ERs forced to turn some away

Even living in the high rises brings no assurance that an ambulance will take you to the Hospital of the University of Pennsylvania. Due to the growing national problem of overcrowding, emergency rooms occasionally must divert ambulances to other hospitals. "On any given day, 10 to 15 [Philadelphia] hospitals are on divert," said Ralph Halper, regional director of Emergency Medical Services for the Philadelphia Fire Department. EMS provides ambulance service to city hospitals. Last year, area hospitals temporarily closed their ERs for close to 20,000 hours, up from 15,300 hours in 1999. And although the numbers may seem startling, Halper defends the system that he says insures adequate care for any emergency. "We are always four to four-and-a-half minutes away from a hospital," he said, pointing out that, if a divert request is honored, "the next hospital, on the long end, is eight minutes from the scene." From Boston to Las Vegas, increased demand, hospital closures and staff shortages have resulted in more ambulance diversions. Flu season also contributes to the problem during the winter months. Hospitals must, by statute, receive any ambulance or patient at the door. EMS determines whether a patient's condition warrants overriding a divert request. "The first thing under consideration is the welfare of the patient," Halper said. According to Sue Canning, an emergency administrator at HUP, a hospital will only remain on divert status for four hours. "When you reach capacity in the emergency department and you have people who need in-patient beds upstairs and the waiting room is overcrowded, [it's up to] the attending physician to decide on diversion status," she said. For example, at 4:30 p.m. yesterday, eight Philadelphia hospitals were instructing ambulances to divert patients to other locations. EMS medical director Crawford Mecham, who is also a Penn professor of emergency medicine, is quick to point out that diversions are part of the system. "At any given time in the city a number of hospitals have requested diversions, [but] it's not something that has suddenly happened," the HUP physician said. So far this month, HUP has had to divert only sparingly. "Last week we were closed about eight hours," said Canning, citing the figure representing the total divert time for the entire month. "A lot of other hospitals have been closed more," he added, pointing out that Presbyterian Hospital, a member of the University Health System, has had to divert more often than some other hospitals because of its smaller size.