journalsentinel

The theory behind ambulance diversion is that it is supposed to direct ambulances away from jammed ERs to less-busy hospitals that can offer care more quickly. In practice, that is often not how it works because when one hospital goes on diversion, surrounding hospitals typically are soon overwhelmed by the diverted patients.

There also is an assumption in this scenario, that the only two options are to go to an overcrowded ER and wait for care or go to a more distant (and perhaps less-qualified) hospital and get care there. In the places where diversion has been ended, it has been shown there is another option that gets at solving the issue of ER crowding. That is to reform the rest of the hospital options so the ER can be more quickly emptied. For instance, hospitals are adjusting elective surgery schedules, reforming admissions and discharges and changing how rooms are cleaned, all with an eye to making the movement of patients more efficient.

To the question: How often is it the case that diversions save lives? No one knows that because there have been no peer-reviewed studies of ambulance diversion systems. There have been several studies that indicate diversion does not solve overcrowding and poses risk to patients.

Yes, EMTs do work through the local EMS systems. That's where they learn about which hospitals are on diversion and which aren't. In Chicago, the regional hub would let the medics know which hospitals are open to ambulances. An important thing to note is that some hospitals will accept serious trauma cases like shooting victims even when they're on diversion.

Thanks for the comment. How often are diversions happening in Indy?

Thanks for your interest, u/UncleDan2017. You're right that EMTALA requires hospitals to treat people who arrive at their doors, or within 250 yards of their doors. But, if a hospital emergency department can divert an ambulance before it gets to the hospital, EMTALA does not apply.

Hospitals that turn away or divert ambulances don't mention the money at all. They say it is for safety and convenience of patients. But research shows financial incentives behind diversion, like the fact that elective surgeries on average net more money for hospitals than emergency cases. If hospitals have to pick between canceling elective surgeries and going on diversion, there is an incentive to go on diversion, research has found. Fixing hospital operations that then reduces ER overcrowding costs money too and if the ER cases don't make as much money anyway, the incentive to fix the flow is not strong, researchers found.