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Local EMS Agency Ambulance Diversion Policies — Santa Barbara

POLICY REFERENCE NO.: 300.09

DATE ISSUED: 01/01/98

Ambulance Diversion Policy
  1. PURPOSE:

    To define the procedures by which EMS providers and/or Base Hospitals may:

    1. 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.
    2. Provide a mechanism for a hospital in the Santa Barbara County EMS system to have patients diverted away from its emergency department when it has been determined that the hospital is not staffed, equipped, and/or prepared to care for additional or specific types of patients.
    3. Assure that ambulances are not unreasonably removed from their area of primary response when transporting patients to a medical facility.
  2. AUTHORITY:

    California Adminitrative Code, Title 13, Section 1105(c): "In the absence of decisive factors to the contrary, ambulance drivers shall transport emergency patients 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. POLICY:

    It is not the policy of Santa Barbara County EMS to promote diversion of patients unless unusual situations apply. When it is appropriate, hospitals may divert patients according to the following conditions. This policy shall not negate prearranged interhospital triage and transport agreements approved by Santa Barbara County EMS.

  4. PROCEDURE:
    1. DIVERSION REQUEST CATEGORIES

      A hospital may request that ambulances be diverted for the following reasons using the following terminology:

      1. Internal Disaster

        Hospital's emergency department cannot receive any patients because of a physical plant breakdown (e.g. fire, bomb threat, power outage, safety issues in the ED, etc.).

      2. Emergency Department Saturation

        Hospital's emergency department resources are fully committed to critically and/or seriously ill patients and are not available for additional ALS patients.

      3. Lack of Neuro/CT-Scanner Capabilities

        Hospital is unable to provide appropriate care due to non-functioning CT-Scanner and/or unavailability of a neurosurgeon, and is therefore not an ideal destination for patients likely to require these services.

      4. Intensive Care Unit (ICU)/ Critical Care Unit (CCU) Saturation

        Hospital's ICUs do not have any available licensed beds to care for additional patients, and is therefore not an ideal destination for patients likely to require these services.

    2. PATIENT DESTINATION
      1. Authority for patient destination rests with the Base Hospital.
      2. Diversion requests may be honored provided that:

        1. Santa Barbara County Public Safety Dispatch has been notified. See C.2.a. A hospital on diversion due to internal disaster shall not receive patients.
        2. The patient does not exhibit an uncontrollable problem in the field. An "Uncontrollable Problem" is defined as:
          1. Unmanageable airway,
          2. Uncontrolled hemorrhage,
          3. Full arrest,
          4. Shock, or
          5. Any patient that the paramedic on scene or the BH MD feels would likely deteriorate due to diversion.
      3. If some area hospitals are on diversion due to Emergency Department saturation and other area hospitals are on diversion due to ICU saturation, patients being diverted should be transported to a hospital with an open emergency department and no critical beds over one that is on diversion due to Emergency Department saturation.

        If all area hospitals are on diversion for the same reason, then patients cannot be diverted for that reason and the patient will be transported to the closest medical facility.

      4. Base hospitals shall not direct ALS units to transport patients to any medical facility that has requested diversion of ALS patients due to an incapacitating internal disaster, regardless of transport time restrictions as identified in Section IV.A.1 of this policy.
    3. PROCEDURE FOR REQUESTING DIVERSION OF ALS PATIENTS
      1. To ensure that hospitals do not divert patients without the knowledge and concurrence of hospital administration, the hospital administrator or his/her designee must authorize the need for diversion.
      2. To initiate, update or cancel a diversion, the Administrator or his/her designee shall notify Santa Barbara County Public Safety Dispatch and adjacent Base Hospitals.
        1. The caller will use the following statement format to initiate, update, or cancel a diversion: "This is (first name, last name) at (name of hospital). It is (date, time). We are (going on, updating, canceling) the (specified) diversion." Notification will indicate the expected duration of the diversion status and the category/categories for which it is diverting patients using terminology specified in Section IV.A. of this document.
        2. Hospitals on diversion status shall immediately notify Dispatch and the adjacent Base Hospitals as soon as diversion is no longer necessary.
        3. Hospitals will maintain a "Diversion Log" (broken down by date; time; reason for diversion; date/time/returned to normal status) of initiation, update, and cancellation of diversions, and will submit a written report to the EMS Agency monthly.
        4. Problems with policy and procedure related to diversion notification will be directed to the Administrator, Santa Barbara County EMS.
        5. Problems arising during a diversion, requiring immediate action, should be directed to Dispatch and/or the adjacent hospitals.
      3. Santa Barbara County EMS staff may perform unannounced site visits to hospitals on diversion status to ensure compliance with these guidelines.
      4. Hospital shall develop internal policies and procedures for authorizing diversion of patients in accordance with this policy. These policies shall include internal activation of backup procedures. These policies and procedures shall be approved according to the hospital policy approval procedure and shall be available to the EMS staff for review.

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