Trauma diversion within a tiered emergency department closure policy

Abstract

Study objectives: Emergency department (ED) closures impart a considerable strain on community and hospital trauma resources. Trauma and nontrauma ambulance transports alike play a significant role in the diversion of trauma patients. Policies to address these issues and appropriately direct patients to adequate facilities are necessary for the timely management of the most critical cases. This retrospective study evaluates the role of a trauma bypass designation in reducing out-of-hospital emergency medical services (EMS) diversion of trauma patients within a tiered ED closure policy. Methods: We evaluated data about ED closures from 1997 through 2003, incorporating 3 Level I trauma centers and 10 county-operated EMS Life Squads. A tiered ED closure policy was introduced in Lucas County, OH, in May 2000 to address a progressive problem with EMS diversions. Before this new system, all hospital EDs were either open or completely closed to EMS traffic, which included all traumas. The tiered protocol provides various closure options, including basic life support bypass, advanced life support (ALS) bypass, and trauma bypass, leaving hospitals the ability to be open to select EMS transports. The trauma bypass designation allows the ED to be closed to trauma but open to all other patients. ALS bypass, however, diverts all EMS transports, including trauma victims, to the next closest appropriate facility. During this period, data were collected pertaining to Level I trauma center closures and subsequent patient diversions throughout Lucas County. Results: After the introduction of the tiered ED closure policy, trauma-only closure hours increased slightly from 291.79 in 2001 to 330.77 (13%) in 2003. ALS closure hours, however, decreased dramatically within the same period, from 999.81 in 2001 to 273.13 (73%) in 2003. This policy resulted in a significant decrease in overall ED closures to trauma patients, from 1,291.60 hours in 2001 to 603.90 (53%) hours in 2003. Conclusion: A trauma bypass designation within a tiered ED closure policy increases the capability of a Level I trauma center to continue receiving EMS transports in the event that trauma resources are unavailable. Furthermore, the tiered system itself decreases ALS bypass hours in these 3 hospitals, thus reducing the trauma closures indirectly by reallocating resources.