Right Column
Local EMS Agency Ambulance Diversion Policies — CONTRA COSTA COUNTY EMS AGENCY: POLICIES AND PROCEDURES
EMERGENCY DEPARTMENT DIVERSION AND UNUSUAL EVENT NOTIFICATION
January 1, 1998
ART LATHROP, EMS Director
JOSEPH BARGER, MD., EMS Medical Director
POLICY #24 - EMERGENCY DEPARTMENT DIVERSION AND UNUSUAL EVENT NOTIFICATION
- OBJECTIVES:
- To transport emergency patients to the most accessible medical facility which is staffed, equipped, and prepared to administer emergency care appropriate to the needs of the patient.
- To provide a mechanism for hospitals to have ambulance patients diverted away from their emergency department when it has been determined that the hospital is not staffed, equipped, and/or prepared to provide emergency care for additional patients.
- To maintain availability of emergency ambulance units countywide.
- To provide hospitals with a notification process for alerting the on-call Health Officer of an emergency incident internal to the hospital (e.g., bomb threat or internal disaster which may include fires, hazardous material events, or massive power failures).
- HOSPITAL ELIGIBILITY FOR AMBULANCE DIVERSION:
An emergency department is to be considered eligible for diversion when there are a number of critical patients in the emergency department, such that more critical patients arriving in the department could not be cared for adequately and the hospital has implemented its own internal procedures for identifying and activating backup staff and/or resources.
NOTE: An emergency department is not considered eligible for diversion solely because all critical care beds are occupied or because there is a lack of specific clinical back up. Title 22 requires a hospital with a basic emergency service to accept all patients and to provide emergency stabilization and appropriate transfer if necessary.
- DIVERSION CRITERIA:
When a hospital has followed identified procedures to initiate diversion, ambulances will by-pass that hospital and will transport the patient to another facility staffed, equipped and prepared to receive the patient* except as follows:
- Under no circumstances shall a Basic Life Support ambulance with a Code 3 emergency patient be diverted from the closest appropriate receiving facility.
- Paramedics shall by-pass the hospital on diversion and transport to the closest facility staffed and equipped to receive the patient if, in the paramedics' judgement, the patient has been stabilized to the extent that the extra transport time should not be deleterious to the patient. If there is any question regarding the patient's stability for the longer transport, the paramedics shall consult with their base for assistance in determining the appropriate destination.
*See attached list of hospitals in Contra Costa County and immediately adjacent areas by emergency service capability.
- PROCEDURES FOR REQUESTING AND IMPLEMENTING DIVERSION:
- Prior to requesting diversion status, a hospital shall meet the following conditions:
- Authorization for diversion status must be obtained from the hospital administrator or his/her designee.
- Each hospital shall establish an internal diversion protocol, which must be approved and on file with the EMS Agency. The internal diversion protocol must include:
- definitions and standards for activation which are consistent with this policy;
- identification of internal approval process;
- procedures for identifying and activating backup staff and/or resources;
- procedures for internal review of the diversion and reporting to the EMS Agency.
- The notification process for initiating and terminating ED diversion shall include: (Hospital initiating ED diversion is responsible for completing and documenting these steps.)
- Notify the next closest emergency department and verify their capability of handling critical patients.
- Notify both base hospitals.
- Contact and instruct each ambulance and fire transport agency within the area to divert ambulance traffic to the next closest emergency facility.
- Notify Sheriff's Communications and request that the on-call Health Officer be notified.
- To re-establish normal ambulance traffic to an emergency department, the preceding steps should be followed in reverse order.
- Prior to requesting diversion status, a hospital shall meet the following conditions:
- HOSPITAL NOTIFICATION OF HEALTH OFFICER FOR UNUSUAL EVENTS:
- For notification of an emergency event internal to the hospital, the hospital shall provide the following information to Sheriff's communications for relay to the on-call Health Officer.
- Type of internal incident requiring notification.
- Number of injuries associated with the incident (if any), and anticipated time frame for resolution of the incident.
- Whether the hospital anticipates the incident will impact the emergency department, and the facility's ability to receive ambulance patients.
- Whether the hospital anticipates requesting outside assistance, and if so, what type of resources are requested.
- This information shall also be provided in writing to the EMS Agency on the EMS "Hospital Diversion and Unusual Incident Notification Form".
- For notification of an emergency event internal to the hospital, the hospital shall provide the following information to Sheriff's communications for relay to the on-call Health Officer.
- EMS AGENCY NOTIFICATION:
An EMS "Hospital Diversion and Unusual Event Notification Form" is to be completed for each implementation of this policy. These forms are to be forwarded to the EMS Agency within 72 hours of each event or diversion incident.
HOSPITALS IN CONTRA COSTA COUNTY AND IMMEDIATELY ADJACENT AREAS BY EMERGENCY SERVICES CAPABILITY
WEST COUNTY
- Doctor's Medical Center - San Pablo Campus (Basic) All emergency services, except neurosurgery; burn center.
- Doctor's Medical Center - Pinole Campus (Basic) All emergency services, except obstetrics.
- Alta Bates Hospital, Berkeley (Basic) All emergency services.
- (Alameda County)
- Kaiser Hospital, Vallejo (Basic) All emergency services.
- (Solano County)
- Sutter Solano Hospital, Vallejo (Basic) All emergency services
- (Solano County)
CENTRAL COUNTY
- Contra Costa Regional Medical Center (Basic) All emergency services.
- Mt. Diablo Medical Center (Basic) All emergency services.
- John Muir Medical Center (Basic) All emergency services, trauma center.
- Kaiser Hospital, Walnut Creek (Basic) All emergency services.
- San Ramon Regional Med Center (Basic) All emergency services.
EAST COUNTY
- Sutter/Delta Medical Center (Basic) All emergency services.
CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
Emergency Medical Services
AMBULANCE DIVERSION OR HOSPITAL UNUSUAL EVENT NOTIFICATION
Date on Diversion: ____/____/____ Time: _____________ Charge Nurse: _____________________ Hospital: _________________
Date off Diversion: ____/____/____ Time: _____________ ED Physician: ___________________________
Reason(s) ED diversion was initiated: (detailed explanation to include number and types of patients in ED)
__________________________________________________________________________________
_________________________________________________________________________________
Decision to initiate ED diversion was made by: __________________________________________________________________________________
Steps taken to access additional staff and/or resources: _______________________________________________________________________________
_______________________________________________________________________________
Type of Unusual Event and type (if any) resources requested:_______________________________________________________________________
Diversion Notification*
| Phone Numbers | Person Contacted | Time | Initials | Person Contacted | Time | Initials |
|---|---|---|---|---|---|---|
* These calls must be made when initiating and discontinuing diversion status.
This form is to be completed for each initiation/discontinuation of emergency department diversion pursuant to EMS Policy 24, Emergency Department Diversion. This form is to be forwarded to the EMS Agency within 72 hours of each diversion period.