizzard, and the September 11, 2001 Attack.

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As I'm sure is normal our diverson policy says that during "Code Yellow" or "Code Red" status in the county that no diverson will be accepted.

"Code Yellow" is used due to weather conditions or any abnormal increase in volume and is a recommendation to squads to prepare to bring in more crews, as well as arrangments to staff the 4 county MCI units.

"Code Red" is used when the above or other large scale incident happens. The code status can be specific to North, Central, South or county wide. Additonal units should be staffed and squads should expect units to be relocated to cover the effected areas.

I've been working on the EMS responce to terrorism program on LMS and it makes you think what our local hospitals surge capiblities are. Also, do we have secondary areas that can be used to treat, relocate, manage a massive amount of patient influx. On top of that do we have a system in place for mass population and or mass patient relocation?

The hell with diverson, say due to weather related damage one of your hospitals must be evacuated have you thought at all the amount of resources it would take, where you would take people and how long it would take to do such a thing?

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