DIVERSION: 

The Dirtiest Word in the Emergency Room 

I think I have already told you this but the most disturbing noises an ER doc hears is the 'beep, beep, beep' of a reversing ambulance. As a matter of fact I am sure most of my nightmares begin or end with that sound. And here we go again tonight, no beds and too many ambulances. Ever year like geese flying south, they flock to the ERs by the thousands, as the weather gets cold. The ER censuses are always highest at the peak of the flu season. This year is no exception. The hospital tonight has no bed availability, except for the code bed 'the bed of last resort.' In addition the ER has seven admitted patients as borders until a bed opens in the hospital. With no beds available the hospital goes on "diversion."

Diversion is a status that tells the fire department the current hospital is full, no room at the inn. Typically, this allows for the ambulance crew to bring the patients to other hospitals, especially if the patient is very ill. 

It is sort of a big deal in the hospital. First you need to make sure there are truly no beds available. If the nursing administrator fails get the nursing staff to cover new beds, they cannot be opened. Then the question is how many ER beds are available? The status of the ER is the final part of the decision tree. The ER director is called and the ER is put on "Divert." 

" We always do our best to move the patients quickly out of the ER, for their sake and to free up the ER resources," says Sally Trainor, RN, Nurse Administrator of Roxborough Memorial Hospital. Going on divert is a last resort. Some times it is inevitable. 

"The worse night I can remember was last year," recalls Nurse Trainor. "We had eleven patients admitted to the hospital and not a single bed available. And worse they just kept coming."

For small area hospitals like Roxborough Memorial and St. Agnes going on diversion is only a matter of time, once the large area hospitals hang the 'no vacancy' sign. Many a night I have worked and found a slew of ambulance crews waiting their turn at triage. This means that MCP or in St. Agnes' case Jeff and or Methodist have gone on divert. Shortly after the other smaller ERs have little choice but to follow suit.

But what happens when all of the area hospitals are on divert. Well, nothing. The ambulance crews treat all the ERs as if they are not on divert, they have no choice.
So where is the real problem. How come the hospitals can't staff the beds on an as need basis? The answer is not simple. First, there is the issue of reimbursements. Who is going to pay to have a little more availability verses a little less. Hospitals are finding it difficult to staff the beds, especially when they are not paid to keep them open. These factors, added to a growing older population that needs more medical resources including emergency services, are likely at the root of the current problem.

I don't know any easy solution. I suspect the answer will take the form of increased government support for hospitals and the emergency rooms. I just hope they find the answers soon.  

  Eye Care Available For All

VISION USA offers free eye exams and eyewear to all eligible low-income working Pennsylvanians and their families. 

According to State Rep. LeAnna Washington, the program, which is sponsored by the Pennsylvania Optometric Association and the Pennsylvania Vision Institute, offers eye care to state residents who meet income requirements based on household size who do not have public or private insurance that covers eye examinations.

"Our eyesight is precious, and we have a responsibility to ourselves and especially to our children, to maintain proper eye care. This program is invaluable to families who would otherwise be unable to care for their children's vision," Washington said.

There are several ways to apply for the program. Applicants can contact their local Salvation Army office, or the Association for the Blind executive office at 717-234-3261. They can receive an application through the mail by writing VISION USA at 243 N. Lindbergh Blvd, St. Louis, MO, 63141. All mailed applications must be postmarked by Jan. 22.

Applications are also available online. To apply, visit www.aoanet.org and click on the VISION USA icon in the "Meet the AOA" section. Online applications must be completed before Jan. 26.

  Students Visit Seniors

The Mayor's Office of Community Services, sponsored elementary school student visits to two senior centers in honor of the Martin Luther King Day of Service. 

Blankenberg Elementary School students visited the Smith Pinn Senior Center at 4400 W. Girard Avenue. Students from the McKinley Elementary School visited the Norris Square Senior Center at 212 N. Howard St. Trees were planted by the kids at both sites in honor of Dr. King. MOCS, established in 1965, is the community action agency for the city. m. 
   

Coaches Needed

 Kingsessing Recreation Center Youth Football League is seeking coaches, assistant coaches, and equipment managers. For information call Andrew Gentsch 215-727-1090, or 727-2892, or 685-2695.