Hospitals on "divert" status...

[VentMedic]

I've been working on the EMS responce to terrorism program on LMS and it makes you think what our local hospitals surge capiblities are. Also, do we have secondary areas that can be used to treat, relocate, manage a massive amount of patient influx. On top of that do we have a system in place for mass population and or mass patient relocation?

The hell with diverson, say due to weather related damage one of your hospitals must be evacuated have you thought at all the amount of resources it would take, where you would take people and how long it would take to do such a thing?

That is definitely something to think about. I know we do in Florida every hurricane season. The 2004 season had us flying patients out of state because some of our hospitals were maxed from taking in patients from damaged subacutes, NH and other hospitals. Supplies such as oxygen may not be available for several days to replenish the rapidly depleting main supply tank. Hurricane Andrew taught us alot in Florida. Unfortunately, when Katrina was heading for NOLA, those lessons were never applied there even though they were talked about alot.

Citizens get irrate when hospitals do evacute in the face of potential disaster. They too have the opportunity to evacuate but may make the choice to stay and then complain when other exercise good judgement for safety. If the hospital keeps emergency staff available, it may encourage people in the community not to evacuate. If the hospital takes a direct hit, emergency crews will have to take the risks of rescuing the hospital based crews. This takes the resources away from other rescues.

I have participated in the evacuation many hospitals over the last 3 decades. It can be a nightmare if there is not plan in place but just random calls for assistance. Returning the patients back to their proper facilities can be even more taxing on resources. Hurricane Georges taught me alot on that situation.

One of my more memorable evacuations was Tampa General many years ago. Why someone would build an 800 bed trauma center on an island with one little bridge is a question to ponder.

http://standeyo.com/NEWS/06_USA/060710.Tampa.surge.html

http://www.sptimes.com/2005/09/24/news_pf/...l_s_plan_.shtml

[Richard B the EMT]

Most here know I live beachfront by the Atlantic Ocean. My girlfriend's mom is in an extended care pavilion of a local hospital, and if we have to do a coastal evacuation due to an inbound hurricane, I know which facility inland she's going to.

As for me, if I'm not stuck at work, my mom and I have to relocate to the Aqueduct Racetrack.

The Racetrack?

Yes. That is where we are supposed to meet the busses that will transport mom and me to a "host" area. Considering the population, thats the 2 of us, and a couple hundred thousand of our closest friends.

Me, personally? I'm thinking the Superdome during Katrina, except with "Noo Yawk" accents, instead of "southern/Cajun".

My friends at the New York City Mayor's Office of Emergency Management at least advise me that I am in a "Level 3" area. 1 and 2 go first, as they are lower to sea level.

As for those who should evacuate, but don't because "We've never run from a storm," can I have a contact number for your next of kin?

Those who feel that, when the OEM orders them to leave their pets, "if it's safe for the pets, it's safe for me", same deal. It'll hurt, but you can get a new pet, but where am I going to get another YOU?

[JPINFV]

Me, personally? I'm thinking the Superdome during Katrina, except with "Noo Yawk" accents, instead of "southern/Cajun".

Meh, I'd rather be at a Qualcomm (main 2007 California wild fire shelter for San Diego county) shelter. You know you're at the right shelter when there's a rock band playing for the evacuees*.

*My parents live in the area and were lucky enough to not have to evacuate. They were on the border of the voluntary evac zone, though. One of the small fires was about 5 minutes away from them, but that one was put out quickly.

[sweetridecoug99]

The only 2 cents I can put in about diversion, is that here in southeastern massachusetts, the hospitals that do go on diversion only do so because 1, they cant move patients out as quickly as they wanted, and 2, something serious has happened like a code or multiple traumas at the same time.

[NYC-EMS]

We have (ER Divert) in Jersey City as well.

[Niftymedi911]

No hospitals are allowed to divert EMS unless deemed by our Shift Commander.

We must contact our shift commander on a Tac channel to requesting hosiptal destination. The patient's request, location, nature of illness, and priority are taken in to consideration. The trucks are rotated from hospital to hospital and when a certain hospital has an offload greategr then 1 hour trucks are sent somwhere else unless nature of call or priority precipitates that.

The only way the hospital cna divert is if they're on "internal disaster mode".

[boeingb13]

They tried that here in Jacksonville (Florida) but what it amounted to was the rescue's stopped calling ahead letting the er's know they were coming unless it was a code. There were alot of problems for sometime. Now that no hospital can divert anymore, things are running pretty smoothly.

[Dustdevil]

They tried that here in Jacksonville (Florida) but what it amounted to was the rescue's stopped calling ahead letting the er's know they were coming unless it was a code.

LOL! I like that!

In a better system, EMS would not be calling into the hospital anyhow. That should be a dispatcher job, not a field medic job. Unless you need a physician consult, there is no reason for the field medic to divert his attention from his patient to give a lot of pointless info to some nurse.

[Richard B the EMT]

With the thought that what works in one area might not work in another, I'm mentioning that the FDNY EMS On Line Medical Control is at an FDNY EMS facility, not in an Emergency Department. We have a few sub-stations AT some EDs, if there should be an overload of calls, but most are handled in house.

If a notification is needed for a call working through the OLMC, the OLMC makes the call to the ED that is going to get the patient.

If the call is not actively "on line" with the OLMC, the involved ambulance crew calls dispatch over the radio, either gives the information to be relayed to the ED to the dispatcher, or tells the dispatcher to read what the crew typed into the Computer Assisted Dispatch with the "on the way to the hospital" signal update.

With that last, the computer radio signal, in the "printout", would possibly read as follows...

"47W3 47A3 82A H40, M 45 MVA VICTIM FX ARM BILAT 140/94 HR 150 RESP ASSIST TUBED ETA 7".

(Text transmissions over the CAD/Radio from the units are always in all caps, so I wasn't "shouting".)

Translation is as follows:

ALS 47Willie (tour 3) and assisting unit BLS 47Adam (tour 3) transporting ALS call to hospital 40 (St. Johns Episcopal-Far Rockaway). Pt is Male, 45 years old, in a Motor Vehicle Accident, Fractured Arm both sides. Blood Pressure 140 over 94, Heart Rate150, assisted respirations via intubation, with an Estimated Time of Arrival of 7 minutes.

(Not trying to be insulting, just doing an oversimplification for our new folks in the City)