Harbor:Surge plan - Revision history

Bchap23: /* Surge Plan */

2025-10-17T17:34:50Z

Surge Plan

← Older revision		Revision as of 17:34, 17 October 2025
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	*** Can see AED patients in PED - thoughtfully select patients		*** Can see AED patients in PED - thoughtfully select patients
	*** If nursing available, utilize shared vertical room model (1 RN, 4 chairs to room, 2nd room next door to eval patients); with 2 nurses, can see 8 patients in 4 rooms		*** If nursing available, utilize shared vertical room model (1 RN, 4 chairs to room, 2nd room next door to eval patients); with 2 nurses, can see 8 patients in 4 rooms
	** '''Flex to hall space'''		** '''Flex to hall space''' - if > 4 hours wait for definitive care
	*** '''Disaster (X-hall) chairs'''		*** '''Disaster (X-hall) chairs'''
	*** '''PWR overflow treatment chairs'''		*** '''PWR overflow treatment chairs'''

Bchap23: /* Surge Plan */

2025-10-17T17:32:09Z

Surge Plan

← Older revision		Revision as of 17:32, 17 October 2025
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	*** Can see AED patients in PED - thoughtfully select patients		*** Can see AED patients in PED - thoughtfully select patients
	*** If nursing available, utilize shared vertical room model (1 RN, 4 chairs to room, 2nd room next door to eval patients); with 2 nurses, can see 8 patients in 4 rooms		*** If nursing available, utilize shared vertical room model (1 RN, 4 chairs to room, 2nd room next door to eval patients); with 2 nurses, can see 8 patients in 4 rooms
	** Flex to hall space		** '''Flex to hall space'''
	*** Disaster (X-hall) chairs		*** '''Disaster (X-hall) chairs'''
	*** PWR overflow treatment chairs		*** '''PWR overflow treatment chairs'''
	*** Admitted ward patients to hall		*** '''Admitted ward patients to hall'''

	** Inpatient pre-surge:		** Inpatient pre-surge:

Bchap23: /* Surge Plan */

2024-12-19T18:03:38Z

Surge Plan

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 ==Surge Plan==
-* There are three levels of surge.  The surge level is determined by meeting the "Resource Utilization Indicators" (see below). When a surge level is met, the patient flow facilitator (PFF), in consultation with the ED attending and OCN will enact the surge plan. Alerts go out to all hospital leadership. If you think criteria have been met to activate the Surge Plan - contact the PFF at '''68647''', pager x0939.
+* There are three levels of surge.  The surge level is determined by meeting the "Resource Utilization Indicators" (see below). When a surge level is met, the patient flow facilitator (PFF), in consultation with the ED attending and OCN will enact the surge plan. Alerts go out to all hospital leadership. If you think criteria have been met to activate the Surge Plan - contact the PFF at '''68647''', pager x0939.  It is based on current criteria, NOT what may happen in a few hours.
 * Refer to [https://wikem.org/wiki/Harbor:Infectious_Disease_Threats#Covid_Surge_Plan|ED_Surge_Plan] for things we can do internally to maximize use of ED space and when to escalate to DEM admin on duty and Clinical Nursing Director.
 * Things to consider in ED for pre-surge with OCN:
-* Things to consider inpatient for pre-surge:
+** EMS
-** Floor RN and Charge RN's evaluate patients daily for potential downgrades and directly contact the Attending
+*** Consider closure to ALS to decompress rooms for next sick patient
-** Maximize use of discharge lounge
+*** If prolonged APOT times, BLS agency may call MAC and have us placed on "BLS Sat"
 ===Resource Utilization Indicators (Need any 3)===

Bchap23: /* BLS Diversion */

2024-12-19T17:50:09Z

BLS Diversion

← Older revision		Revision as of 17:50, 19 December 2024
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	==BLS Diversion==		==BLS Diversion==
	*“BLS ED Sat” is added to ALS ED Sat and marks the ED in the countywide ReddiNet system as “closed” to all ALS and BLS arrivals.		* “BLS ED Sat” is added to ALS ED Sat and marks the ED in the countywide ReddiNet system as “closed” to all ALS and BLS arrivals.
	*“BLS ED Sat” does NOT redirect specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal).		* “BLS ED Sat” does NOT redirect specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal).
	*Very serious decision given consequences to community. Only to be used when situation in ED is felt to be truly unsafe for patients.		* Very serious decision given consequences to community. Only to be used when situation in ED is felt to be truly unsafe for patients.
	*Requires hospital administration approval		* '''Requires hospital administration approval'''
			* If MAC closes us to BLS due to prolonged APOT times, the closure is for 4 hours; if this occurs, please notify ED AOD

Bchap23 at 22:55, 25 November 2024

2024-11-25T22:55:44Z

← Older revision		Revision as of 22:55, 25 November 2024
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	** Xchairs outside RME hallway if staffing allows, assign to Fast Track, Green/Purple, and PED if adult trained attending		** Xchairs outside RME hallway if staffing allows, assign to Fast Track, Green/Purple, and PED if adult trained attending
	** Chairs outside rooms or in waiting room (WR) for discharge for quicker room cleaning for next patient		** Chairs outside rooms or in waiting room (WR) for discharge for quicker room cleaning for next patient
	** Second ~~clerk or router~~ RN to help check in patients into WR		** Second RN to help check in patients into WR
	** NA to help take vitals before triage		** NA/router to help take vitals before triage
	** Provider to help triage get caught up		** Provider to help triage get caught up
	** Consider closure to ALS to decompress rooms for next sick patient		** Consider closure to ALS to decompress rooms for next sick patient
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	** UCC to see all ESI4/5s (no exclusions) --> RME Director and UCC Director to coordinate		** UCC to see all ESI4/5s (no exclusions) --> RME Director and UCC Director to coordinate
	** OR/PACU: Hold patients in OR and procedural areas if PACU full		** OR/PACU: Hold patients in OR and procedural areas if PACU full
	** ~~ED hospitalist rounds with~~ ED Charge RN ~~on boarders and contacts inpatient teams~~ for downgrades/discharges		** ED Charge RN communicate with boarder admitting team for downgrades/discharges
	** ICU identifies stable patients to transfer to Rancho Los Amigos or LAC+USC		** ICU identifies stable patients to transfer to Rancho Los Amigos or LAC+USC
	** Transfer female patients to open 7W rooms		** Transfer female patients to open 7W rooms

Bchap23: /* ALS Diversion */

2022-12-28T22:37:11Z

ALS Diversion

← Older revision		Revision as of 22:37, 28 December 2022
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	~~'''~~BLS Diversion~~'''~~		==BLS Diversion==
	*“BLS ED Sat” is added to ALS ED Sat and marks the ED in the countywide ReddiNet system as “closed” to all ALS and BLS arrivals.		*“BLS ED Sat” is added to ALS ED Sat and marks the ED in the countywide ReddiNet system as “closed” to all ALS and BLS arrivals.
	*“BLS ED Sat” does NOT redirect specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal).		*“BLS ED Sat” does NOT redirect specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal).
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	Schlesinger/Chappell/Wu 5/5/22		Schlesinger/Chappell/Wu 5/5/22


	==Surge Plan==		==Surge Plan==

Bchap23 at 22:36, 28 December 2022

2022-12-28T22:36:38Z

← Older revision		Revision as of 22:36, 28 December 2022
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	~~'''~~ALS Diversion~~'''~~		==ALS Diversion==
	* The goal of diversion is to ensure safety of current ED patients and of patients being transported by EMS by:		* The goal of diversion is to ensure safety of current ED patients and of patients being transported by EMS by:
	** Allowing staff time to move patients within or through the ED to free up space/staff resources.		** Allowing staff time to move patients within or through the ED to free up space/staff resources.
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	*Request is made by phone to the MAC on behalf of the CMO. Cannot be done via ReddiNet		*Request is made by phone to the MAC on behalf of the CMO. Cannot be done via ReddiNet

			Schlesinger/Chappell/Wu 5/5/22




	~~Schlesinger/Chappell/Wu 5/5/22~~

	==Surge Plan==		==Surge Plan==

Bchap23 at 22:29, 28 December 2022

2022-12-28T22:29:12Z

← Older revision		Revision as of 22:29, 28 December 2022
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	'''ALS Diversion'''		'''ALS Diversion'''
			* The goal of diversion is to ensure safety of current ED patients and of patients being transported by EMS by:
			** Allowing staff time to move patients within or through the ED to free up space/staff resources.
			** Allowing the ED time to prepare for next round of sick patients.
	* ED Saturation (aka Diversion) is a process of marking the ED in the countywide ReddiNet system as “closed” to adult Advanced Life Support (ALS) arrivals.		* ED Saturation (aka Diversion) is a process of marking the ED in the countywide ReddiNet system as “closed” to adult Advanced Life Support (ALS) arrivals.
	**“ALS ED Sat” does NOT redirect BLS arrivals or specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal)..		** “ALS ED Sat” does NOT redirect BLS arrivals or specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal).
	*ALS ED Sat” lasts for two hours but can be ended earlier. At the end of the two-hour diversion, ReddiNet will automatically re-open the hospital to ALS.		** ALS ED Sat” lasts for two hours but can be ended earlier. At the end of the two-hour diversion, ReddiNet will automatically re-open the hospital to ALS.
	*If the nearest alternative ED is also noted as “ALS ED Sat”, ALS ambulances will be directed to the closest ED, regardless of “ED Sat” status on ReddiNet.		** If the nearest alternative ED is also noted as “ALS ED Sat”, ALS ambulances will be directed to the closest ED, regardless of “ED Sat” status on ReddiNet.
	*“ALS ED Sat” is not a command, but a suggestion. EMS can still bring the patient to the MAR if it is considered to be the safest decision (e.g. patients in extremis)		** “ALS ED Sat” is not a command, but a suggestion. EMS can still bring the patient to the MAR if it is considered to be the safest decision (e.g. patients in extremis)
	*'''Goal''' of Diversion is to ensure safety of current ED patients and of patients being transported by EMS by::
	**Allowing staff time to move patients within or through the ED to free up space/staff resources.
	**Allowing the ED time to prepare for next round of sick patients.

	'''Guidelines for ALS Diversion triggers''':		'''Guidelines for ALS Diversion triggers''':
	*Consider when not enough space to care for the next critical patient coming by ambulance		* Consider when not enough space to care for the next critical patient coming by ambulance
	**Not enough treatment spaces despite decompress patients to other beds/hallway		** Not enough treatment spaces despite decompress patients to other beds/hallway
	**Not enough staff (RN, RT, provider, etc.) or supplies (vents, blood, etc.)		** Not enough staff (RN, RT, provider, etc.) or supplies (vents, blood, etc.)
	*Diversion ~~decisions made~~ by ~~joint agreement of~~ MICN, ~~OCN~~, AED Charge~~, and Attending~~		* Diversion is a joint decision by the MICN, AED charge nurse, AED attending(s), Overall Charge Nurse (OCN)
	*OCN & Attending names are recorded in the ReddiNet as the Authorizing personnel		** Consider carefully as it results in longer transport times for potentially critically ill patients
			** OCN & Attending names are recorded in the ReddiNet as the Authorizing personnel

	* ~~Joint decision by the MICN, AED charge nurse, AED attending(s), Overall Charge Nurse (OCN)~~		* '''Indicators to consider''':
	** Consider carefully as it results in longer transport times for potentially critically ill patients		** NEDOCS>140 (must be done hourly while on diversion status) '''and''' Hospital Surge level
	** Indicators to consider:		** EMS closure criteria
	*** NEDOCS>140 (must be done hourly while on diversion status) '''and''' Hospital Surge level		** Surrounding hospital status
	*** EMS closure criteria		** All ED rooms are full (Peds=18, AED=55 [Tr 5 beds, AED 22 beds, RME 6-9, 13-20, Gold 16 beds]) and 30% or greater of the ED patients are ESI1, ESI2, or admit boarders
	*** Surrounding hospital status		* '''If group decision is to close, proceed with the 1 hour ED closure; must reevaluate the department before going on ED ALS diversion again'''<ref>Harbor ED Policy 20.4, LA County EMS policies 503, 506, & 513</ref>
	*** All ED rooms are full (Peds=18, AED=55 [Tr 5 beds, AED 22 beds, RME 6-9, 13-20, Gold 16 beds]) and 30% or greater of the ED patients are ESI1, ESI2, or admit boarders		**Closure to ED saturation should always be accompanied by closure to interfacility, ED to ED, and other transfers through the Medical Alert Center (MAC). All MAC closures are discussed with the House Supervisor/Patient Flow Facilitator (PFF) or Administrative Officer of the Day (AOD).
	** '''If group decision is to close, proceed with the 1 hour ED closure; must reevaluate the department before going on ED ALS diversion again'''<ref>Harbor ED Policy 20.4, LA County EMS policies 503, 506, & 513</ref>
	***Closure to ED saturation should always be accompanied by closure to interfacility, ED to ED, and other transfers through the Medical Alert Center (MAC). All MAC closures are discussed with the House Supervisor/Patient Flow Facilitator (PFF) or Administrative Officer of the Day (AOD).
	* Other potential reasons for ambulance diversion:		* Other potential reasons for ambulance diversion:
	** CT: based on the availability of alternate scanners; AED Attending will notify the ED Overall Charge for Reddinet entry		** CT: based on the availability of alternate scanners; AED Attending will notify the ED Overall Charge for Reddinet entry
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	*Very serious decision given consequences to community. Only to be used when situation in ED is felt to be truly unsafe for patients.		*Very serious decision given consequences to community. Only to be used when situation in ED is felt to be truly unsafe for patients.
	*Requires hospital administration approval		*Requires hospital administration approval


	'''Guidelines for BLS Diversion triggers''': Requires hospital administration approval		'''Guidelines for BLS Diversion triggers''': Requires hospital administration approval
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	*Request is made by phone to the MAC on behalf of the CMO. Cannot be done via ReddiNet		*Request is made by phone to the MAC on behalf of the CMO. Cannot be done via ReddiNet

	Schlesinger/Chappell/Wu 12/28/22



			Schlesinger/Chappell/Wu 5/5/22

	==Surge Plan==		==Surge Plan==

Andreawu at 22:12, 28 December 2022

2022-12-28T22:12:15Z

← Older revision		Revision as of 22:12, 28 December 2022
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	**Allowing staff time to move patients within or through the ED to free up space/staff resources.		**Allowing staff time to move patients within or through the ED to free up space/staff resources.
	**Allowing the ED time to prepare for next round of sick patients.		**Allowing the ED time to prepare for next round of sick patients.


	'''Guidelines for ALS Diversion triggers''':		'''Guidelines for ALS Diversion triggers''':
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	** Internal Disaster (see https://www.wikem.org/wiki/Harbor:Disaster_plan)		** Internal Disaster (see https://www.wikem.org/wiki/Harbor:Disaster_plan)
	** Helipad: due to unsafe landing conditions, damage to the helipad, current helicopter on the pad, deployment of the decon trailers for a large Hazmat incident; MAC must immediately be notified of closure		** Helipad: due to unsafe landing conditions, damage to the helipad, current helicopter on the pad, deployment of the decon trailers for a large Hazmat incident; MAC must immediately be notified of closure











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	*Very serious decision given consequences to community. Only to be used when situation in ED is felt to be truly unsafe for patients.		*Very serious decision given consequences to community. Only to be used when situation in ED is felt to be truly unsafe for patients.
	*Requires hospital administration approval		*Requires hospital administration approval


	'''Guidelines for BLS Diversion triggers''': Requires hospital administration approval		'''Guidelines for BLS Diversion triggers''': Requires hospital administration approval
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	*Request is made by phone to the MAC on behalf of the CMO. Cannot be done via ReddiNet		*Request is made by phone to the MAC on behalf of the CMO. Cannot be done via ReddiNet

			Schlesinger/Chappell/Wu 12/28/22



	Schlesinger/Chappell/Wu 5/5/22

	==Surge Plan==		==Surge Plan==

Bchap23 at 22:05, 28 December 2022

2022-12-28T22:05:49Z

@@ Line 1: / Line 1: @@
 '''ALS Diversion'''
-*ED Saturation (aka Diversion) is a process of marking the ED in the countywide ReddiNet system as “closed” to adult Advanced Life Support (ALS) arrivals.
+* ED Saturation (aka Diversion) is a process of marking the ED in the countywide ReddiNet system as “closed” to adult Advanced Life Support (ALS) arrivals.
 **“ALS ED Sat” does NOT redirect BLS arrivals or specialty center patients arriving to Harbor (e.g. Trauma, STEMI, Perinatal)..
 *ALS ED Sat” lasts for two hours but can be ended earlier. At the end of the two-hour diversion, ReddiNet will automatically re-open the hospital to ALS.
@@ Line 16: / Line 16: @@
 *Diversion decisions made by joint agreement of MICN, OCN, AED Charge, and Attending
 *OCN & Attending names are recorded in the ReddiNet as the Authorizing personnel
@@ Line 38: / Line 64: @@
 Schlesinger/Chappell/Wu  5/5/22