Wash. county reduces interstate ambulance diversions

Hospitals in the county have become less dependent on diverting ambulances "across the river" to Oregon


Jack Heffernan
The Columbian, Vancouver, Wash.

CLARK COUNTY, Wash. — Fewer Clark County ambulances are being diverted to Portland hospitals, saving crucial time for patients and emergency medical providers, according to local officials.

Historically, Clark County’s two hospitals have diverted ambulances when their emergency departments are full, meaning local patients sometimes find themselves in Oregon beds. But since early 2018, diverted patients have largely only been taken to PeaceHealth Southwest Medical Center or Legacy Salmon Creek Medical Center.

Legacy Salmon Creek Medical Center is one of two hospitals in Clark County, Wash., that has reduced ambulance diversions to Portland, Ore. (Photo/Legacy Health)
Legacy Salmon Creek Medical Center is one of two hospitals in Clark County, Wash., that has reduced ambulance diversions to Portland, Ore. (Photo/Legacy Health)

In the rare case that both hospitals are in divert status, the hospitals accept ambulance patients in an alternating fashion.

“The end result is that all (ambulance) patients are still delivered to a Clark County care facility — none are diverted across the river into Oregon,” according to a statement from PeaceHealth.

Nationally in the last 15 years, factors like medical costs and changing uses of emergency rooms have increased the need for hospitals to divert patients, said Dr. Lynn Wittwer, Clark County medical program director.

“Emergency departments have been, sort of, overwhelmed,” Wittwer said.

On average, PeaceHealth was in divert status eight hours per month in 2017, 10 hours in 2018 and 13 hours so far this year, according to hospital data. The 2019 figures include the period covering the measles outbreak, which affected 71 people in Clark County between Jan. 13 and March 18.

Wittwer and Clark County Fire & Rescue Chief John Nohr said that PeaceHealth generally enters divert status less often than other hospitals in the metro area. Legacy Salmon Creek did not respond to a request for statistics about its emergency department.

Before 2018, the two hospitals would divert patients to, and accept them from, a selection of hospitals in Portland closest to Clark County. When multiple hospitals enter divert status, it can lead to slower transport times — and reduce favorable outcomes for patients.

“We didn’t do it a tremendous amount, but we did it enough to stretch the system,” Wittwer said. “That doesn’t work. That’s not good for the patient.”

A heavy dose of snow that slammed the area a couple of years back — bringing illnesses, accidents and busy emergency rooms with it — prompted the Clark County hospitals to become more independent, Wittwer said. Representatives from the hospitals committed to primarily accept or divert patients to each other, save a major incident.

“If everyone was on divert, patients still had to go someplace,” Wittwer said. “(Clark County hospitals) wanted to try to take control of that.”

PeaceHealth is the only Level 2 trauma center in Southwest Washington and one of three trauma centers in the metro area. Level 2 means the hospital is prepared to respond to the most severe illnesses and injuries, but doesn’t have a teaching or research department like Level 1 centers.

“It has everything it needs,” Nohr said.

While patients can receive treatment in an ambulance, it’s not as extensive as the care they receive in a hospital. In other words, patients with severe conditions can’t afford to sit in traffic on the way to Portland.

“If it’s life-threatening, we need to reduce that transport time as much as possible,” Nohr said.

PeaceHealth doesn’t divert its most critical patients — such as those with heart attacks, traumas and strokes — or anyone that paramedics specifically determine need to go there, spokesman Randy Querin said.

There are a few exceptions, including patients who have pediatric conditions that are not immediately life-threatening. They are typically taken to Randall Children’s Hospital or Doernbecher Children’s Hospital in Portland. Burn patients will usually go to Legacy Oregon Burn Center in Portland.

But those who need immediate treatment in Clark County are extremely likely to get it, Wittwer said. “With lights and sirens, they’re not going across the river.”

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©2019 The Columbian (Vancouver, Wash.)

McClatchy-Tribune News Service

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