Destination & Diversion Guidelines

Transcription

1 Date: October 15, 2012 Page 1 of 5 Destination & Diversion Guidelines Purpose: To define the decision-making process regarding the destination of EMS patients. To provide a guideline and policy regarding the diversion of patients from their selected choice of destination in cases where resources are limited and the destination facility is overwhelmed. 1. Destination General A. All patients shall be transported to the hospital or freestanding surgical outpatient facility of choice unless: a. There is an immediate threat to life or limb. In these cases, the patient will be taken to the closest appropriate facility*. b. The patient is a minor, or incompetent. In these cases, the family or legal guardian may choose the destination facility. c. The patient suffers from an illness/injury requiring a specialized care center as outlined in this protocol. d. The chosen facility removes the EMS unit from the service area for an extended period of time creating a shortage of local resources. e. The facility of choice is a freestanding surgical outpatient center incapable of providing definitive care. f. The facility of choice is on diversion status as defined in this protocol. g. A major disaster exists where patients are triaged and sent to a predetermined facility based on available resources. B. Patients requesting transport outside of the Medical Control Authority area may be taken to that facility if: a. The patient has a pre-existing relationship with the requested facility. b. In the provider s opinion, the patient s condition will not likely deteriorate or worsen an outcome due to an extended transport time. C. When a patient is transported outside the Medical Control area, providers will follow the originating Medical Control Authority s protocols until contact with the on-line physician at the receiving facility can be made. If orders are required for transport, contact on-line medical control prior to leaving the area and obtain standing orders. D. No other individuals (police, fire, bystander, physician, etc.) are permitted to determine the destination of a patient without prior approval of on-line medical control. E. In the event a patient s destination facility of choice differs from the most appropriate destination; contact medical control for assistance. *Closest appropriate facility may be a facility capable of providing definitive care or, if definitive care is not readily available, resuscitative care for the patient s condition in consultation with on-line medical control or as defined by protocol. MCA Name Saginaw Valley MCA

2 Date: October 15, 2012 Page 2 of 5 2. Destination Trauma Patients A. All trauma patients will be triaged using the most current Centers for Disease Control Field Triage Decision Scheme (see page 5). B. Destination of the trauma patient shall be directed by the Field Triage Decision Scheme unless: a. It is medically necessary to transport the patient to a hospital without a trauma center for initial assessment and stabilization before transport: 1. Unable to open or maintain an airway 2. Traumatic arrests 3. Uncontrollable external bleeding b. Unsafe or medically inappropriate due to adverse weather conditions or excessive transport time (in excess of 30 minutes). c. Transport will result in a shortage of local resources. d. No trauma center is able to receive and provide care to the patient without undue delay: 1. Cases where there is a mass casualty incident 2. Natural disaster 3. Internal disaster within the trauma center facility e. The trauma patient, legal guardian, or legal representative requests transport to a facility that is not a trauma center. 1. In these cases, the provider should advise the patient or representative that their decision my impact their ability to survive or quality of life. 2. When in doubt, contact medical control for assistance. 3. Document all interactions and the patient or representative sign the Patient Refusal form. C. A Trauma Center is defined as being verified by the American College of Surgeons as a Trauma Center. Designation of trauma centers is pending the establishment of a statewide trauma system by the Michigan Department of Community Health. 3. Diversion It may be necessary during times of extremely high patient volume, overwhelmed resources, or internal disaster for a facility to divert ambulances away from their emergency department (ED). During this period, under most circumstances, ambulance patients will not be accepted. A. Definitions a. Diversion The act of redirecting EMS patients to alternate facilities in a systematic fashion when the requested facility is temporarily incapable of providing care safely to any further EMS patients, through a coordinated plan. b. Selective Diversion Refers to the diversion of EMS patients by a facility based on the temporary lack of a specific resource at a particular time. c. Diversion Status Refers to a particular facility s ability to accept patients: 1. Status A The ED is available to receive all patients.

3 Date: October 15, 2012 Page 3 of 5 2. Status B The ED is able to accept patients but lacks specific capabilities. A period of selective diversion where a critical piece of equipment may be inoperable or there may be a lack of critical care beds for admission. The facility must identify which resources are lacking and communicate them to the EMS providers. 3. Status C The ED is saturated and cannot safely accept further EMS patients. All EMS traffic will be diverted to other receiving facilities. 4. Status D An internal disaster at a receiving facility where not only EMS patients must diverted but all patients (e.g. fire, bomb threat, poweroutage, etc.). d. If at any time, ALL receiving facilities in a particular county or region are on diversion status, then they will be considered open and accepting all EMS traffic. e. EMResource - A web-based communication software program that provides resource management (i.e., ambulance diversion status, bed tracking, emergency department status, public health communication and reporting). The primary program used for participating hospitals to report diversion status. B. Criteria for Diversion a. The decision to divert EMS patients shall be made only after a hospital has exhausted all internal mechanisms possible to avert a diversion. Available resources must be limited to the point where concerns over patient safety are perceived possible. b. Diversions shall not be based on financial considerations, such as patient payer mix, saving beds for elective procedures/admissions or potential deterioration of currently hospitalized patient, or in anticipation to receive certain transfers or incoming patients. c. A decision to divert shall be made by the Emergency Physician on duty in consultation with nursing staff in charge and/or hospital administration, as appropriate. In any case, appropriate hospital administration representatives must be notified immediately of the diversion status so that corrective action may be taken as soon as possible to begin accepting EMS patients again. d. Diversion data will be reviewed by the Medical Control Authority on a regular basis as necessary. e. If there is a particular conflict or impasse that cannot be resolved amongst the facilities in the Medical Control Authority, the Medical Director will be contacted to facilitate and reach an agreement. Additionally, the Medical Director retains overriding authority to change any facility s status in the rare instance when it may become necessary for the benefit of the EMS system and/or its patients. C. Procedure a. At the time a facility determines diversion is necessary, they will update their status using EMResource.

4 Date: October 15, 2012 Page 4 of 5 b. Diversion requests will be honored for a period of four (4) hours from the time the request is made, after which time the facility will automatically revert back to Status A. 1. If the facility needs additional time on diversion, it must again update their status using EMResource. 2. If the diversion is cancelled prior to the four (4) hour expiration, a facility may update their status using EMResource and return to accepting EMS patients. D. Prehospital Considerations a. Patients requesting transport to a facility, which is currently on diversion, should be notified of that diversion and the fact that the appropriate resources to care for them are not currently available at that institution. b. An alternative facility destination should be requested from the patient. c. If the patient persists in the request of the facility currently on diversion, contact medical control.

5 Date: October 15, 2012 Page 5 of 5 CDC Field Triage Decision Scheme