This is the new policy, Please also log on to the MEMS Medic web site for more information including the miranda language that we want you to use when explaining this policy to patients.
medic.metroems.org
MEMS Patient Destination Policy
1 May 2008
Patient destination will be based upon hospital capability and capacity considerations in accordance with the following guidelines:
1. MEMS will continue to recognize that some area hospitals lack the capability to handle certain patients and are not normally an appropriate destination.
2. When area hospitals are over capacity they will continue to report that condition to MEMS, but will no longer be placed on diversion status. Instead, MEMS will continue to log the information and proceed using the following definitions:
Alpha status (green) – The hospital is in normal operations in the given category
Bravo status (yellow) – The hospital is currently over capacity. The hospital will report this condition to MEMS from the category list provided below. In turn, when the hospital is no longer in an over capacity status, they will report this condition to MEMS and will be returned to Alpha (green) status. After two hours in Bravo status, the hospital will automatically revert back to Alpha status.
Charlie status (red) – The hospital lacks the capability to provide a specific type of care and would not normally be an appropriate destination for a patient whose condition would require care in that category. The Charlie determination will be made by the AEPF and the respective hospital administrators for each specific category of care MEMS is tracking for each hospital in the MEMS service.
If the hospital lacks capability in a given area, they would normally always be in Charlie status for that specific category of care. One potential exception is neuro coverage. In this case, depending upon available staffing coverage, a hospital’s status could be reported as Charlie for only that time the capability is lacking and would return to an Alpha or Bravo status when that capability is restored. Example: A facility can report itself in Charlie status for neuro surgery when they do not have a neuro surgeon on call.
Overcrowding is considered a capacity, not a capability issue.
3. Consistent with state EMS rules and regulations, MEMS will transport the patient to the hospital of their choice within our service area. If the patient requests to be transported to a hospital that does not have the capability to treat the patient, MEMS will advise the patient and have them designate another.
4. If the patient requests to be transported to a hospital reporting “Bravo” (over capacity) status in the category of care needed, MEMS will advise the patient that their treatment may be delayed and suggest alternate appropriate hospitals reporting “Alpha” status in that category of care. MEMS will take the patient to the hospital of their choice including their original request.
5. In the event the patient does not, or cannot, designate the hospital of choice, MEMS will transport the patient to an appropriate hospital reporting “Alpha” status in the category of care required. If no hospitals are in “Alpha: status, MEMS will transport to the closest appropriate hospital.
6. If the patient is code blue, or, if in the opinion of the treating paramedic, the patient is in a critical condition, the paramedic may elect to go to the closest hospital regardless of the current capability or capacity status of that facility.
7. In the event MEMS declares a mass casualty incident, or MCI, (8 triage red and/or yellow or 10 patients in any triage category), MEMS will determine the distribution of all patients based upon current hospital capability and capacity considerations as well as total patient count, other concurrent demands for ambulance services, availability of MEMS and mutual aid ambulances, travel distance and other immediate operational considerations.
8. Exception: MEMS will continue to recognize psych diversions. MEMS will transport the patient to the facility of their choice if that facility is not on psych diversion, unless we are in psych “round-robin” status. Psych “round-robin takes effect when 3 of the 4 major hospitals (Baptist Little Rock, Baptist Springhill, St. Vincent Infirmary and UAMS) report themselves on psych diversion. When 3 of these 4 hospitals are on psych diversion, MEMS will distribute psych patients on a “round-robin” basis to all Pulaski County emergency departments.
9. MEMS will use the following categories of care in recording Alpha, Bravo and Charlie status:
Entire Facility Emergency Room
Critical Care – Trauma* Critical Care – Medical
Stemi/Cath lab Neuro Surgery*
Other Neuro* Emergency Surgery*
Labor and Delivery Ortho
Stroke/CVA* Psych
Peds Cat Scan*
* If the hospital loses all of their CAT scan machines, the hospital would be considered to not have capability in theses areas
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