EMS: Diversion Or Not: That Is The Question?

It seems that hospital diversions are becoming more of an issue for fire services around the country.


Paramedic Company 14 to Mercy Hospital, we are inbound with a 68-year-old male, substernal chest pain—” “Stand by, Paramedic Company 14, this is Mercy Hospital, we have no beds available, you need to divert to another hospital.” “OK! We’ll try another hospital. This is...


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Paramedic Company 14 to Mercy Hospital, we are inbound with a 68-year-old male, substernal chest pain—”

“Stand by, Paramedic Company 14, this is Mercy Hospital, we have no beds available, you need to divert to another hospital.”

“OK! We’ll try another hospital. This is Paramedic Company 14, we acknowledge your transmission. Paramedic Company 14 to Community Hospital, we are inbound with a—”

“Negative Paramedic Company 14, this is Community Hospital, we are also diverting patients, we have no beds.”

Sound familiar? It seems that hospital diversions are becoming more of an issue for fire services around the country. Fire service EMS managers around the country agree this problem has gotten steadily worse.

What is adding to this problem? Most agree it is a compilation of several things. First, the baby boom population is becoming older and more susceptible to diseases and illness. Also adding to the equation is the fact that managed care has made hospitals more financially accountable for their operations. To save money, hospitals are not staffing as many beds as they once did. Finally, a nursing shortage does not help the matter.

This past winter, the flu season in many parts of the country dramatically impacted this delicate balance of accepting or diverting patients from hospitals.

During the height of the flu season this past January, a St. Louis Fire Department ambulance was diverted from seven different hospitals with a chest-pain patient. One afternoon, the Houston Fire Department found 12 area hospitals on “diversion” status, causing the department to use its Critical Resources Dispatch protocols for the fleet of 62 ambulances. Tucson officials had to meet and change the current diversion policy because ambulances were crisscrossing town, trying to find hospitals to accept patients. As one official said, “It’s gotten to a point where something has to be done, because it’s had a very negative effect on our ability to serve.”

The problem got so severe with the number and variety of closings in the Twin Cities, Minneapolis and St. Paul, that a deal that had been struck last June had to be implemented. That arrangement says only two hospitals can close at any one time in either the west or east metropolitan areas. If a third one says it also needs to close, then all hospitals have to remain open to all patients.

Central Florida, Chicago, Greenville, NC – name your area this past flu season. By mid-January, the federal Centers for Disease Control (CDC) in Atlanta said 21 states were reporting major outbreaks of flu – obviously putting a severe strain on hospitals and fire departments that provide EMS transport.

What many services do not realize is that diversions should be an “advisory” status only. Most hospitals cannot refuse patients unless the facilities are physically closed. Federal laws are in place and apply to participating hospitals. A participating hospital is any hospital which accepts funding from the Medicare program administered by the Department of Health and Human Services, Health Care Financing Administration (HCFA). This applies to virtually all hospitals in the United States, with the exception of specialized hospitals, such as Shriner’s Hospital for Crippled Children.

The federal laws do not apply to just Medicare patients. The chief federal law that prevents hospitals from refusing treatment to patients is the Emergency Medical Treatment and Active Labor Act (EMTALA). The purpose of EMTALA is to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to “charity hospitals” or “county hospitals” because they are unable to pay or are covered under the Medicare or Medicaid programs. In essence, hospitals are required by law to screen all patients seeking emergency care and to provide medical treatment to stabilize those patients with emergency conditions or women in labor.

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