Diversion Information

What is a hospital diversion?

A status updated by a hospital stating they cannot accept patients because they are experiencing an overload.

Why have a diversion plan and policy?

Outside of MCIs, hospital diversions occur for many reasons. These can be from seasonal problems like flu, no beds in the hospital, or to get the patient to a facility capable of better taking care of that patient.

Acute care hospitals (those with emergency departments) occasionally become overwhelmed with patients, exceeding the capacity for medical staff to adequately treat and monitor those patients. To alleviate this temporary situation, a receiving hospital – after completing an established process – may declare a diversion of acute patients, whereby ambulances are diverted to other area hospitals.

The diversion plan helps coordinate the movement of diverted patients in order to alleviate patient overload at receiving hospitals.

Can an EMS provider override a hospital diversion? 

They can. Examples where this may occur are if a patient is in extremis, or for significant weather/traffic delays, or mechanical problems.  An EMS provider who believes an acute decompensation is likely to occur if the patient is diverted to a more distant hospital ALWAYS has the option to take that patient to the closest Emergency Department regardless of the diversion status.

The decision to override a hospital’s diversion status should not be made lightly. Hospitals on diversion do not go on diversion lightly either. In order to declare a diversion status a hospital must have exhausted internal mechanisms for dealing with overload. Overrides performed by EMS providers are reviewed by the ODEMSA Diversion Committee.

What is a regional diversion status and what are the stages? 

A regional diversion status is where multiple hospitals are on some diversion. As this causes a systemic problem, regional diversion statuses were created to provide for systematic responses to different types of diversion.

The first type of diversion is Stage Green:

This is the resting stage of the region. A couple hospitals may be on diversion but this is usually transient and does not effect the region. This is where all agencies and facilities are in normal operation.

The second type of diversion is Stage Red:

The stage is triggered when more than 5 hospitals are on similar types of diversion. At this point the RHCC notifies appropriate contacts of the status. During this time, agencies should notify their providers of this status. EMS providers will change from calling a destination hospital to calling the RHCC hotline (1-800-276-0683) for patient placement by the Patient Distribution Center “PDC”. Patient’s are then sent to the closest appropriate facility. The object is to distribute patients evenly to allow for hospitals to come off of diversion. Coordination of patients and resources occur until a majority of hospitals come off of diversion. An After Action review is performed.

The third type of diversion is Stage Black:

This stage is triggered when 8 or more hospitals are on similar diversions. At this point the RHCC notifies appropriate contacts of the status. During this time, agencies should notify their providers of this status. EMS providers will change from calling a destination hospital to calling the RHCC hotline (1-800-276-0683) for patient placement by the Patient Distribution Center “PDC”. Patient’s are then sent to the closest appropriate facility. The object is to distribute patients evenly to allow for hospitals to come off of diversion. Coordination of patients and resources occur until a majority of hospitals come off of diversion. An After Action review is performed.