Hospital Diversion

[ronmicha]

Saturday night, August 19th. I heard five emergency units at Methodist University Hospital waiting on beds requiring them to request additional time out of service. The supervisor was sent to the hospital to see what was going on. I thought the purpose of a paramedic/EMT was to provide emergency care and transportation to the hospital. Then, at the hospital, other personnel take over. If a cot is the “bed” of choice, so be it. I hate to be harsh but I’m a disabled person and one of those units might be one that I would be depending on later to take care of me. Another problem is “diversion”. I think hospitals need to stop this practice and not be allowed to “divert” units to other hospitals. I’m really glad to be able to be listening to the scanner again but some of the “news” I’m hearing is distressing me all dealing with the state of medical care today. Didn’t mean to get “political” on the forum but all of us need to be concerned. Oftentimes, those poor paramedics are cruising the streets looking for someone to take their patients.
Ron

 

[Neal]

Hospital Diversions

Ron,

Long wait times and hospital diversions in Memphis are a daily normal happening. This occurs at most hospitals several times a day.

It is not unusual for patients to wait 6 hours in an emergency room before being seen. Sometimes the wait is as long as 12 hours. A few years ago a city fireman went to Methodist Centeral with chest pains and was put in a chair in the waiting room without being properly evaluated and without any treatment. Several hours later he died in that chair.

There are legitamate reasons for diversions. The hospital not being able to properly treat a specific injury for instance. This should be a rare occurance.

There is only one Level One Trauma Center in an area. (State Law). Memphis had at one time several Level Two Trauma Centers. (Baptist, Methodist, St. Francis) Now almost daily The Med ( our only Level One Trauma Center ) closes and refuses to take any more patients. This starts a chain reaction at most of the other hospitals. They will start telling the ambulances that they are "on diversion" and to take their patients to a place of a higher level of care. All of the Level Two Trauma Centers have given up their Level Two status. These hospitals do not want the indigent patients that the city hospital "The Med" refuses.

Hospitals are required by law to evaluate anyone who presents at the Emergency Department and to give any and all lifesaving treatment until the patient is stable enough to be transported to another facility that will accept them. They are not required to treat or admit stable patients.

All of the hospitals emergency departments are overloaded with indigent patients who have such emergencies as three week old ingrown toe nails etc. These idiots take up time, beds and staff, so that these facilities have trouble with true emergencies. The emergency departments are severly understaffed and overworked.

As soon as a patient arrives on the hospital property they are the responsibility of the hospital. The hospital doesn't want to take over the patient care so they make the ambulance wait and keep the patient on the ambulance stretcher. The ambulance crew is then tied up often for hours waiting on the hospital to do what is required by law. The ambulance crew is then doing the work for the hospital for free. - read between the lines (the hospital doesn't have to hire as many nurses) - (there is a federal law that says that this delay can't happen if the hospital receives any federal monies. This point has been brought to the attention of the hospitals but nothing is being done about it).

If you as a patient want to go to a specific hospital ie. Methodist University and they are on diversion and you are competant to make a decision then the ambulance is required by law to take you to the destination of your choice. The hospital can not refuse to see and evaluate you and to treat any life threatening problems. You also have the right to refuse any treatment at any time.

It is also not unusal in Memphis for the fire depatment to run out of ambulances (they have 31) and not have an ambulance available for a true emergency. This happens often. It is because of their policy of transporting anyone who calls. You would not believe how many fire trucks, firemen, paramedics and ambulances are tied up everyday on B.S. calls.

My advice to anyone in Memphis - NEVER EVER get sick or injured.

I have been a paramedic for over 32 years and started the EMT and Paramedic programs in Memphis. I have watched the quality of both decline for many years now. The Memphis Fire Department at last has a very qualified, educated and concerned Chief, Gary Ludwig. He has some great well thoughtout plans to turn around these problems and to minimize the dropout rate of paramedics. I sincerely hope he can withstand the "Memphis politics and policies" . If he is allowed to implement his plans, EMS will again be a profession a Paramedic or EMT can point to with pride.

I'll step down from my soap box now.

Neal Talley

 

[ronmicha]

Thanks Neal!

Thanks for the explanation. I knew some of what you told me already. I might have mis-spoke on using the word "diversion". One particular day it sounded like everybody was "diverting". There's no real answer. It's a real mess.
Ron

 

[icom1020]

Does the State of Tennessee still have regional EMS directors? I know when my brother was starting out in Knoxville in the late 70's, they had EMS directors/Paramedics who drove around in Suburbans, can't remember their radio designation. "K-Comm" was a local dispatch run through the Knox County Emergency Management that dispatched Knox Co. Ambulance Authority(long gone) but also any unit coming into the county had to contact them on 155.205 A beep at the beginning of the transmission would occur when "K Comm" came on the air not to be confused with a local dispatch traffic. Those were the days...

 

[jalexand69]

My advice to anyone in Memphis - NEVER EVER get sick or injured.

I couldn't agree more. When I lived in Joplin, paramedics and EMT-firefighters were allowed to triage, but I don't know the specific protocols. Many times a volunteer fire fighter would arrive before an ambulance, and I'd hear the FF relaying information to the paramedics en route at which time the medics would ask if the patient had reliable transportation to the hospital. If so, then the FF was supposed to ask the patient if he/family/friends could handle the transportation. If the patient had no way and/or the condition was serious, the ambulance would continue en route. I don't know how well this worked, but FF told me that rarely would a patient out in the county have to wait longer than 30 minutes. If so, then WINGS would be launched. I should also say, though, I never heard calls for upset stomachs after partying or some of the colorful calls I used to hear on the vocal frequency when I lived in Memphis. Fortunately, both Joplin hospitals had helicopters.

As for diversion, a nurse at Baptist East told me that they weren't allowed to divert anymore (back in 2004). It sounds as if the hospitals have found a way around this from your post. I was also told that the ER doesn't staff residents (like orthopedics) as they once did. My Memphis doctors will NOT take emergency calls at all; they order me to the ER and hospital admission, if necessary. j c