Ambulance Diversions and ER Overcrowding: Could Primary Prevention Be The Solution?

*Wwwweeeeeooohhhh!*

You hear the sirens and pull over as the ambulance speeds by, knowing that in some small way you just helped save a life.

But is that really the case? The delivery of a patient into emergency care does not guarantee a positive outcome, but it is an essential step. The timeliness of an ambulance arrival to the emergency room or emergency department (ED) is critical when the difference between life and death can be a matter of seconds. Overcrowding is a problem that EDs have been struggling with for quite some time and it is also the reason why the ambulance buzzing by you on the highway may not arrive where it was originally intended.

To manage overcrowding, EDs commonly divert incoming ambulances. This means that the ED is temporarily closed to incoming ambulance traffic. Now before anyone goes and grabs their pitchfork, there is a reason behind this closure. Overcrowding can cause delays for patients who await treatment so diversion to the next nearest hospital is a logical solution. However, diversion of ambulances can create an overcrowding problem at the next hospital too. When this happens, patients in critical condition have even more increased wait times, and the second (or third) hospital may not have the appropriate technology. This is especially a concern with heart attack victims.

A recent study done in California determined that “patients whose nearest hospital ED had significant ambulance diversions experienced reduced access to hospitals with cardiac technology,” which led to a 4.6 percent decreased likelihood of revascularization and a 9.8 percent increase in one-year mortality compared to patients who did not experience diversion. For those of you following along, this could mean that people in cardiac arrest are more likely to die because of a diversion!

Overcrowding is a key factor in ambulance diversion. Although policymakers are working to reorganize the system and make it more efficient, while others such as Dr. Marc Futernick think that hospitals should simply stop diverting despite overcrowding, another solution can be an increased focus on prevention to tackle the problem before it begins. The Affordable Care Act provides incentives for the prevention of chronic diseases by “improving access to preventive services for eligible adults in Medicaid”. Through the ACA, preventative measures and screenings are available at no cost in order to improve long term health. The key to prevention is that it improves healthcare outcomes by addressing the problem before it becomes so serious that it requires hospitalization and the use of ambulances. In 2013 there were 359,400 incidents of out-of-hospital cardiac arrest. With a 9.5% survival rate, individuals with future risk of a cardiac episode need to take their health seriously. Their health influences not only themselves and their family but also the patients who visit emergency departments for non-preventable health issues and may not receive treatment due to overcrowding from preventable cases.
ER overcrowding and disease prevention are linked. When you take that step to save another’s life by pulling over to let an ambulance pass, take a step to save your own and ask your provider about preventive care.


 

Rosie Wood is a senior at the University of North Carolina at Chapel Hill and an intern at Duke’s Center for Research on Personalized Health Care