Menu
Search
Organization Title


 

Local EMS Agency Ambulance Diversion Policies — Los Angeles guidelines

PURPOSE:

To outline the procedure for receiving hospitals to request diversion of advanced life support (ALS) units.

AUTHORITY:

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

PRINCIPLES:

  1. A receiving hospital may request to divert 9-1-1 ALS units away from its emergency department when temporarily not staffed, equipped, or prepared to care for additional patients. Basic life support (BLS) units may not be diverted. Whether diversion requests will be honored depends on available system resources.
  2. Trauma hospitals shall not request diversion of trauma patients as long as contractual clinical obligations can be met as enumerated in this policy.
  3. All hospitals are required to communicate diversion requests via ReddiNet.

POLICY:

  1. Diversion Request Categories
    1. Request for diversion due to Emergency Department (ED) Saturation - Hospital's ED resources (beds, equipment and /or appropriately trained personnel) are fully committed and are not immediately available for additional incoming patients transported by ALS units.
    2. Request for diversion to Neurosurgery (neurosurgeon unavailable) - Hospital may divert only those patients with obvious neuro-trauma that includes:
      1. Blunt head injury associated with altered consciousness at the time of paramedic assessment, seizure, unequal pupils, or focal neurological deficit; or
      2. Open or closed injury to the spinal column associated with sensory deficit or weakness of one or more extremities.

        NOTE: Patients meeting the above criteria are normally transported to a trauma center, unless a trauma hospital cannot be accessed.

    3. Request for diversion due to lack of CT-scanner - Hospital is unable to provide appropriate diagnostic measures due to non-functioning CT scanner.
    4. Request for diversion to Trauma Care (applies to trauma hospitals only) - Hospital is unable to care for additional trauma patients because the trauma team is already fully committed to caring for trauma patients in either the OR, ED or CT. The rationale for a temporary closure/diversion shall be communicated via the ReddiNet system and will only be honored when a reason code is entered. Reason codes include the following:
      1. Lack of Critical Equipment: Trauma patients may be diverted when the hospital determines that critical equipment which is likely to be definitive in diagnosis or treatment is unavailable.
      2. Operating Room Saturation: Trauma patients may be diverted when both the primary, dedicated trauma operating room and staff and the back-up operating room and staff are fully committed in accordance with California Code of Regulations and the Trauma Hospital Services Agreement; and when the base hospital determines that the lack of Operating Room space is likely to persist to the extent that the care of any additional trauma patients may be jeopardized.
      3. Emergency Department Saturation: Trauma patients may be diverted when the hospital's emergency department trauma resources are fully committed in accordance with California Code of Regulations and the Trauma Hospital Services Agreement.

        NOTE: Waiver -- For all other circumstances in which hospital is temporarily unable to meet a contractual requirement and the hospital believes it is in the best interest of patient care to divert 9-1-1 trauma patients with specific injuries, hospital shall contact the EMS Agency to request a waiver. If a waiver is granted, the hospital and the Medical Alert Center will jointly ensure that affected base hospitals and provider agencies are properly advised of the nature and extent of the waiver.

    5. Request for diversion due to Pediatric Critical Care (applies to Pediatric Critical Care Centers (PCCC) only) - Hospital is unable to provide appropriate care due to ED saturation, or non-functioning CT-scanner.
    6. Request for diversion due to Internal Disaster - Hospital cannot receive any patients because of a physical plant breakdown, fire, bomb threat, power outage, etc. This category does not apply to work actions. Requests for diversion due to Internal Disaster will be honored for both ReddiNet and non-ReddiNet equipped hospitals.

      NOTE: Work Actions -- If a hospital has a critical shortage of medical personnel due to a work action and patient care is threatened, the hospital may divert ALS units to one or more of the following categories, as appropriate: Emergency Department Saturation, Neurosurgery, Trauma, and/or Pediatric Critical Care.

  2. Procedure for Requesting Diversion of ALS Units
    1. To ensure that base hospitals and EMS providers have accurate, current information when making patient destination decisions, each receiving hospital shall maintain a current diversion status with the Medical Alert Center (MAC) and its area base hospitals. Hospitals are considered to be "open" to all categories, unless the MAC and area base hospitals have been informed of the diversion request.
    2. Hospitals shall notify the MAC and area base hospitals of their requested diversion status via the ReddiNet only. Telephone communication is only necessary when the ReddiNet is not operational or when hospital is requesting diversion due to internal disaster. The MAC shall be notified via telephone at (213) 887-5310 and area base hospital's ED shall be notified by requesting hospital.
    3. All hospitals shall notify the MAC and area base hospitals via ReddiNet as soon as diversion status is deemed necessary and again when it is no longer necessary.
    4. The MAC will routinely request, via H.E.A.R., hospitals to update orreconfirm their diversion status at the following times:
      • 0730 - 0800
      • 1530 - 1600
      • 2330 - 2400

      Unless a hospital reconfirms its request to remain on diversion to a given category at the above times, hospital status will be changed to "open." The ReddiNet system performs this function automatically. Therefore, it is imperative that hospitals update the MAC via ReddiNet at the above times.

    5. Hospitals shall maintain a current diversion policy and records indicating, at a minimum, the name of the authorized administrator who approved the diversion request, date and time of diversion, the category(ies) in which a diversion request was necessary, and the time hospital canceled the diversion request.
    6. Hospitals shall maintain a current diversion policy and records indicating, at a minimum, the name of the authorized administrator who approved the diversion request, date and time of diversion, the category(ies) in which a diversion request was necessary, and the time hospital canceled the diversion request.

      NOTE: It is the responsibility of the hospital requesting diversion due to internal disaster to notify area base hospital(s) and all affected provider agencies.

    7. The EMS Agency staff may perform unannounced site visits to hospitals requesting diversion to ensure compliance with these guidelines.

CROSS REFERENCE:

Prehospital Care Policy Manual:

  • Ref. No. 502, Patient Destination
  • 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
  • Paramedic Base Hospital Agreement
  • Trauma Hospital Agreement

Connect With Us