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Local EMS Agency Ambulance Diversion Policies — Orange County

ORANGE COUNTY EMS AGENCY POLICY NO. 310.96

GUIDELINES FOR HOSPITALS REQUESTING BYPASS OF PATIENTS

  1. I. AUTHORITY:

    Health and Safety Code Sections 1798, 1797.220, California Code of Regulations, Title 13, Section 1105(c).

  2. APPLICATION:

    A procedure for paramedic receiving centers (PRC) and specialty centers to request bypass of ambulance-transported patients.

  3. OBJECTIVES:
    1. To assure the transport of a patient with an emergency medical condition to the most accessible medical faci-lity which is staffed, equipped, and prepared to ad-minister emergency care appropriate to the needs of the patient.
    2. To minimize hospital bypass.
    3. To provide a mechanism for a PRC to have paramedic and basic life support (BLS) escorted patients bypass its emergency department (ED) when it has been determined that the ED is not appropriately staffed, or equipped, to care for additional patients.
    4. To assure that the involved service provider units are not unreasonably removed from their area of primary response when transporting patients.
  4. PROCEDURE:
    1. BYPASS REQUEST CATEGORIES

      A PRC or specialty center may request bypass of patients for the following reasons and using the following terminology:

      1. Closed: ED Saturation - ED resources are fully committed and are not available for additional in-coming patients despite efforts by the hospital to accommodate peak loads.
      2. Closed: Neuro (applies to Neuro Centers only) - Neuro center is unable to provide appropriate neurosurgical care due to the unavailability of a neurosurgeon or CT scanner.
      3. Closed: Trauma (applies to Trauma Centers only) - Trauma team is unable to respond due to commitment to provide surgical care to another trauma patient.
      4. Closed: Internal Disruption - PRC cannot receive any patients because of a physical plant shutdown, (e.g., fire, bomb threat, power outage, etc.).
      5. Closed: CT scanner out-of-service. Patient requires emergent CT scan, e.g. symptoms of acute ischemic stroke began within 2 hours.
    2. BASE HOSPITAL DIRECTION (PARAMEDIC ESCORTED PATIENT)
      1. Final authority for paramedic escorted patient destination rests with the BH physician.
      2. The BH physician will honor an ED or specialty center bypass request provided that:
        1. The patient does not exhibit an uncontrollable problem in the field (e.g., UNMANAGEABLE AIRWAY, UNCONTROLLED HEMORRHAGE OR FULL ARREST).

          NOTE: PATIENTS EXHIBITING UNCONTROLLABLE PROBLEMS IN THE FIELD WILL BE TRANSPORTED TO THE MOST ACCESSIBLE APPROPRIATE RECEIVING CENTER REGARDLESS OF ITS OPEN/CLOSED STATUS.

        2. The involved ALS unit estimates that it can reach an "open" facility within a safe period of time, as approved by the BH physician.
      3. If three or more receiving centers (ED, trauma or neuro) are "closed" the bypass request may not be honored and the patient will be transported to the most accessible appropriate receiving center re-gardless of its open/closed status. (The only exception will be closure due to internal disruption).
      4. Designated moderate trauma victims may be sent to a PRC (reference: EMSA Policy/Procedure #310.30, Trauma Triage Guidelines).
    3. RECEIVING CENTER (RC) BYPASS REQUEST
      1. To request a paramedic escorted patient bypass to another receiving center, the center must notify by HEAR/Reddinet all BHs of its status prior to actually bypassing patients. The center must indicate:
        1. The category/categories for which it is closed using terminology specified in Section IV in this document, and
        2. The expected duration of the "closed" status.
      2. The center on "closed" status shall immediately notify the BH as soon as bypass is no longer necessary.
      3. To ensure that the BH has accurate, current infor-mation when making patient destination decisions, each medical center on "closed" status shall remain closed until restated "open" or the center will be automatically opened every eight hours on the ReddiNet system, unless they enter a continuing closed status.
      4. BLS ambulances shall contact receiving centers to ascertain that they are able to receive the pa-tient. If not, ambulance dispatch should contact the next closest receiving centers regarding their status or contact the closest base hospital for as-sistance in determining an open PRC.
      5. To ensure that receiving centers do not "close" without the knowledge and concurrence of hospital administration, the hospital administrator or his/her designee and the ED medical director or his/her designee must authorize the request for bypass.

        The ED shall maintain a written log indicating, at a minimum, the names of the individuals who author-ized the bypass, and the dates and times and cate-gory for which it closed. A copy of this log will be sent to the OCEMS Agency the first of each month.

ORANGE COUNTY/HEALTH CARE AGENCY: EMERGENCY MEDICAL SERVICES

MONTH HOSPITAL

REFERENCE: POLICY #310.96

HOSPITAL BYPASS REPORT
TIMEREASON
DATE CLOSED OPENED ED SATURATED NEURO CLOSED
NEURO SURG
NEURO CLOSED
CT
TRAUMA CLOSED INTERNAL DISRUPTION AUTHORIZED BY

REVISED: BOR:laa:08-31-93

P/P 4:1702

IMPLEMENTATION DATE:

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