How Paramedics Choose Where to Take You

Paramedics lifting patient from ambulance
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One of the most common questions I get is how paramedics choose which hospital emergency department to take a patient. Like most questions about emergency medical services, the answer is a little complicated.

Most importantly, how an ambulance crew chooses where to take a patient depends on the system. In other words, where you are in the country when you call 911 has the biggest effect on how the paramedics will decide where to take you.

In some areas of the country, there is only one hospital in the response zone. In that case, the decision is simple.

Most parts of the country have protocols to help paramedics decide where to go. Some patients require specialty care while others might have insurance requirements. Sometimes the determination is based on the needs of the system, which uses a centralized coordinator to disperse patients equally to area hospitals. In the parts of California where I have practiced, patients are traditionally offered a choice of destination hospitals to choose from, unless their condition warrants a specialty hospital.

There's just no way to say for sure how the paramedics will choose a hospital. Here are a few of the most common determinants.

Specialty Centers

There's something to be said for specializing. When seconds count or knowing the tiniest details will make a difference, you want to go to a specialty center for your care.

Some specialties don't currently have a place in emergencies (cancer centers for instance) but there are a few that trump patient preference when it comes to figuring out which hospital to point the ambulance at.

  • Trauma centers are the most common type of specialty hospitals. There are 4 levels of trauma centers designated by Roman numerals. Level I trauma centers can handle the most patients and the most severe cases. In many EMS systems around the country, serious trauma patients must be taken to a trauma center for treatment, regardless of closest hospital or patient preference. In some EMS systems, patients have to be flown by helicopter to reach specialty centers.
  • Burn centers handle severely burned patients with treatments and equipment that other hospitals don't have access to.
  • Cardiac care centers are sometimes referred to as "STEMI centers" because of the type of heart attack they most commonly treat in an emergency. These are the places you want to be if you are having an S-T elevated myocardial infarction (STEMI), which responds very well to certain types of treatment if that treatment is done quickly. 
  • Stroke centers are to the brain what a STEMI center is to the heart. These teams also go for the NASCAR pit crew style, but they're aiming a little farther north than their cardiac counterparts. Strokes happen in the brain.
  • Children's hospitals know how to treat kids better than anyone else. When kids are involved and there's a children's hospital in the area, paramedics often have to transport patients there. Additionally, some children's hospitals are also pediatric trauma centers.

Disasters and Muli-Casualty Incidents

When EMS systems get overwhelmed with too many patients—usually in a multi-casualty incident or a disaster—the patients will be divided up among the available hospitals. Transportation will be coordinated through a Disaster Control Facility.

Neither the patients nor the paramedics will have a say in where any individual patient will be taken. In many cases, specialty centers are still utilized if possible.

In severe disasters such as hurricanes or floods, emergency patients can be transported to destinations as far away as other states. This is especially true if the infrastructure (hospitals, ambulance services, etc.) are damaged.

Insurance and Patient Choice

I'd say the most common determinant of hospital destination comes from the patients. In most parts of the country, patients get to choose their hospital. Most of the time, your insurance contracts with a particular hospital.

It is illegal for an ambulance crew to ask about insurance before transporting a patient (theoretically, the patient could get funneled to a substandard hospital if he or she doesn't have insurance or has a poor insurance). Therefore, it's very important for each of us to know which emergency department our insurance wants us to use. If we are given a choice, the insurance will expect us to choose the correct one.

Closest Facility

The final and simplest choice for hospital destination is to just take the patient to the closest one. This might not be the case, however, for all the other options listed above. You shouldn't be surprised if a loved one is transported to a hospital but doesn't end up at the one nearest you. There are a lot of reasons why that may not be the best choice.

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