Harbor:Diversion for ALS and BLS

Diversion decisions made by MICN, Overall Charge RN and Area Charge RNs, and Attending huddle q4 hours prn

ALS Diversion

• ED Saturation (aka Diversion) is a process of marking the ED in the countywide ReddiNet system as “closed” to adult Advanced Life Support (ALS) arrivals.
  • ED Saturation does NOT redirect BLS arrivals or patients arriving to Harbor as a specialty center (e.g. Trauma, STEMI, Perinatal).
• Up to two hours at a time. At the end of the two-hour diversion, ReddiNet will automatically re-open the hospital to all 9-1-1 traffic.
• If the nearest two alternative EDs are also noted as “ED Saturation”, ALS ambulances will be directed to the closest ED, regardless of “ED Sat” status on ReddiNet. (everyone is open)
• Goal of ED Saturation is to ensure safety of current ED patients and of patients being transported by EMS. Diversion facilitates this by:
  • Allowing staff the time to move patients within or through the ED to free up space/staff resources to care for additional patients, without pressure of incoming patients.
  • Allowing the ED time to prepare for next round of sick patients.

Guidelines for ALS Diversion triggers:

• Not enough space to care for the next critical patient coming by ambulance
  • Not enough treatment spaces despite decompress patients to other beds/hallway
  • Not enough staff (RN, RT, provider, etc.) or supplies (vents, blood, etc.)

Guidelines for BLS Diversion triggers: Requires hospital administration approval

• Very serious decision given consequences to community
• Above ALS diversion triggers AND
• Number of ambulance triage and #ESI 2’s in waiting room = 5-8
• WR #s = 50-60
• WR LOS = >12hrs
• No trauma bays open
• OCN to notify Clinical Nursing Director or designee + Attending to notify DEM AOD --> Approval by CMO/CEO or designee