How does 911 work?

[Liz CA]

If you call 911 in your area do you have a choice what hospital you are being taken to?

If the patient is coherent, can s/he request a different hospital than the one paramedics would choose?

Aren't there independent paramedics and those affiliated with certain hospitals and does this influence where the patient is taken or is it always the nearest facility?

What if that facility has a bad reputation?

 

Something happened this week (not in my family) where a person was taken to a hospital known for its less than stellar care history and he died. 

 

 

Edited January 31, 2018 by Liz CA

[Pawz4me]

I suspect there's variation from area to area on how it's handled.

 

Here all 911 ambulances are operated by the county and staffed by county-employed EMTs and paramedics. They do not have any ties or allegiance to specific hospitals.

 

The only thing I know with reasonable certainty is that if you're critially injured they're going to take you to the hospital that is a Level 1 trauma center. 

[Entropymama]

First, the 911 operator has no say in where the ambulance takes you. They just dispatch first responders. 

 

Yes, patients (or their parents) can request a particular facility. They may be denied that request for a number of reasons - the paramedics feel the level of trauma requires a particular facility, the requested facility is too far away. 

 

Yes, there are 'for profit' ambulance companies that are not affiliated with hospitals but will pick up patients and transport them. Sometimes they are county based, like sheriffs, sometimes they are actual companies that have contracts with counties/cities. I do not know if they will only transport to certain facilities. I suppose it is possible. 

 

It isn't always the nearest facility, it's usually the nearest facility that can provide adequate care. Things like insurance coverage can influence this (if the nearest facility isn't in network, for example). 

 

I very much doubt a facility's reputation plays into where ambulance drivers who have the autonomy to choose take a patient. It would be hard to justify to your superiors that you drove an extra 20 minutes because you've heard stories about such and such a place that was closer. 

[JenneinCA]

I called 911 when I broke my ankle.

 

When the ambulance arrived I was asked if I had Kaiser insurance or something else. I have the something else so they suggested I go to a certain hospital. It was both the closest and the one that has a ankle/foot surgeon on call for the ER. If I had asked they would have taken me somewhere else. And if I had Kaiser insurance they definitely would have taken me there.

 

Around here, the ambulances will take you to wherever is closest or to Kaiser if you don’t have an opinion. I was in far too much pain and quite out of it at the time to argue about anything.

[Katy]

I'm sorry for your loss.  I'm under the impression this greatly varies by area.  Sometimes an ambulance service has choices, in other areas there are contracts and they aren't allowed to make choices.  In our area they give you a choice, and by default if someone isn't capable of choosing they are taken to the highest trauma center in the area.  If when they get to the hospital the local hospital cannot handle it, they are taken to the closest state University hospital, and from there they are sometimes transferred to Mayo or Chicago (we're in the Midwest), or a couple different children's hospitals, depending on the diagnosis.

 

In the past few days there was a case in Cleveland where a victim of a drive by shooting (18 shots) drove out of Cleveland and maybe 10 blocks into a suburb.  The police called for an ambulance, but the service refused to cross into the suburb.  The ambulance for that suburb was much further away.  The news story indicated the victim survived, but there are definitely cases where local ambulance services have their own agreements and contracts in place.

[Ottakee]

When I have called 911 for MIL I have told dispatch that she needs to go to x hospital even though y was closer. Never had an issue. Granted hospital X had the specialists she needed for her kidney transplant and heart.

[Liz CA]

 

I very much doubt a facility's reputation plays into where ambulance drivers who have the autonomy to choose take a patient. It would be hard to justify to your superiors that you drove an extra 20 minutes because you've heard stories about such and such a place that was closer. 

 

 

This is what I was wondering about. The hospital in our area has a terrible reputation, the next small hospital in one direction is about 15 miles, in another direction are several larger hospitals with trauma care; they are 40-45 miles away.

 

So...your chances of survival can vary widely depending on where you are located.

Edited January 31, 2018 by Liz CA

[mom2scouts]

If we call 911, we get EMTs from the city fire department. They usually take people to the closest hospital, but will go to other hospitals if requested by the patient.

[City Mouse]

Did the man ask to go to a particular hospital and was refused?

It is quite possible that the choice of hospital made no difference in his death.

 

When I lived in Houston, it was not uncommon for certain hospital ERs to be too full, and the hospital would refuse to accept any more patients until the numbers were down. Choice in hospital was allowed to a certain extent, but it was not unlimited as the emergency ambulance is not a taxi service.

 

Where I live now is very rural, and not great medical care is just the cost of living here. There is very little close by and "close" is relative. Major trauma requires an air ambulance that can take a while to arrive, and most heart attacks are fatal just because of the distance to medical care.

[Rachel]

Around here you can request which hospital. The three main hospitals are within a couple miles of each other. There is another emergency room across town (affiliated with one of the main hospitals) but it does not handle every type of emergency. If you requested that hospital but we’re havjng a stroke, you would not be taken there.

[BarbecueMom]

This is what I was wondering about. The hospital in our area has a terrible reputation, the next small hospital in one direction is about 15 miles, in another direction are several larger hospitals with trauma care; they are 40-45 miles away.

 

So...your chances of survival can vary widely depending on where you are located.

I was a dispatcher in a similar kind of location. County EMS, one regional hospital, University hospital was 1.5-2h away by ambulance, 3.5h to major city trauma centers. As far as I remember, they always went to the regional hospital, even if they transferred almost immediately to University.

 

If you were rural enough to get Air Evac out there, they could go straight to University and skip the regional hospital. Dispatch couldn't make those calls though, and we didn't even have radio contact with the flight crew. They had their own dispatch.

 

I honestly have no idea how it works where I live now. I'm in between two hospitals, and our preferred option is just a couple minutes farther away. It actually has a reputation as not being a great hospital, but I've been hospitalized there and been satisfied with our ER visits too (and they have a peds ER). The other one my mom was at last year... yikes. I've been ordered not to let the ambulance take her there again.

[Alessandra]

It's an interesting question. My kids play school sports, often traveling for meets. When I fill in the emergency card, I write in big letters what hospitals they could go to. Hospitals not in the network have ZERO coverage (unless it is truly life or death situation). I hope, if the need arises, they will respect our (= our plan's) choice. ☹ï¸

[EKS]

In our town you have a choice.  In the next town over you do not.

[Spryte]

We have choices here, too. The paramedics ask if you have a preference.

Edited January 31, 2018 by Spryte

[TechWife]

As others have said, it depends. 

 

In the case you are describing, it is entirely possible that the patient would have died no matter what hospital they were taken to. Also,  sometimes people talk poorly about a hospital where they or a relative had a complication or death, but that doesn't mean the hospital actually did anything wrong. 

[stephanier.1765]

I've often wondered about this myself. My preference would be the military hospital so I don't end up with a huge bill but I wasn't sure they would take me there. However I've been at the military ER and have had ambulances pull up so they must figure it out somehow.

[Liz CA]

Did the man ask to go to a particular hospital and was refused?

It is quite possible that the choice of hospital made no difference in his death.

 

When I lived in Houston, it was not uncommon for certain hospital ERs to be too full, and the hospital would refuse to accept any more patients until the numbers were down. Choice in hospital was allowed to a certain extent, but it was not unlimited as the emergency ambulance is not a taxi service.

 

Where I live now is very rural, and not great medical care is just the cost of living here. There is very little close by and "close" is relative. Major trauma requires an air ambulance that can take a while to arrive, and most heart attacks are fatal just because of the distance to medical care.

 

 

Not sure if he did. He was still able to make the 911 phone call, described his symptoms and the ambulance got to him while he was alive but several hours later he died at the hospital. 

 

As others have said, it depends. 

 

In the case you are describing, it is entirely possible that the patient would have died no matter what hospital they were taken to. Also,  sometimes people talk poorly about a hospital where they or a relative had a complication or death, but that doesn't mean the hospital actually did anything wrong. 

 

 

You are both right, of course. He may have died either way. It's just one of those things that can go round and round in your head.

This particular hospital with the bad reputation seems to have "earned" its bad reputation over many years. I have lived in this area for over 5 years now and have NEVER met anyone who had received services there and had anything positive to say about them. 

 

Thank God, I have never had to call 911 but if I ever had to and could still communicate, I'd beg them to take me to any other place. ;)

[brehon]

If you call 911 in your area do you have a choice what hospital you are being taken to?

If the patient is coherent, can s/he request a different hospital than the one paramedics would choose?

Aren't there independent paramedics and those affiliated with certain hospitals and does this influence where the patient is taken or is it always the nearest facility?

What if that facility has a bad reputation?

 

Something happened this week (not in my family) where a person was taken to a hospital known for its less than stellar care history and he died. 

 

This is really going to vary by state and even agency. In my state generally speaking, patients who display appropriate cognition (as opposed to mental competence) are to be transported to whichever hospital they request as long as the receiving facility can handle their conditions. For instance, there is one hospital in my area we cannot transport OB patients to regardless of the patient's request. That facility simply is not able to handle any OB patients. There are exceptions to this law (and it is a law in my state) and those generally include a hospital having an internal emergency of some sort, a disaster occurring in the area, etc.

 

As far as the paramedics, there are three different kinds of agencies/companies one can work for:  a private company (this is almost always a for-profit company); a municipality (usually a city and usually as part of the city's fire department); or a third service agency (usually a county or other governmental agency - hospital district, etc). Obviously, the latter two are non-profit government agencies. There are probably other permutations of paramedics; however, those are the three major ways one works as a ground transport paramedic. I have only ever worked as part of a third-service county agency; so, I can only speak in generalities about the other two types.

 

In my agency, we will transport patients to their preferred hospital unless a situation exists that makes that impossible. A facility's reputation isn't supposed to influence where a paramedic transports; however, given other reasonably close choices, it does. Trust me. There are enough good facilities in my area that patients have plenty of choices. In an area where there aren't choices between reasonably close hospitals (e.g., the facilities are 30+ minutes apart, certainly if they are more than an hour apart), it is generally accepted practice to either transport to the closest facility knowing that the patient will be transferred to a larger/better equipped hospital for definitive care or, if allowed by state statute/local rule/agency SOP, call for HEMS.

 

As far as the person you mentioned, there's really no way of knowing whether going to a slightly further out facility would have saved him. California is kind of unique (and not in a good way) in EMS because, although it was one of the states where EMS became a profession, in many ways the state lags behind the rest of the country as far as what paramedics are allowed to do and how they are regulated. I feel very fortunate - and even more importantly feel that my patients are extremely fortunate - that there are two nationally recognized, extremely progressive EMS systems in my area and I work for one of them.

Edited January 31, 2018 by brehon

[Tap]

We have 2 major hospitals in our town and are just across the state line with multiple large hospitals, children's specialty hospitals and university hospital on the other side of the line.

 

From what I understand......For minor emergencies, they will take you to your choice of  our two local hospitals.  There are exceptions that they will cross the state line for, but often a person is transported to a local hospital, stabilized, and then if they need to be moved across the state line for specialty care, the hospital will call for another ambulance service to transport the patient to the new hospital. 

[rose]

This thread make me glad to live in Canada. Here there is only one ambulance service per province. If I call 911 the ambulance will be dispatched and then will take me to the closest ER. If that hospital can't deal with the problem they will stabalize the patient and ship them out to a tertiary care hospital. I don't have to worry about which hospital because our provincial insurance will cover any of them. We do pay for ambulance rides but they're not that expensive. I haven't taken one in a long time but I think that they're about $75 per trip.

[katilac]

We do pay for ambulance rides but they're not that expensive. I haven't taken one in a long time but I think that they're about $75 per trip.

 

All you have to do is add a zero to that and you will know how much it costs where I live (within the US). 

[JenneinCA]

All you have to do is add a zero to that and you will know how much it costs where I live (within the US).

From personal experience the bill for the ambulance was $2500. I live about eight miles from the hospital and broke my ankle. No blood but I did get an iv and pain meds on the way. It took them about 45 minutes from the time they arrived where I fell to when I was being off loaded at the er. That includes the driving time and the time getting me loaded and set.

[Sandwalker]

I have a sticker on my car that says Take Me To (Local) Hospital. Luckily I don't know if it works.

[MooCow]

Where I live it's county EMS that responds and a city fire department that comes as well. The EMS cross counties all the time and will take requests depending on the situation.

[Arctic Bunny]

This thread make me glad to live in Canada. Here there is only one ambulance service per province. If I call 911 the ambulance will be dispatched and then will take me to the closest ER. If that hospital can't deal with the problem they will stabalize the patient and ship them out to a tertiary care hospital. I don't have to worry about which hospital because our provincial insurance will cover any of them. We do pay for ambulance rides but they're not that expensive. I haven't taken one in a long time but I think that they're about $75 per trip.

Maybe in your province... approx $1600 here. There are multiple EMS companies, but are coordinated through a single dispatch centre.

[katilac]

From personal experience the bill for the ambulance was $2500.  

 

 

approx $1600 here.  

 

And this is why people are Ubering to the emergency room. 

[bolt.]

Here you are always taken to the nearest hospital. They are all the same. There are four hospitals where I live (a major city) basically arranged one per quadrant -- plus a children's hospital.

 

It would be quite a drive to go to a different hospital (if it wasn't the nearest one) and I can't see why the average person would be motivated to choose one hospital over another. Everyone is 'covered' at every hospital, and every hospital offers the same services for emergencies.

 

Apart from major cities, many communities (towns, small cities) have only one hospital, or a non-hospital emergency department.

 

I can see if a person previously had a bad experience, or there might be other individual reasons that a person had a preference... I'm not sure what would happen in that case.

[rose]

Maybe in your province... approx $1600 here. There are multiple EMS companies, but are coordinated through a single dispatch centre.

 

Wow! I just double checked because you got me doubting. The BC ambulance site said it's an $80 flat fee for ground or air.

[goldberry]

We have a hospital nearby with a poor reputation.  If you are able to ask the ambulance, they will take you to a different one farther away.  If you don't or can't ask, they take you to the closest one with facilities to treat you.

[katilac]

 

It would be quite a drive to go to a different hospital (if it wasn't the nearest one) and I can't see why the average person would be motivated to choose one hospital over another. Everyone is 'covered' at every hospital, and every hospital offers the same services for emergencies.

 

 

Not really. Some ERs are going to have a lot more experience with trauma, for example, and thus might also put more of their efforts toward trauma education and preparation. They might have more and varied specialists on immediate call. Another hospital might be the go-to place for heart attacks and strokes. 

 

This is one reason why patients are sometimes stabilized and then transferred to a different hospital. If a patient needs more care than the medics can provide to stay alive, then it's straight to the nearest one. But if they can stabilize them in the ambulance, it's better to head to the 'correct' hospital in the first place. If you have a routine broken arm, it won't matter. But if somebody shoots you three times, you're going to want that high level trauma center. 

[Arctic Bunny]

Wow! I just double checked because you got me doubting. The BC ambulance site said it's an $80 flat fee for ground or air.

Well, now you made me look for facts, lol.

 

“The basic pickup fee, every time the ambulance goes out, is $245. All patients are charged this minimum amount. The mileage fee is $2.30 per kilometre for all out-of-town calls. If the ambulance must wait (for example, during a trip to a specialist in Regina), the first half-hour is free. A waiting fee of $100 is charged for every hour after.“

 

Having never lived closer than 75km from a hospital... and I’ve been places where it’s 40 km from the ambulance. So that would be.... $521. If you needed more than, say, an X-ray, another 210 km transfer. And another $483. And if the ambulance waited that whole time, I guess that would add up, too!

And insurance help you if Starz gets called instead!

[bolt.]

Not really. Some ERs are going to have a lot more experience with trauma, for example, and thus might also put more of their efforts toward trauma education and preparation. They might have more and varied specialists on immediate call. Another hospital might be the go-to place for heart attacks and strokes.

 

This is one reason why patients are sometimes stabilized and then transferred to a different hospital. If a patient needs more care than the medics can provide to stay alive, then it's straight to the nearest one. But if they can stabilize them in the ambulance, it's better to head to the 'correct' hospital in the first place. If you have a routine broken arm, it won't matter. But if somebody shoots you three times, you're going to want that high level trauma center.

I'm not sure why you are correcting me, when this whole thread is about the differences between different localities.

 

It would be an incredible statistical anomaly if any one of our hospitals somehow got significantly more "experience with trauma" than the others. (I guess maybe if there was more violence or vehicle accdents in certain neighbourhoods?) Even if there was, though, it's clear that any "extra" trauma education would be offered to all relevant staff at each individual hospital. (A greater quantity of a certain kind of patients -- ie needing trauma care -- at one hospital would not justify allowing staff at other hospitals to be less than thouroughly trained.)

 

All of the hospitals in my urban area are supposed to have sufficient on-call specialists. (If there was a difficulty with achieving that standard, I'm thinking backup personnel would simply be drawn from specialists who ordinarily work at another location.) All of the hospitals are "go to places" for heart attacks and strokes. If one of them was below the others, it would need to be investigated and fixed. We don't have any hospitals with emergency departments that are not "high level trauma centres".

 

Our hospitals don't have ranks (apart from larger cities having more robust facilities than smaller cities/towns) or specializations. (In the emergency department -- we do have cancer centres and joint clinics and that sort of non-urgent specialization.) Any serious ongoing difference in care levels would be cause for immediate concern. People who lived near a deficient hospital would be outraged. This is socialized medicine: we expect fairness and equality as a baseline. For the most part, we have it -- so we go to the nearest hospital.

 

The thing about stabilization and transfer does happen, and for some of the reasons you identified -- but usually from rural to urban centres. Those cases would need to go to their local hospital first for stabilization before transfer, so that's still going the the closest hospital as the first stop. I can't think of an ambulance driving a patient away from a local hospital towards a major urban hospital without at least stopping at the local hospital before the transfer. (Maybe it happens with certain high-needs situations... there might be a protocol?)

Edited February 1, 2018 by bolt.

[SparklyUnicorn]

I doubt one has a choice here.  If you need to get to a different hospital and you aren't literally dying, I'd recommend calling a cab.  To take an ambulance any further than necessary is ridiculously expensive.

 

They may transfer one to a place that has better facilities for certain conditions or send you straight there (probably via helicopter if it is that serious). 

 

 

[MedicMom]

As everyone else has said, it’s so regionally dependent that it’s hard to answer.

I work(now part time) at a privately owned 911 service. It’s not AMR or part of a large service, so we have a bit more leeway perhaps. There are three main hospitals we transport to, and two of them are affiliated(owned by the same nonprofit). One of them is a cardiac and stroke center, the other is little more than an urgent care. There is also a larger and highly rated hospital 30 minutes away. Patients generally have the choice where they go, as long as they are competent to make decisions. If they are not, our medical control at the main hospital can decide. So if the patient’s family wants them to go to Hospital A, but the issue is low acuity and Hospital B can handle it, med control is likely to tell us to go to Hospital B. If the patient can’t decide medical control has that authority. Also, if the patient is having an acute stroke or heart attack as determined by the EKG we’ve done, they automatically have to go to the stroke/cardiac center. It is the same for trauma.

 

Most of our patients any more want to go to the really good hospital 30 minutes away. We try to accommodate as long as the call volume is okay. If we are just too busy and need an ambulance back in service quickly, we have to tell the patient we cannot go that far and they have to choose between the other three hospitals.

 

There are large cities where they have a main medical control who decides where the patient goes. The paramedic radios into that medical control and the doctor determines what hospital they go too. The patients in those systems really don’t have choice.

 

As far as the costs, that’s what your insurance is billed. Some insurances will not pay the extra mileage to your preferred hospital if there is one closer that can meet your needs. If you have a cut finger, for instance, they’ll only pay to the closest hospital that can suture it up. If you’re having a heart attack, they’ll pay the mileage for you to go to a cardiac center, even if it’s bypassing two closer hospitals. This is the issue with the “surprise ambulance bills†that are in the news—people are getting billed for hundreds of dollars that their insurance will not pay(Medicare is one). The insurance doesn’t care about the quality of the nearest hospital or where your doctors are. They will pay mileage to the closest appropriate facility and anything after that is your responsibility. I once worked for an ambulance agency that made us have patients sign a statement of understanding that they would be billed the extra mileage when they insisted on going to a farther away hospital.

[unsinkable]

I'm not sure why you are correcting me, when this whole thread is about the differences between different localities.

 

It would be an incredible statistical anomaly if any one of our hospitals somehow got significantly more "experience with trauma" than the others. (I guess maybe if there was more violence or vehicle accdents in certain neighbourhoods?) Even if there was, though, it's clear that any "extra" trauma education would be offered to all relevant staff at each individual hospital. (A greater quantity of a certain kind of patients -- ie needing trauma care -- at one hospital would not justify allowing staff at other hospitals to be less than thouroughly trained.)

 

All of the hospitals in my urban area are supposed to have sufficient on-call specialists. (If there was a difficulty with achieving that standard, I'm thinking backup personnel would simply be drawn from specialists who ordinarily work at another location.) All of the hospitals are "go to places" for heart attacks and strokes. If one of them was below the others, it would need to be investigated and fixed. We don't have any hospitals with emergency departments that are not "high level trauma centres".

 

Our hospitals don't have ranks (apart from larger cities having more robust facilities than smaller cities/towns) or specializations. (In the emergency department -- we do have cancer centres and joint clinics and that sort of non-urgent specialization.) Any serious ongoing difference in care levels would be cause for immediate concern. People who lived near a deficient hospital would be outraged. This is socialized medicine: we expect fairness and equality as a baseline. For the most part, we have it -- so we go to the nearest hospital.

 

The thing about stabilization and transfer does happen, and for some of the reasons you identified -- but usually from rural to urban centres. Those cases would need to go to their local hospital first for stabilization before transfer, so that's still going the the closest hospital as the first stop. I can't think of an ambulance driving a patient away from a local hospital towards a major urban hospital without at least stopping at the local hospital before the transfer. (Maybe it happens with certain high-needs situations... there might be a protocol?)

My understanding about one reason why some hospitals in the US are designated as stroke centers or burn centers or Level One trauma centers is to maximize resources by reducing duplication of services.

 

It makes more sense to have the best cardiac care team, with the most up to date equipment and education in one place. "Time means tissue" If a patient is having an active MI and all the ambulance services and paramedics know which hospital has the cardiac cath lab, then the patient has the best chance to if they head right there.

 

Also, for Trauma designation, hospitals have to meet criteria regarding the physical layout of the hospital, with services on the same floor and within so many feet. Bc of time "the golden hour" every minute, second counts. Some hospitals physical structure don't meet the criteria and it would be impossible to fix it. Like...impossible to move OR to same floor as ER.

 

Edited to add: another specialty that not every hospital has is a secure psychiatric ER. The physical realities of some hospitals mean that it is not possible to have one every where.

Edited February 1, 2018 by unsinkable

[brehon]

I'm not sure why you are correcting me, when this whole thread is about the differences between different localities.

 

It would be an incredible statistical anomaly if any one of our hospitals somehow got significantly more "experience with trauma" than the others. (I guess maybe if there was more violence or vehicle accdents in certain neighbourhoods?) Even if there was, though, it's clear that any "extra" trauma education would be offered to all relevant staff at each individual hospital. (A greater quantity of a certain kind of patients -- ie needing trauma care -- at one hospital would not justify allowing staff at other hospitals to be less than thouroughly trained.)

 

All of the hospitals in my urban area are supposed to have sufficient on-call specialists. (If there was a difficulty with achieving that standard, I'm thinking backup personnel would simply be drawn from specialists who ordinarily work at another location.) All of the hospitals are "go to places" for heart attacks and strokes. If one of them was below the others, it would need to be investigated and fixed. We don't have any hospitals with emergency departments that are not "high level trauma centres".

 

Our hospitals don't have ranks (apart from larger cities having more robust facilities than smaller cities/towns) or specializations. (In the emergency department -- we do have cancer centres and joint clinics and that sort of non-urgent specialization.) Any serious ongoing difference in care levels would be cause for immediate concern. People who lived near a deficient hospital would be outraged. This is socialized medicine: we expect fairness and equality as a baseline. For the most part, we have it -- so we go to the nearest hospital.

 

The thing about stabilization and transfer does happen, and for some of the reasons you identified -- but usually from rural to urban centres. Those cases would need to go to their local hospital first for stabilization before transfer, so that's still going the the closest hospital as the first stop. I can't think of an ambulance driving a patient away from a local hospital towards a major urban hospital without at least stopping at the local hospital before the transfer. (Maybe it happens with certain high-needs situations... there might be a protocol?)

Your area doesn’t have designated Trauma Centers (Levels I-IV)? Or designated STEMI/ROSC centers? Or both primary and comprehensive stroke centers? Or various levels of NICUs? Or burn centers?

 

That’s what we’re talking about - throughout the US certain ERs (& the hospitals they’re attached to) have gone through differing accreditations to treat certain categories of patients. It’s not necessarily or solely related to geography, but which hospitals/ERs meet specific criteria to treat certain types of medical or trauma conditions.

 

In my area (in a two county area), there are two Level II trauma centers & (a bit further away) a Level I trauma center; there are 7 STEMI/ROSC centers; there are 3 primary stroke centers and 3 comprehensive stroke centers.

 

So, no, I would never take a STEMI patient to a non-STEMI center barring certain rare circumstances nor would I transport a Category I trauma patient to a local ER that doesn’t have a Level I or II trauma center designation.

 

It’s not a matter of fairness; it’s allocation of very expensive resources. My understanding, after talking with several Canadian ER doctors at a recent medical conference, was that Canada also had designated specialty ERs/hospitals, at least in the bigger cities. Is that not accurate?

[Sandwalker]

My understanding about one reason why some hospitals in the US are designated as stroke centers or burn centers or Level One trauma centers is to maximize resources by reducing duplication of services.

 

It makes more sense to have the best cardiac care team, with the most up to date equipment and education in one place. "Time means tissue" If a patient is having an active MI and all the ambulance services and paramedics know which hospital has the cardiac cath lab, then the patient has the best chance to if they head right there.

 

Also, for Trauma designation, hospitals have to meet criteria regarding the physical layout of the hospital, with services on the same floor and within so many feet. Bc of time "the golden hour" every minute, second counts. Some hospitals physical structure don't meet the criteria and it would be impossible to fix it. Like...impossible to move OR to same floor as ER.

 

Edited to add: another specialty that not every hospital has is a secure psychiatric ER. The physical realities of some hospitals mean that it is not possible to have one every where.

Yes. Level One Trauma centers (I work at one) are required to have trauma surgeons in hospital at all times, not just on call. The golden hour is cut into if the doctor has to be called from home.

[bolt.]

I've learned something new! We do have differences in trauma levels. They are very hard to look up! What I've been trying to say is that all of them can and do treat major trauma (which apparently means levels one, two or three) and few would divert patients during the initial ambulance ride. That would be outside of the norm, but it sounds like it does happen in cases that fit certain criteria.

 

I'm amending my discription to: in general, one is transported to the nearest hospital, but some exceptions apply. In the exceptional cases, the patient's opinion wouldn't be likely to be a deciding factor... your ambulance world be directed where it belongs for medical reasons.

 

The most likely reason to be redirected would be from smaller cities and towns to larger centres: but there are also other reasons.

Edited February 1, 2018 by bolt.