bipass.pdf

Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23...

Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23 Supersedes: 11/11/22 Page: 1 of 8 Resources: IDPH EMS Rules 515.315 and 515.330 (Source: Amended at 46 Ill. Reg. 20898, effective December 16, 2022) Region IX EMS Plan: Inter-system/Inter-region transports; Bypass/Diversion (Revised 12/22) Section 515.330 EMS System Program Plan m) Written protocols for the bypassing of or diversion to any hospital, trauma center or regional trauma center, STEMI center, Comprehensive Stroke Center, Primary Stroke Center, Acute Stroke-Ready Hospital or Emergent Stroke Ready Hospital, which provide that a person shall not be transported to a facility other than the nearest hospital, regional trauma center or trauma center, STEMI center, Comprehensive Stroke Center, Primary Stroke Center, Acute Stroke- Ready Hospital or Emergent Stroke Ready Hospital unless the medical benefits to the patient reasonably expected from the provision of appropriate medical treatment at a more distant facility outweigh the increased risks to the patient from transport to the more distant facility, or the transport is in accordance with the System's protocols for patient choice or refusal. (Section 3.20(c)(5) of the Act) The bypass status policy shall include criteria to address how the hospital will manage pre-hospital patients with life threatening conditions within the hospital's then-current capabilities while the hospital is on bypass status. In addition, a hospital can declare a resource limitation, which is further outlined in the System Plan, for the following conditions: 1) There are no critical or monitored beds available in the hospital; or 2) An internal disaster occurs in the hospital; (Example, a power failure, flood, fire, or active shooter incident resulting in hospital lockdown at the time that the decision to go on bypass status was made.) I. DEFINITIONS A. “Nearest hospital” is the hospital which is closest to the scene of the emergency as determined by travel time, and which operates a full-time emergency department at the minimum level recognized by the System in its Department approved Program Plan. B. “Nearest Trauma Center” is either the nearest Level I or Level II Trauma Center that can be reached within 30 minutes by ground travel time from the scene of the emergency as defined by Trauma Triage Guidelines in the SOPs. In the event that a specialty care unit is unavailable, the ED of that institution shall be regarded as a functioning comprehensive ED without any specialty care back-up capabilities (e.g., burn unit, spinal cord unit, hyperbaric chamber, Level I Trauma Center). C. Comprehensive Stroke Center or CSC – a hospital that has been certified and has been designated as a Comprehensive Stroke Center under Subpart K. (Section 3.116 of the Act) D. Primary Stroke Center or PSC – a hospital that has been certified by a Department- approved, nationally recognized certifying body and designated as a Primary Stroke Center by the Department. (Section 3.116 of the Act) E. "Hospital bypass” 1. Requests for bypass must only be made based on IDPH criteria after a decision has been reached by medical, nursing and administrative representatives with the authority to make such a request. 2. An appropriately declared and reported bypass status will usually result in EMS patients being taken to a hospital other than the one on bypass unless an exception applies; see Section VI. F. “Peak Census” occurs when a specific hospital is experiencing near capacity census with limited access to inpatient beds, critical care equipment, support resources and staffing which impact the management of patient care. The hospital surge capacity plan may have implemented patient admission to overflow space, which in turn provides a strain on available support resources and staffing.  Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23 Supersedes: 11-11-22 Page: 2 of 8 G. “Surge capacity” refers to the ability to manage a sudden increase in patient volume that would severely challenge or exceed the present capacity of a facility. II. PURPOSE The purpose of this policy is to provide background and practice guidelines for all NWC EMSS hospitals, provider Agencies and EMS personnel when hospital resources are severely limited and Bypass status is being considered, has been requested, approved, and/or declared. III. POLICY STATEMENTS A. A person shall not be transported to a facility other than the nearest hospital, regional trauma center or trauma center, STEMI Center, Comprehensive Stroke Center, Primary Stroke Center, Acute Stroke-Ready Hospital or Emergent Stroke Ready Hospital unless the medical benefits to the patient reasonably expected from the provision of appropriate medical treatment at a more distant facility outweigh the increased risks to the patient from transport to the more distant facility, or the transport is in accordance with the System's protocols for patient choice or refusal. (Section 3.20(c)(5) of the Act) or (iii) another healthcare facility can provide appropriate medical treatment for that person. CAPITALIZATION indicates statutory language B. A System hospital, Trauma center, STEMI Center, Stroke Center, PCI/STEMI Receiving Center, Level III NICU, and EDAP are presumed to have available resources in accordance with the provisions of its System agreement, unless such facility has notified IDPH and the Resource Hospital (NCH) that it is on bypass status. C. Each System hospital shall make every reasonable effort to prevent declaring bypass status. Bypass status should only be declared in compliance with the EMS Act and Rules and IDPH and Region IX recommendations after the hospital has exhausted all internal mechanisms to relieve the limitation of resources, mitigate internal service disruptions or resolve threats/hazards requiring them to go on lockdown status (See E. below). D. Each hospital’s internal policy addressing Peak Census/Surge procedures shall: 1. Delineate procedures for the hospital to follow when faced with a potential or declared resource limitation that would help them to avoid bypass status. 2. Delineate procedures to monitor the status of inpatient bed occupancy as it relates to the appropriation of timely bed assignments to those patients waiting at home, in physicians' offices, in the ED, and in other areas such as the Cardiac Catheterization Lab, Day Surgery, or at other hospitals. 3. Include a list of Providers and their current contact information who customarily transport to that hospital. E. Stricken hospitals shall implement their internal PEAK Census response plan and enter updates into the Illinois EMResource application, accessed at https://emresource.juvare.com/login. F. All reasonable efforts to resolve the essential resource limitation(s) shall be exhausted, including: 1. Considering appropriately monitored beds in other areas of the hospital; 2. Limitation or cancellation of elective pt procedures and admissions to available surge pt care space and redeploy clinical staff to surge patients. 3. Actual and substantial efforts to call in appropriately trained, off-duty-staff; and 4. Urgent and priority efforts have been undertaken to restore existing diagnostic and/or interventional equipment/or backup equipment and/or facilities to availability, including but not limited to seeking emergency repair from outside vendors if in house capability is not rapidly available. G. If bypass is granted/declared, the hospital shall monitor their situation carefully to determine the earliest possible time when the bypass status/lockdown can be lifted.  Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23 Supersedes: 11-11-22 Page: 3 of 8 H. Under EMTALA provisions, Hospitals may not divert a patient without a medical screening exam once on their hospital campus (See appendix). IV. Section 515.315 Bypass or Resource Limitation Status IDPH Review A. The Department shall investigate the circumstances that caused a hospital in an EMS System to go on bypass status to determine whether that hospital's decision to go on bypass status was reasonable. (Section 3.20(c) of the Act) B. The hospital shall notify the Illinois Department of Public Health, Division of Emergency Medical Services, of any bypass/resource limitation decision, at both the time of its initiation and the time of its termination, through status change updates entered into the Illinois EMResource application, accessed at https://emresource.juvare.com/login. The hospital shall document any inability to access EMResource by contacting IDPH Division of EMS during normal business hours. C. In determining whether a hospital's decision to go on bypass/resource limitation status was reasonable, the Department shall consider the following: 1. The number of critical or monitored beds available in the hospital at the time that the decision to go on bypass status was made; 2. Whether an internal disaster, including, but not limited to, a power failure, had occurred in the hospital at the time that the decision to go on bypass status was made; 3. The number of staff after attempts have been made to call in additional staff, in accordance with facility policy; and 4. The approved hospital protocols for peak census, surge, and bypass and diversion at the time that the decision to go on bypass status was made, provided that the Protocols include subsections (c)(1), (2) and (3). 5. Bypass status may not be honored or deemed reasonable if three or more hospitals in a geographic area are on bypass status and/or transport time by an ambulance to the nearest facility is identified in the regional bypass plan to exceed 15 minutes D. Hospital diversion should be based on a significant resource limitation and may be categorized as a System of Care (STEMI or Stroke), or other EMS transports. The decision to go on bypass (or resource limitation) status shall be based on meeting the following two criteria, and compliance with Subsection (c) (3). 1. Lack of an essential resource for a given type or class of patient (i.e. Stroke, STEMI, etc.) Examples include, but are not limited to: a. No available or monitored beds within traditional patient care and surge patient care areas with appropriate monitoring for patient needs; b. Unavailability of trained staff appropriate for patient needs; and/or c. No available essential diagnostic and/or intervention equipment or facilities essential for patient needs. 2. All reasonable efforts to resolve the essential resource limitations(s) have been exhausted including, but not limited to: a. Consideration for using appropriately monitored beds in other areas of the hospital; b. Limitation or cancellation of elective patient procedures and admissions to make available surge patient care space and redeploy clinical staff to surge patients; c. Actual and substantial efforts to call in appropriately trained off duty staff; and  Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23 Supersedes: 11-11-22 Page: 4 of 8 d. Urgent and priority efforts have been undertaken to restore existing diagnostic and/or interventional equipment/or backup equipment and/or facilities to availability, including but not limited to seeking emergency repair from outside vendors if in house capability is not rapidly available. 3. The hospital will do constant monitoring to determine when the bypass condition can be lifted. Such monitoring and decision making shall include clinical and administrative personnel with adequate hospital authority. Efforts to resolve issues in #1 above using all available resource under #2 to come off bypass as soon as such patients can be safely accommodated. E. For Trauma Centers only, the following situations would constitute a reasonable decision to go on bypass status: 1. All staffed operating suites are in use or fully implemented with on-call teams, and at least one or more of the procedures is an operative trauma case; 2. The CAT scan is not working; or 3. The general bypass criteria in subsection (c). F. During a declared local or state disaster, hospitals may only go on bypass status if they have received prior approval from IDPH. Hospitals must complete or submit the following prior to seeking approval from IDPH for bypass status: 1. EMResource must reflect current bed status; 2. Peak census policy must have been implemented 3 hours prior to the request of bypass; 3. Hospital and staff surge plans must be implemented; 4. The following hospital information shall be provided to IDPH: a. Number of hours for in-patient holds waiting for bed assignment; b. Longest number of hours wait time in Emergency Department; c. Number of patients in waiting area waiting to be seen; d. In-house open beds that are not able to be staffed; e. Percent of beds occupied by in-patient holds; f. Number of potential in-patient discharges; and g. Number of open ICU beds. 5. The IDPH Regional EMS Coordinator will review the above information along with hospital status in the region and determine whether to approve bypass for 2 or 4 hours or to deny the bypass request. A hospital may be denied bypass based on regional status or told to come off bypass if an additional hospital in the geographic area requests bypass G. The Department may impose sanctions, as set forth in Section 3.140 of the Act, upon a Department determination that the hospital unreasonably went on bypass status in violation of the Act. (Section 3.20(c) of the Act) H. Each EMS System shall develop a policy addressing response to a system-wide crisis. (Source: Emergency amendment at 46 Ill. Reg. 17682, effective October 23, 2022, for a maximum of 150 days) V. PROCEDURE: PHASE I: PRIOR TO REQUESTING BYPASS (IDPH & Region IX recommendations) A. “Peak Census” occurs when a specific hospital is experiencing near capacity census with limited access to inpatient beds, monitors, critical care equipment, support resources and staffing which impact the management of patient care. The hospital surge capacity plan may have implemented patient admission to overflow space, which in turn provides a strain on available support resources and staffing (Region IX policy).  Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23 Supersedes: 11-11-22 Page: 5 of 8 B. When resource limitations meet a hospital’s tipping point, they shall implement their Peak Census/surge plan and update their status into the Illinois EMResource application, accessed at https://emresource.juvare.com/login to reflect Peak Census/Surge Status. C. IDPH suggests that the following core group should be consulted when a hospital is on peak census status and/or is contemplating the need for bypass: 1. CEO and/or administrator on call; Chief nurse executive or designee 2. Directors of housekeeping, admitting, laboratory and transportation services 3. Nurse and physician directors of inpatient units Hospitals are directed to the IDPH model policy for options to avoid bypass, procedures for advance admission of a pt to an inpatient area, and the five tier bed monitoring and utilization process. They are encouraged to expedite discharges; open boarding beds or overflow units, rapidly clean and prepare beds for incoming pts; and consider cancelling non-emergent surgeries and/or admissions. D. Before a decision is made to request Bypass status, the stricken hospital shall review the Illinois EMResource application to determine if neighboring hospitals are also on the highest levels of peak census or bypass, ED-to-ED communication shall evaluate the possible area-wide consequences of a pending “Bypass” request. E. EDs of stricken hospitals considering the need to request Bypass Status shall notify their EMS Coordinator and discuss the IDPH-recognized grounds for bypass. All Hospital EMSCs shall notify the Resource Hospital EMS Administrative Director who shall consider the need to implement the System Crisis Response plan based on the nature and extent of System-wide resource limitations. VI. PROCEDURE Phase II: Requesting BYPASS STATUS – See the Region IX/NWC EMSS Critical Capacity/Bypass Worksheet (11/22) A. System hospitals must follow IDPH Rules and EMS System/Region IX guidelines with respect to requesting and reporting bypass status. B. Gather the information on the Critical Capacity/Bypass worksheet to provide justification for bypass status. (Max 2 hours for non-internal disasters) C. If bypass is being considered, contact the following to discuss your facility’s situation: Region IX Emergency Preparedness: Steve Baron (RHCC Coord) 224-830-5676 or Gary Brown 815-222-6358 *RHCC will review need for bypass and review EMResource for potential impact If supported, will be given direction to contact IDPH for approval IDPH Region IX EMSC: IDPH Region 9 EMSC: Danielle Albinger, BSN, RN Email the Bypass Worksheet to: [email protected] Then call her Cell: 630-200-7226 D. NOTIFICATION procedures: 1. If IDPH grants approval for bypass: Enter the change in hospital status in https://emresource.juvare.com/login 2. If experiencing an internet connectivity issue, first contact the hospital electronic bed tracking system administrator or others responsible for hospital reporting who may be able to change the hospital’s status from a different location. Option #2: Contact the ED at Sherman Hospital (RHCC) to change hospital status. Option #3: If unsuccessful, contact Juvare Support at 877-771-0911; or via fax to the Division's Central Office at 217-557-3481. 3. The hospital declaring bypass shall notify all surrounding hospitals (including NCH in all cases) that could be impacted by a bypass declaration and EMS agencies that normally transport to that facility through their dispatch centers or  Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23 Supersedes: 11-11-22 Page: 6 of 8 numbers provided by the agencies. This may be accomplished by phone or through a mass notification system if the process has been proven to be a reliable means of communication. Notification must include the hospital's name, reason for bypass, and estimated duration. If on lockdown, be very clear that NO PATIENTS are to be transported to that hospital. 4. EMS AGENCIES are responsible for keeping their personnel informed regarding Bypass Patient Redistribution plans. Provider agency policies shall specifying their way of complying with this requirement. 5. Upon notification of another hospital’s bypass status, the ED charge nurse shall notify appropriate persons within their facility (based on hospital policy) regarding the potential for ED volume increases. 6. It is expected that the hospital on bypass will return to normal operations ASAP. They should reevaluate their status at least every four hours or more frequently if the resource limitation necessitating bypass has been resolved. 7. Notification of BYPASS CANCELLATION shall be promptly entered into https://emresource.juvare.com and communicated to all impacted hospitals and EMS agencies using the same notification methods used to declare bypass status. 8. Hospitals shall notify their EMSC when the Internal Peak Census/Surge plan is deactivated. Hospital EMSCs shall notify the Resource Hospital EMS Administrative Director to cancel the System Crisis Response activation that involved their facility. (Region IX Peak Census/Surge Ambulance Transport Policy) VII. On-line medical control (OLMC) during Bypass declarations EMS personnel shall follow usual and customary OLMC call patterns. Contact the nearest System hospital (or nearest non-System hospital with OLMC privileges if transport would normally go to that location) prior to leaving the scene EVEN IF THAT HOSPITAL IS ON BYPASS. They will let you know if the patient will be accepted by them or routed to another facility. EMS personnel may be directed to call NCH (847) 259-9767 for a receiving hospital assignment. Requests for transport to a facility other than the predetermined destination hospital outlined in the Patient Redistribution Plan require OLMC contact PRIOR TO leaving the scene. If the desired receiving hospital is not a member of the System and/or does not have OLMC privileges, the Resource hospital (NCH) shall provide OLMC and shall call report to the receiving hospital. VIII. Patient distribution plan - pre-established transport destinations for EMS agencies impacted by a hospital’s bypass declaration. Situations which may result in a hospital receiving patients while on bypass A. The patient is unstable and unable to tolerate transport to a more distant comprehensive medical facility. Risks to a pt resulting from a longer transport time are judged to be greater than the benefits of transporting to a nearer hospital on bypass as long as that hospital still has a functioning Emergency Department. Unstable patients with an immediately life-threatening condition whose "LAST CLEAR CHANCE" of survival lies in an EXPEDITIOUS emergency evaluation or resuscitative intervention are NOT TO BE DIVERTED and must be accepted by the closest appropriate ED regardless of Peak Census, Surge, or Bypass status unless an internal hospital disaster is occurring and/or the hospital is on lock-down. UNSTABLE for the purposes of this policy is defined as: Symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs." This includes, but may not be limited to the following: Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23 Supersedes: 11-11-22 Page: 7 of 8 1. Persistently compromised airway/ventilations despite EMS interventions; and/or 2. Severe vascular injury with uncontrolled hemorrhage; cardiac arrest 3. Others as listed below B. Specific patients 1. Advocate LGH will accept the following while on bypass unless experiencing an internal disaster or lockdown: a. Adult/pediatric Level I trauma patients b. Unstable: Adults or children with hemodynamic instability, lack of an airway, or last chance of survival per EMS judgment if ALGH is the closest appropriate hospital. 2. ACUTE STROKE: Transport to the closest appropriate Stroke Center regardless of peak census, surge or bypass status unless their CT scanner is unavailable, an internal hospital disaster is occurring, and/or they are on lock-down. 3. PREGNANT PATIENTS in ACTIVE LABOR or with OB COMPLICATIONS: Transport to the closest hospital with an OB unit regardless of peak census, surge, or bypass status unless an internal hospital disaster is occurring and/or they are on lock-down. 4. Unstable PEDIATRIC PATIENTS: Transport to the nearest EDAP regardless of peak census, surge, or bypass status unless an internal hospital disaster is occurring and/or the hospital is on lock-down. 5. MEDIUM or LARGE SCALE MULTIPLE PATIENT INCIDENTS: Bypass status is vacated unless an internal disaster is occurring and/or the hospital is on lock-down. C. Multiple hospitals simultaneously on bypass in the same geographic area 1. Bypass status may not be honored or deemed reasonable if multiple hospitals in a geographic area are on bypass status and transport time by an ambulance to the nearest facility identified in the regional bypass plan exceeds 15 minutes (IDPH rules 2. When two hospitals servicing the same EMS provider agencies have simultaneously declared bypass and/or two or more hospitals simultaneously on bypass will cause other hospitals to reach the highest level of Peak Census or declare Bypass status, the Resource Hospital shall call or page the System EMS Administrative Director. If he or she fails to respond within 5 minutes, call the EMS MD (see below). They shall determine if the situation necessitates activation of the System's Crisis Response policy. a. Connie Mattera (847) 493-9974 (cell) b. Dr. Matt Jordan (847) 962-6008 3. Hospitals on bypass may be required to accept BLS patients to avert a System Crisis situation. 4. If three or more hospitals are simultaneously on bypass and are adversely impacting patient transports, the EMS MD or EMS Administrative Director will consult with the IDPH Regional EMSC. If transport time by ambulance to the next nearest approved healthcare facility exceeds 15 minutes, the hospital on bypass may be required to accept select ALS patients except in situations of internal disaster or lockdown. In these situations, Resource Hospital (RH) OLMC personnel will coordinate assignment of receiving hospitals for ALS patients in rotation. In some instances, the next nearest open facility may be a non-System hospital. If transport times are less than 15 minutes to a non-System hospital, EMS agencies may be directed to transport to that location in an effort to allow the stricken hospitals time to recover. Notification will be sent from the RH that all communication relative to transport destinations in the stricken area will first go through them.  Northwest Community EMS System POLICY MANUAL Policy Title: Hospital Resource Limitation/Bypass No. B-1 Board approval: 11-10-22 Effective: 8-1-23 Supersedes: 11-11-22 Page: 8 of 8 Attachments: Hospital/Provider Bypass Notice for the NWC EMSS NWC EMSS PEAK CENSUS / Bypass PRE-ALERT FORM Northwest Community EMSS Bypass Worksheet Matthew T. Jordan, MD, FACEP Connie J. Mattera, MS, RN, Paramedic EMS Medical Director EMS Administrative Director APPENDIX EMTALA (Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (42 U.S.C. §1395dd) Provisions The definition of a hospital campus at 42 CFR 413.65(a)(2) means the physical area immediately adjacent to the provider’s main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis. Per 42 CFR 489.24(b), “Hospital property” means the entire main hospital campus, including the parking lot, sidewalk, and driveway, but excluding other areas or structures of the hospital’s main building that are not part of the hospital, such as physician offices, rural health centers, skilled nursing facilities, or other entities that participate separately under Medicare, or restaurants, shops, or other nonmedical facilities. Also, per the American Disabilities Act (ADA), hospital campuses must be accessible to individuals with disabilities. In addition, we know that, during the COVID-19 PHE, non-hospital properties, such as hotels, dormitories, and field hospitals at parks, are becoming extensions of hospitals, otherwise known as temporary expansion sites. This is permissible under the section 1135 waiver of the provider-based regulations at 42 CFR § 413.65 and certain requirements under the Medicare conditions of participation at 42 CFR § 482.41 and § 485.623. See description of Temporary Expansion Locations at https://www.cms.gov/files/document/covid-hospitals.pdf. If an ambulance arrives on any portion of a hospital’s “campus” or “property”, all EDs must conduct a medical screening examination for those patients and provide emergency stabilization to the best of their ability under the conditions. If an emergency medical condition exists, treatment must be provided until the emergency medical condition is resolved or stabilized. If the hospital does not have the capability to treat the emergency medical condition, an "appropriate" transfer of the patient to another hospital must be done in accordance with the EMTALA provisions. EMTALA defines an emergency medical condition as "a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs." The decision to admit, discharge, or transfer a patient, once stabilized, is the responsibility of the emergency physician treating the patient. Any diversions of patients that occur when the facility is not on bypass status shall be reasonable, appropriate, and compliant with Federal, state, and local laws and protocols. The transfer of unstable patients must be "appropriate" under the law, such that (1) the transferring hospital must provide ongoing care within it capability until transfer to minimize transfer risks, (2) provide copies of medical records, (3) must confirm that the receiving facility has space and qualified personnel to treat the condition and has agreed to accept the transfer, and (4) the transfer must be made with qualified personnel and appropriate medical equipment. Hospitals with specialized capabilities are obligated to accept transfers from hospitals who lack the capability to treat unstable emergency medical conditions.  Hospital/Provider Bypass Contact Information for the NWC EMSS Hospitals EMS Agencies System hospitals impacted Ascension Alexian Brothers (ABMC) Northwest Central Saint Alexius Elk Grove Village Addison Consol. DP: IFPD, WDFD Northwest Community DuComm: BLFD 847-952-7454 NorComm: EGTFPD Glen Oaks Fax: 847/ 981-2002 (Lutheran General) Privates Advent Health Glen Oaks Medical Center Glendale Heights DuComm: BLFD ABMC 630/ 545-5758 Privates Northwest Community Fax: 630/ 545-5722 Advocate Good Shepherd Northwest Central Barrington Lake Zurich: LZFR; Wauconda Northwest Community 847/ 842-4444 Red Center: LGFD; LRW Saint Alexius Fax: 847/ 842-4247 Privates Northwest Central Northwest Community ABMC NorComm: Elk Grove Township Saint Alexius Arlington Heights Lake Zurich Good Shepherd 847/ 259-9812 Red Center: LG, LRWFPD PHts, (Lutheran General) Fax: 847/ 618-3991 Wheeling Resurrection Privates Ascension Resurrection Medical Center Chicago (Lutheran General) Privates 773/ 792-5255 Northwest Community Fax: 773/ 990-7632 Ascension Saint Alexius Medical Center ABMC Hoffman Estates Northwest Central Northwest Community 847-843-3508 Privates Good Shepherd Fax: 847/ 755-7602 EMS DISPATCH CENTERS AGENCY NAME PHONE FAX Northwest Central Dispatch (Serving AHFD, BCFPD, BFD, BGFD, 847- 398-2498 847- 590-3300 EGVFD, HEFD, INVFPD, MPFD, PFD, RMFD, SFD) Addison Consolidated Dispatch (WDFD & IFPD) 630- 458-4012 630-495-1906 DuComm: BLFPD 630- 260-7512 630- 665-4893 Lake Zurich (Lake Zurich Fire/Rescue & Wauconda) 847- 438-2349 847- 438-9373 NorComm: EGTFPD 847- 451-8000 630- 903-2850 Red Center: LRWFPD, LGFPD, PHTs, (Wheeling) 847- 724-5700 847- 498-5968 Advantage/Elite Ambulance 847- 413-1133 847- 885-0002 #1: 815- 477-2400 A-TEC #2: 800- 729-2780 779- 220-9987 Superior 630- 832-2000 630- 903-2828 Rev. 11/10/2022 NWC EMSS Peak Census PRE-ALERT FORM Date: DECISION MAKERS ED Physician: ED Coord: Supervisor: Time called: Present in ED: E.D. ASSESSMENT: # Pts on ECG monitors: # Open monitored beds: # Admits holding for monitored beds: INTERNAL ASSESSMENT: get from House Supervisor  No monitored or ICU beds  Unavailability of credentialed/trained staff after failed attempts to call them in  Internal disaster or unsafe situation requires lockdown (nature):  Trauma Centers:  OR limitation  CT down Current census: Step-down: ICU: House: Estimate # of in-house critical or monitored beds that could be available in next 2 hours:  Peak Census procedures completed  Hospital Peak Census status reported to https://emresource.juvare.com.. INTERNAL STEPS TAKEN TO AVOID BYPASS: Document each of the below steps as completed:  Consider appropriately monitored beds in other areas of the hospital; boarding and/or overflow beds opened  Actual and substantial efforts to call in appropriately trained, off-duty-staff; staff reallocated to surge beds  Limitation/cancellation of elective pt procedures  Advance admission of a patient to an inpatient area where the bed is assigned and vacated, but not yet ready to be occupied  All units advised to expedite discharges  Environmental services notified of urgent need to rapidly clean and prepare beds for incoming patients  Urgent efforts made to restore diagnostic and/or interventional equipment/backup equipment and/or facilities to full function, including seeking emergency repair from outside vendors if in house capability is not rapidly available. EXTERNAL ASSESSMENT: Check status of other hospitals in area – Consult IDPH Daily Hospital Resource Availability Tracking system. If neighboring hospitals are also on highest levels of peak census or bypass, ED-to-ED communication shall evaluate possible consequences of a “Bypass” declaration. Alexian Brothers 847- 952-7454 Time: RN Name: ED status/Comments: Glen Oaks 630- 545-5758 Time: RN Name: ED status/Comments: Good Shepherd 847- 842-4444 Time: RN Name: ED status/Comments: Lutheran General 847- 723-5155 Time: RN Name: ED status/Comments: Northwest Community 847- 259-9812 Time: RN Name: ED status/Comments: Resurrection 773- 792-5255 Time: RN Name: ED status/Comments: Saint Alexius 847- 843-3508 Time: RN Name: ED status/Comments: DECISION(S) MADE If decision is made to request BYPASS; Initiate Critical Capacity/Bypass Worksheet to report to IDPH rep Region IX/NWC EMSS Critical Capacity/Bypass Worksheet Area of Focus Comments Date Hospital name: City: Individual completing form Name: Phone: Time: Steve Baron (RHCC Coord) 224-830-5676 or To request bypass CALL: Gary Brown 815-222-6358 Time: e-mail this form to: [email protected] If approved by above: Call IDPH rep: Call cell: 630-200-7226 EMS Coord. notifications Connie Mattera 847-493-9974 Hospital EMSC: Persistent limitations after surge plan activated: ☐ No critical or monitored beds available GENERAL criteria for ☐ Internal disaster (power failure, flood, fire), or active assailant resulting in hospital lockdown requesting bypass: ☐ Insufficient staff appropriate for pt needs after attempts to call them in (See policy p. 1) ☐Trauma Center: CT scan unavailable ☐Trauma Center: All staffed operating suites in use or fully implemented with on-call teams, and at least one or more of the procedures is an operative trauma case ED Bed/Patient Status Total beds ED census now: ED holds waiting for bed Tele admits: ICU admits: assignments/admission Non-Tele admits: Others: ED WR longest wait: ED wait time avg.: ED waiting room census Criticality of WR pts. (ESI Level): Hospital bed status CDU: ED: Other: Alternate beds in use General bed availability Med surg.: Tele: ICU: Potential hospital discharges Tele discharges: Non-tele discharges: Transferring to other hospitals? ☐Yes ☐ No Comments: Plan to expand to alt. care areas ☐Y ☐N Surge Plan activated & Modified electives? ☐Y ☐N strategies Cancelled electives? ☐Y ☐N Extra Staff Called In? Additional steps taken to supplement staffing Hospital: ☐ Peak census Hospital ☐ Peak census ☐ Open ☐ Open Likely destination for EMS pt. ☐ Bypass ☐ Bypass diversions and that hospital’s status Hospital ☐ Peak census Hospital ☐ Peak census ☐ Open ☐ Open ☐ Bypass ☐ Bypass Incident Command Activation Time: ☐Y ☐N Peak Census level now Level: Time posted: Bypass requested by: Print name: ☐ Yes ☐ No Time of determination: Bypass Granted by IDPH Time notification posted in EMResource: https://emresource.juvare.com. Time duration: Approved by: Begin log of bypass notifications and times Created By: Region IX RHCC(NWC EMSS) Date created: 12-16-21 Updated: 11/11/22 Post Until: Updated  Northwest Community EMSS Bypass Notification Worksheet Date: Hospital: Notify Number Alt. # Initiated Updated Canceled Northwest Central: AHFD, BCFPD, BFD, BGFD, EGV, HEFD, 847- 590-3300 INVFPD, MP, Pal, RMFD, SCH Addison (WDFD & IFPD) 630- 458-4012 DuComm: BLFPD 630- 260-7512 Lake Zurich (LZ & 847- 438-2349 Wauconda) NorComm: EGTFPD 847- 451-8000 Red Ctr: LRFPD, LGFD, 847- 724-5700 PHts, Wheeling Advantage-Elite 630- 894-8484 A-TEC 815- 477-2400 Superior 630- 832-2000 Alexian Brothers 847- 952-7454 847- 437-8118 Glen Oaks 630- 545-5758 630- 545-5700 Good Shepherd 847- 842-4444 847- 381-9525 Lutheran General 847- 723-5155 847- 696-0743 Northwest 847- 259-9812 847- 259-9767 Resurrection 773- 792-5255 773- 774-8455 Saint Alexius 847-843-3508 847- 490-6930 Rev. 1-13-20 Note: For other hospitals and phone numbers, see Appendix in SOPs  Northwest Community EMS System Criteria for CT Resource Limitation If a hospital has declared bypass due to a CT scanner resource limitation – DO NOT transport patients with the following to their location: Indications for HEAD CT: Acute head injury; suspected intracranial hematoma (epidural, subdural) Suspected stroke, TIA, subarachnoid hemorrhage Indications for SPINE CT: Acute spine trauma (injury within previous 48 hours) where there is a higher than average likelihood of fracture or dislocation, bulging or herniated disc, or mechanical instability of the spine that requires spine motion restriction. Pt may c/o midline spine pain, have visible injury, or findings of neuro loss or deficit. Indications for CHEST CT Chest trauma with possible pneumothorax, hemothorax, rib fractures and flail segments, pulmonary contusion, disruption to the thoracic aorta, diaphragmatic rupture Indications for ABDOMINAL/PELVIC CT Acute abdominal/pelvic trauma Kidney and bladder trauma Possible Abdominal Aortic Aneurysm (AAA)