Supporting Lectures:Review the following lecture: The Emergency Medical Treatment Active Labor Act (EMTALA)ProjectThe project assignment provides a forum for analyzing and evaluating relevant topics
CASE 83
Emergency Divert Status
Kevin D. Zeiler
Robert and Roy, emergency medical technician paramedics (EMT-P) were back on the streets after a slow afternoon of handling administrative tasks in the office. Neither paramedic had checked the divert status board before heading out, so they were unaware that numerous hospitals in the city were on Emergency Department (ED) divert.* After having worked 18 hours with only 3 hours off, they were hoping to settle into a quiet shift that would allow them an opportunity to get some rest.
Within 30 minutes of getting to their first assigned post, the radio call came through that an adult and child were injured in an automobile accident. Robert and Roy headed to the scene to find that a father and daughter had been riding a bicycle when they were struck at high speed by an automobile. The injuries were serious and both needed emergency treatment. The paramedics decided to take both patients to the nearby city hospital for treatment.
Robert rode in the back and was in charge of caring for the patients, while Roy drove. On the way to the facility the young girl quit breathing and required intubation to sustain her airway. Because of the time required to intubate and stabilize the patient, Robert never notified the receiving facility that they were coming with two critical emergent patients. In addition, Roy, as the driver, never contacted the facility and also never contacted dispatch to see if the facility was on divert.
Upon their arrival at the city hospital, Robert and Roy found out that the hospital was on ED divert as well as pediatric trauma divert. In other words, they were not accepting any patients to the ED and they were not accepting any children. Because Robert and Roy felt that they could not support the pediatric patient any longer in the back of an ambulance, they wheeled both patients into an unprepared Emergency Department. A verbal battle ensued between the emergency room physician and the paramedics, which led to a further delay in care for the injured trauma patients. Ultimately, the hospital agreed to care for the patients, but soon realized that the young girl had gone into cardiac arrest and died. She could not be resuscitated.
Discussion Questions
1. Who is at fault in the above scenario? Why?
2. As an emergency department supervisor, what legal principle would you rely on to make your case about the divert status of your facility?
3. As a health administrator in charge of ambulance operations, what issues must you address with your ambulance crew? How would you frame your argument concerning legislation that has been enacted to protect patients from hospital divert situations?
4. Is there any issue with the paramedics concerning the amount of time they recently worked?
5. Finally, explain the liability issues for all participants, i.e., the receiving hospital, the ambulance service, physicians, paramedics, supervisors, etc.
ADDITIONAL RESOURCES
Buchbinder, S. B., & Shanks, N. H. (Eds.). (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones & Bartlett.
EMTALA.com. Retrieved from http://www.emtala.com/
Furrow, B. R., Greaney, T. L., Johnson, S. H., Jost, T. S., & Schwartz, R. L. (2008). Health law: Cases, material and problems (6th ed.). St. Paul, MN: Thomson-West.
Moy, M. M. (2012). EMTALA answer book (2012 ed.). New York, NY: Aspen.
* Diversion or divert status is a “temporary status for a health care facility, where its administration informs its emergency medical services that the hospital is full” (Diversion status. (n.d.). In The free dictionary. Retrieved from http://medical-dictionary.thefreedictionary.com/Diversion+Status).
