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TSA-V

Facility Diversion Guidelines

Subject: Diversion of Ambulance Traffic from Emergency Facilities

Purpose: To develop a standardized diversion policy that identifies area specific trauma resources and assures continual access to the appropriate trauma facility for each trauma patient.

Statements: System hospital facilities, both Trauma Center and non-Trauma centers, should request diversion activation only when the resources and capabilities of that facility have been exhausted to the point that further ambulance traffic would jeopardize the care and treatment of patients at that facility as well as any subsequent patient transported by an ambulance.

It is recognized in advance that no diversion strategy can guarantee total compliance with these guidelines and it is likely that ambulances will deliver patients to hospitals which have requested diversion activation. It is further understood that a request for diversion activation is honored as a courtesy by the local EMS system. All Requests for Diversion are for CODE 1 Status Patients Only.

Diversion requests DO NOT apply to those patients with extremely life threatening conditions (e.g. cardiac or respiratory compromise, Cardiac Arrest, lack of airway control or other problems that must be immediately addressed by a physician).

Procedure:

1.      Each facility will develop procedures for their facility to be placed on diversion status and procedures for implementation of these guidelines.

A.     Suggested reasons for facility diversion for Provisional requests might include, but not limited to:

·  Trauma Surgeon/General surgeon/Orthopedic Surgeon/Neurosurgeon is not available

·  Inoperable CT Scanner

·  Multiple Critical Patients in the ED or Numerous ED Holds

B.     Priority Requests might include, but not limited to:

    Physical Plant Failure/Structural Compromise

 Disaster Activation Response

C.     Detailed Requests

            No in-house bed availability  

            (ICU, Pediatrics, Telemetry, Med/Surg)

2.      Each facility shall designate a person responsible for decisions regarding diversion status. The Trauma Medical Directors in conjunction with the Emergency Department physician shall be notified in cases of Trauma Diversion.

3.      Each facility must have a Local Mass Casualty plan and know how to activate the other resources within the TSA-V if needed.

4.      Each facility must have policies and procedures in place to open critical beds in the event of a mass casualty.

5.      Communication of Diversion Status:

A representative from hospital administration must notify MedCom and online medical direction source as well as the administration of any receiving hospital within a 20 minute radius of diversion implementation and deactivation.

6.  Time Period for diversion status:

Diversion request will be in allotments up to eight (8) hours. A hospital may deactivate a diversion request at any time.

A representative from hospital administration must notify MedCom and online medical direction sources, as well as the administration of any receiving hospital within a 20 mile radius to request an extension beyond each (8) hour allotment.

Neglect or failure of a hospital to notify MedCom and online medical direction source at the end of the requested eight (8) hour allotment will automatically convert to diversion deactivation.

7.   Authorization for over ride of diversion request:

The online EMS physician may over ride a diversion request after consideration of the following:

1.      Severity of the patient

2.      Distance and estimated time to an alternative appropriate faculty.

3.      Patient request

4.      Inclement weather conditions

5.      Resources availability and capabilities of the transporting pre-hospital provider

6.      All other potential receiving facilities within a 15 minute radius of the patient location have requested diversion considerations.

8.        A facility which is greater than 20 minutes from the next receiving facility may go on diversion when the above mentioned facility diversion criteria is met. EMS shall inform the patient and or family of the diversion status of this facility and the distance to the next closets facility. EMS may override the families request if it is deemed necessary to transport to said facility in order to obtain the level of care necessary for treating the patient. Online medical control should be notified if the patient or family request the diverted facility or severity of the patient warrants EMS to transport there for stabilization.

       Section 1867 does not obligate the ambulance service to transport the patient to that      

       Hospital.

9.      Each facility will be requested to document and report diversion activities to the TSA  

"V" Quality Assurance Committee. A form shall be developed in which any hospital going on trauma diversion must complete and submit to the TRAC Regional Administrator within 7 days. This must include the reason for diversion and authorizing authority. The Pre-Hospital, Disaster and Communication Committee will review for appropriateness.

10. Each EMS system will be requested to document and report to the TSA "V" QI Committee those situations where a diversion request has not been honored or has been overridden by the online EMS physician.