California Ambulance Diversion Policy Passes Test

A system for distributing ambulance patients to hospitals in Stanislaus County is working "as good as can be expected" and could become the permanent policy, officials said Thursday.

The diversion system, which permits hospitals to close their emergency rooms to most ambulance traffic for up to two hours, is not new. It is used in many counties in California but has not been the policy in Stanislaus County, which has only four hospitals with emergency rooms.

To keep from overwhelming the ERs at Memorial Medical Center and Doctors Medical Center of Modesto, Emanuel Medical Center of Turlock and Oak Valley Hospital in Oakdale, a plan was triggered in which ground ambulances took patients to hospitals on a rotation.

Emergency service officials, along with the hospitals and ambulance companies, decided to try diversion on a trial basis from June to November. They liked how it worked and extended the trial through the busy winter months.

"For the most part, the hospitals have been pleased with it," said Steve Andriese, executive director of Mountain Valley EMS Agency, which regulates ambulance response in Stanislaus and four other counties.

"The hospitals want to have the ability to relieve the pressure. It has had the positive effect of keeping ambulance turnaround to a minimum."

Cindy Young, emergency services director for Memorial Medical Center of Modesto, said the system received good reviews at a regional EMS meeting last month.

"What is good is that we are communicating well when a hospital is on diversion status," she said.

After ERs were swamped in early 2005, the Mountain Valley EMS told hospitals that things needed to change.

Emergency-room crowding was causing ambulance crews to stack up at hospitals while waiting to deliver their patients, and those crews were not able to respond to calls.

Under the diversion plan, a hospital can divert most ambulances for two hours at a time. Patients with life-threatening conditions are still taken to the nearest appropriate hospital, and patients with serious injuries are rushed to the trauma centers at Memorial or Doctors.

If more than one hospital goes on diversion at the same time, the option is canceled, and the ambulances revert to the rotation system, the draft policy says.

Emanuel went on diversion for a total of 29 hours in January, said spokesman John Gilbert. That hospital had the worst trouble with ambulance delays a year ago, with instances of crews waiting up to two hours to hand over patients.

Gilbert said diversion has helped to reduce pressure on ER staff.

At the urging of Mountain Valley, the hospital adopted internal procedures to address ER crowding. Employees from other departments are called to assist in the ER when an ambulance has waited more than 15 minutes to hand over a patient. Other measures are taken to free hospital beds for waiting patients, he said.

The new system has not meant that emergency rooms are less crowded this winter.

Memorial recorded 10,800 emergency-room visits in January and February, an increase of 260 visits over 2005. From December to February, Emanuel had almost 1,000 more ER patients than a year ago.

During a rash of upper respiratory tract infections in February, almost 20 percent of patients who came through the Memorial ER needed to be admitted for hospital care, Young said. Hospital beds were not always available; some patients waited in emergency-room beds for 16 to 24 hours for a regular hospital room.

Patients with less-serious conditions could expect to spend three to four hours from sign-in to discharge during peak hours, Young said.

The growing patient volumes were not the only reason hospitals and ambulance companies tried the diversion system. Under the rotation system, patients often were not taken to hospitals in their insurance network, and ambulances transporting patients from southern San Joaquin and northern Merced counties were turned back.

The diversion policy has been extended through 2006, and the Mountain Valley EMS could ask its board to permanently approve the policy in 2007.

Overall, the local emergency-room crowding is not as bad as reports in other metropolitan areas in California.

According to the Associated Press, some public hospitals in Los Angeles County close their emergency rooms to ambulances an average of 20 hours a day and the average for private hospitals is 12 hours or more per day.

Bee staff writer Ken Carlson can be reached at 578-2321 or kcarlson@modbee.com.

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