1.) SUMMARY
This policy is intended to facilitate optimal care of the emergency patient, recognizing that at times both Emergency Department and EMS resources are limited. This is a voluntary policy and is intended to help EMS agencies determine hospital destination for patients who are suitable for diversion. At times, due to patient condition or specific needs, patients will be transported to hospitals on diversion. If it is determined by EMS, in consultation with the patient, that it is in the best interest of the patient to be transported to a restricted facility, then transport to the restricted facility is permissible. EMS will explain to the patient that, due to the restriction, the potential exists for a delay in patient care at the restriction facility. EMS will notify the restricted facility of the patient transport.

This procedure provides for hospitals to notify the CECOMS Center of restrictions in their patient care capabilities and for the CECOMS Center to advise EMS squads/ communication centers and R.E.D. Center of these restrictions.

2.) RESTRICTION CATEGORIES
The following are five standard restriction categories which shall be used by the CECOMS Center / R.E.D. Center. These categories and their meanings are as follows:

a. CRITICAL RESTRICTION – TRAUMA
This status indicates that the hospital is unable to provide emergency surgical treatment to a patient. This restriction might be put into effect, for example, if the operating room was already full to capacity or if the surgical team was not readily available. In the event ambulance personnel have a patient that will require emergency surgery and the nearest hospital has imposed this restriction, the EMS personnel should divert to the next nearest appropriate facility.

b. CRITICAL RESTRICTION – MEDICAL
This status indicates that a facility does not have available beds in either the Intensive Care Unit (ICU) or Coronary Care Unit (CCU). This status should be imposed only when beds are unavailable in either unit. This restriction recognizes that patients requiring intensive medical care can be accommodated at least temporarily in either unit.

c. FULL RESTRICTION
This implies that the hospital is unable to receive any patients transported by ambulance. No patient should be transported to a hospital which has imposed this restriction unless the patient’s condition falls within the “Exceptions to Restrictions” category defined in Section 3. This would apply, for example during acute overload of the Emergency Department with critical patients, or a completely full in-house occupancy.

d. TREAT AND RELEASE ONLY
This implies that the hospital is able to receive patients who are not likely to be admitted but are regarded as “treat and release”. This restriction further implies that the hospital is unable to receive patients who are likely to require admittance in order to be properly treated. No patient other than those regarded as treat and release should be transported to a hospital which has imposed this restriction unless the patient’s condition falls within the “restriction exceptions” category.

e. FULL RESTRICTION EXCEPT FOR TRAUMA
This restriction is available for use by Trauma Centers to permit them to severely limit admissions to their hospital while continuing to maintain trauma hospital availability. The purpose of this policy is to provide assurance that major trauma patients will be received at a trauma facility even though the trauma facility is unable to receive any other patients unless the patient’s condition falls within the “Restriction Exceptions” in section three.

3.) RESTRICTION EXCEPTIONS
Regardless of the type of restriction a hospital is on, there are situations when EMS personnel may need to transport a patient to a hospital on restriction. These situations include the following:

Patients in cardiopulmonary arrest.


Patients with unstable airways that cannot be adequately managed by EMS personnel.


Patients felt to be in extremis and any diversion to another facility would dangerously
delay needed immediate intervention.


Patients who are receiving ALS care and any diversion to another facility would
extend transport time greater than 15 minutes.


Patients who typically receive their care at the hospital on diversion, and any
diversion from that hospital would potentially jeopardize the expedient care of their
emergency condition.

4.) RESTRICTED AUTHORIZATION
The CECOMS Center will only accept restrictions or the removal of a restriction(s) from an authorized administrative representative of a hospital. Every year, the CECOMS Center shall update its list of administrative representatives authorized to place and remove a restriction. Should the administrative representative of the hospital change, the hospital is to inform the CECOMS Center of the change in writing.

5.) RESTRICTION PLACEMENT /REMOVAL
It is the responsibility of the hospitals to immediately notify the CECOMS Center when a restriction is placed, removed and /or modified. To place or remove a restriction, the authorized hospital representative shall contact the CECOMS Center at (216) 771-1363. The CECOMS Center personnel will document the information in the hospital log, and status board. The administrative representative of the hospital will be called back for confirmation. Once the restriction placement or removal is received, the CECOMS Center shall immediately notify the R.E.D. Center of the status. Should the R.E.D. Center receive the notification, the CECOMS Center shall be notified immediately by the R.E.D. Center.

6.) RESTRICTION CONFIRMATION
The CECOMS Center will contact each hospital with a restriction twice daily to determine whether the restriction is still in effect. The CECOMS Center will contact the authorized administrative representative during the following time periods:

When contacted, the authorized hospital administrative representative shall reconfirm, modify or remove the restriction. The CECOMS Center shall immediately notify the R.E.D. Center of any changes in a restriction.

7.) NOTIFICATION TO MUNICIPAL EMS PROVIDERS AND HOSPITALS
CECOMS will provide current hospital status information to all EMS departments and hospitals at any time upon request. It is encouraged that EMS providers contact CECOMS while enroute to a call or prior to patient transport.

CECOMS can be contacted as follows:

1.) Telephone (216) 771-1363

2.) 155.400 – HEAR 1

3.) 155.340 – HEAR 2

4.) 462.975 / 467.975 MHz – MED 10

5.) 424.375 / 429.375 MHz – Channel A

8.) EMS SQUAD ADVISORY
Whenever an EMS squad contacts the CECOMS Center or the R.E.D. Center regarding a transport to a hospital with one of the aforementioned capability restrictions, the CECOMS Center / R.E.D. Center will advise the EMS squad of the restriction. It is the EMS squad's decision on whether to divert to another hospital. If requested by the EMS squad to do, the CECOMS Center / R.E.D. Center will:

a. Advise the EMS squad as to the status of nearby hospitals,
b. Notify the restricted hospital of the incoming transport, or
c. Place the EMS squad in communication with the restricted hospital.