Purpose: To transport the pre-hospital patient to the closest appropriate facility that is staffed, equipped and prepared to provide care appropriate to the needs of the patient. To provide a temporary mechanism for receiving hospitals to request diversion of pre-hospital patients when they are not staffed, equipped or prepared to provide adequate care of additional patients.

Participants: Snohomish County EMS agencies and affected agencies in contiguous counties. Snohomish County area hospitals and affected hospitals in nearby counties. Snohomish County Emergency Dispatch agencies.

Definitions:
1. Types of Diversion
a. Limited Diversion
b. ED Saturation Diversion
c. Closed Diversion
2. Hospital Catchment Zones:
The physical area of each participant hospital which generally reflects their primary patient population
3. Internal Peak Census Policy:
Each hospital will have a Peak Census Policy/Protocol which will address: a. Definitions of conditions for activation
b. Specific procedures to secure additional staff and resources
c. Notification and approval of the hospital administrator/designee to place the hospital on prehospital (EMS) diversion
d. Procedure for internal review of cases of pre-hospital (EMS)_diversion
4. Eligibility
a. The hospital ED has exceeded its safe capacity for caring for critical patients. Lack of inpatient beds, Critical Care beds and/or medical staff backup does not meet criteria for ED diversion.
b. The hospital has initiated its own Internal Peak Census Policy to address correction of the underlying issues.
5. Limitations
Diversion causes EMS disruptions which result in prolonged transport times, delay in subsequent response to 911 calls, and transport of patients to hospitals not of their choosing. The following limitations therefore apply:
a. Diversion is temporary. Each request shall expire in two hours. Hospitals are encouraged to end diversion as early as possible.
b. If two or more hospitals in contiguous areas request critical diversion simultaneously, both facilities are downgraded to limited diversion status.
Implementation:
1. Hospitals will identify issues leading to the necessity for diversion 2. Internal procedures to mitigate these issues will be implemented
3. The appropriate hospital administrator/designee will be notified and authorization to implement pre-hospital diversion will be obtained
4. Dispatch agencies will be notified by hospital administration/designee

Pre-hospital Procedure:
1. Limited Diversion
a. ALS and BLS units within the hospital's catchment area will transport to that hospital b. Units outside a hospital's catchment area will be transported to the closest appropriate facility
c. Units will make attempts to honor a patient's request should they indicate a desire to be transported to a hospital on diversion. EMS may contact that hospital regarding this.

2. Emergency Department Saturation Diversion
a. BLS units not transporting code red will divert to the next closest appropriate facility b. ALS units may divert to a next closest appropriate facility if in the medic's judgment this delay will not jeopardize patient care
c. Resuscitations, ST-Elevation Myocardial Infarction, Acute Respiratory Failure will be transported to the closest appropriate facility regardless of diversion status.

3. Closed Diversion
a. The Emergency Department is closed to all pre-hospital transports due to some physical or functional disaster
b. All ALS and BLS units will divert to the next closest appropriate facility. EMS Office Notification:
Hospitals are no longer required to notify the EMS office of initiation of diversion. Occurrences will be tracked via Dispatch Center data for ongoing quality assurance and control.

Dispatch Notification:
Hospitals will notify county dispatch centers of status and start time, by telephone. Dispatch centers will notify EMS.

Hospital Notification:

Hospitals will notify surrounding facilities (adjacent hospitals) of status and start time by telephone.

Diversion Policy Adopted November 2, 2005 2 Revised May 15, 2006