Menu
Search
Organization Title


 

Local EMS Agency Ambulance Diversion Policies — Los Angeles

PURPOSE:

To ensure that 9-1-1 patients are transported to the most appropriate facility which is staffed, equipped and prepared to administer emergency and/or definitive care appropriate to the needs of the patient.

AUTHORITY:

  • Health and Safety Code, Division 5, Section 1797.220
  • California Code of Regulations, Title 13, Section 1105 (c)

PRINCIPLES:

  1. 9-1-1 patients shall ordinarily be transported to general acute care hospitals with a basic emergency department permit. Transport to other medical facilities (hospitals with a stand-by permit, clinics and other medical facilities approved by the EMS Agency) shall be performed only in accordance with this policy.
  2. In the absence of "decisive factors to the contrary" 9-1-1 patients shall be transported to the most accessible medical facility equipped, staffed, and prepared to receive emergency cases and administer emergency care appropriate to the needs of the patient.
  3. The "most accessible receiving" (MAR) facility may or may not be the closest facility geographically. Transport personnel shall take into consideration traffic, weather conditions or other similar factors which may influence transport time when identifying which hospital is most accessible.
  4. The most appropriate health facility for a patient may be that health facility which is affiliated with the patient's health plan. Depending upon the patient's chief complaint and medical history, it may be advantageous for the patient to be transported to a facility where he/she can be treated by a personal physician and/or the individual's personal health plan and where medical records are available.
  5. ALS Units utilizing Standing Field Treatment Protocols (SFTPs) shall transport patients in accordance with this policy.
  6. Patients shall not be transported to a medical facility that has requested diversion due to internal disaster.
  7. Notwithstanding any other provision of this reference, and in accordance with Reference No. 503, Guidelines for Hospitals Requesting Diversion of ALS Units, final authority for patient destinations rests with the base hospital handling the call. Whether diversion request will be honored depends on available system resources.

POLICY:

  1. Transport of Patients by EMT-I Personnel
    1. EMT-I personnel shall transport 9-1-1 patients deemed stable and requiring only basic life support (BLS) to the MAR, regardless of its diversion status (exception: internal disaster). For pediatric patients, the MAR is considered to be the most accessible Emergency Department Approved for Pediatrics (EDAP). For perinatal patients, the MAR is considered to be the most accessible perinatal center.
    2. EMT-I personnel may honor patient requests to be transported to other than the MAR provided that the patient is deemed stable and requires basic life support measures only and the ambulance is not unreasonably removed from its primary area of response.
    3. In life-threatening situations (e.g., unmanageable airway or uncontrollable hemorrhage) in which the estimated time of arrival (ETA) of the EMT-Ps exceeds the ETA to the MAR, EMT-Is should exercise their clinical judgement as to whether it is in the patient's best interest to be transported prior to the arrival of paramedics.
  2. Transport of Patients by EMT-P Personnel
    1. Patients should be transported to the MAR unless:
      1. The base hospital determines that a more distant hospital is more appropriate to meet the needs of the patient; or
      2. The patient meets criteria or guidelines for transport to a specialty care center (i.e., Trauma, EDAP, PCCC, Perinatal); or
      3. The patient requests a specific hospital, and
        1. The patient's condition is considered sufficiently stable to tolerate additional transport time; and
        2. The EMS provider has determined that such a transport would not unreasonably remove the unit from its primary area of response. If requests cannot be honored, the provider should attempt to arrange for alternate transportation, i.e., private ambulance, to accommodate the patient's request; and
        3. The requested hospital does not have a defined service are (For hospitals with a defined service area, refer to Section IV of this policy.)
      4. The medical facility has requested diversion to 9-1-1 patients requiring advanced life support (ALS), as specified in Ref. No. 50ALS units may be directed to an alternate "open" facility provided:
        1. The patient does not exhibit an uncontrollable problem in the field as defined by unmanageable airway or uncontrolled hemorrhage.
        2. The involved ALS unit estimates that it can reach an alternate facility within fifteen (15) minutes, Code 3, from the incident location. If there are no "open" facilities within this time frame, ALS units shall be directed to the MAR, regardless of its diversion status (exception: internal disaster).
    2. BLS patients transported by ALS personnel may be transported to an alternate open facility if the MAR has requested diversion.

      NOTE: On an "as needed basis", the EMS Agency may extend maximum transport time.

  3. Transport to Health Facilities without a Basic Emergency Department Permit
    1. Hospitals with a Stand by Emergency Department Permit: Patient requests for transport to hospitals with a Stand-by Emergency Department Permit may be honored by EMT-I or EMT-P personnel if base hospital contact is made; and
      1. The base hospital concurs that the patient's condition is sufficiently stable to permit the estimated transport time; and
      2. The base hospital contacts the requested hospital and ensures that a physician is on duty and willing to accept the patient.
    2. Other medical facilities approved on an individual basis by the EMS Agency: 9-1-1 patients may be transported to medical facilities other than hospitals (i.e., clinics) only when approved in advance by the EMS Agency.
  4. Transport to Health Facilities with a Designated Service Area (Service Area Hospitals)
    1. Patients shall be transported by EMT-I or EMT-P personnel to hospitals with a designated service area whenever the incident location is within the hospitals' defined service area (exception: diversion to internal disaster). In most instances, the service area hospital is also the MAR.
    2. If a patient within the defined service area meets criteria or guidelines for a specialty care center not provided by the service area hospital, this patient shall be transported to the appropriate specialty care center.
    3. Patient requests for transport to a service area hospital when the incident location is outside the hospital's defined service area or inside the service area of another hospital may be honored by:
      1. EMT-I personnel if it is a BLS patient, the receiving hospital is contacted and agrees to accept the patient, and the transporting unit is not unreasonably removed from its primary response are
      2. EMT-P personnel if the base hospital is contacted and concurs that the patient's condition is sufficiently stable to permit the estimated transport time, the requested hospital agrees to accept the patient, and the transporting unit is not unreasonably removed from its primary response are The receiving hospital may be contacted directly if the ALS unit is transporting a BLS patient.
  5. Transport to Specialty Care Centers
    1. Trauma Hospitals: Transport of trauma patients shall be in accordance with Ref. No. 504 and Ref. No. 506. Requests for diversions due to trauma care may be honored as outlined in Ref. No. 50
    2. EDAPs and PCCCs: Transport of pediatric patients shall be in accordance with Reference No. 510. The MAR for the pediatric patient is the most accessible EDAP.
    3. Perinatal Centers: Patients meeting Perinatal Center criteria shall be transported in accordance with Ref. No. 51The MAR for the perinatal patient is the most accessible Perinatal Center.
CROSS REFERENCE:

Prehospital Care Policy Manual:

  • Ref. No. 503, Guidelines for Hospitals Requesting Diversion of MICUs
  • Ref. No. 504, Trauma Catchment Areas
  • Ref. No. 506, Trauma Triage
  • Ref. No. 508, Sexual Assault Patient Destination
  • Ref. No. 510, Pediatric Patient Destination
  • Ref. No. 511, Perinatal Patient Destination
  • Ref. No. 512, Burn Patient Destination
  • Ref. No. 519, Management of Multiple Victim Incidents

Connect With Us