2. Diversion So what are the rules? MBEMSC Pre-Hospital Systems Coordination Committee December 2004

3. Purpose The purpose of this program is to give the pre-hospital provider a practical overview of Diversion, and the Internet Based Diversion system.

4. What is Diversion? Essentially an Emergency Department is full and is re-directing ambulances from their ED Essentially an Emergency Department is full and is re-directing ambulances from their ED

5. Why divert ambulances? ED’s divert ambulances for only two reasons. ED’s divert ambulances for only two reasons. –Internal Disaster –ED Saturation

6. Most Common Reason ED Saturation What causes ED Saturation? Boarding of patients in the ED

7. What does this mean to the EMT Honor Diversion Status Honor Diversion Status –Allows an ED to clear Boarding patients out quicker –Allows patients being transported by the EMT to be seen sooner at other ED’s

8. Is There An Exception There are several: There are several: –Trauma Center patients –Immediate life threatening situations –Complex medical history related to event –Recently discharged

9. Who’s on Diversion? How does the EMT know when an ED is on Diversion? How does the EMT know when an ED is on Diversion? Does the CMED tell all ambulances which hospitals are on diversion? Does the CMED tell all ambulances which hospitals are on diversion?

10. What will I see? If a provider service accesses the Internet Based Diversion System what will they see? If a provider service accesses the Internet Based Diversion System what will they see? Hospital CityStatusRegionLast UpdatedUpdated By BOSTON MED CTR-HARRISON A BOSTONDiversion0412/13/2004 10:36:40 AMUlrich B.I.D. Needham (Glover) NEEDHAMOpen0411/8/2004 7:42:56 PMC-MED; Auto Open BETH ISRAEL DEACONESS BOSTONOpen0412/11/2004 4:30:30 PMauto BOSTON MED CTR-EAST NEWTO BOSTONOpen0412/5/2004 3:09:52 AMAuto Open/Timed Out BRIGHAM AND WOMENS BOSTONOpen0412/11/2004 3:28:57 AMC-MED CAMBRIDGE HOSPITAL CAMBRIDGEOpen0412/10/2004 7:03:47 PMcmed4 CARITAS NORWOOD HOSPITAL NORWOODOpen0412/12/2004 3:12:56 PMOperations CARNEY HOSPITAL BOSTONOpen0411/29/2004 3:20:17 PMcmed timed out CHILDRENS HOSPITAL BOSTONOpen049/28/2004 3:17:38 PMauto open EMERSON HOSPITAL CONCORDOpen0410/28/2004 11:32:59 AMstaff FAULKNER HOSPITAL BOSTONOpen0412/8/2004 5:01:45 PMcmed LAHEY CLINIC BURLINGTONOpen0412/12/2004 12:37:28 AMCMED MASS GENERAL HOSPITAL BOSTONOpen0412/11/2004 8:22:01 PMcmed

11. Website is Unavailable Local computer/internet problems Local computer/internet problems –Contact another local dispatch center that has access Webpage Server down Webpage Server down –Contact ED directly –Contact CMED on ED status

12. Practical Application You are transporting a patient that insists in being transported to a local facility that is currently on diversion You are transporting a patient that insists in being transported to a local facility that is currently on diversion –The patient does not meet any of the exception criteria defined in the diversion rules –If not transported to the hospital of choice the patient refuses to be transported at all How should this incident be handled?

13. Practical Application I cont… Every effort should be made by the ambulance crew to inform the patient of the potential risks of being transported to a facility that is on diversion Every effort should be made by the ambulance crew to inform the patient of the potential risks of being transported to a facility that is on diversion Every effort should be made by the ambulance crew to notify the receiving facility in advance of arrival Every effort should be made by the ambulance crew to notify the receiving facility in advance of arrival –The circumstances of transport should be explained to the facility

14. Practical Application II Your have assessed your patient and have begun transporting your patient to hospital A. Your have assessed your patient and have begun transporting your patient to hospital A. The hospitals diversion status changes while enroute to the hospital from open to on diversion The hospitals diversion status changes while enroute to the hospital from open to on diversion What should be done?

15. Practical Application II cont… Every effort should be made by the ambulance crew to notify the receiving facility in advance of arrival Every effort should be made by the ambulance crew to notify the receiving facility in advance of arrival –The circumstances of transport should be explained to the facility Upon arrival at the hospital the ambulance crew should explain: Upon arrival at the hospital the ambulance crew should explain: –Hospital was open at the time of transport –Family was already committed to bringing patient to the facility –Every effort was made in advance to notify the ED

16. Any Questions

17. The End