Ethics of ambulance diversion.

Area of Science:

• Emergency Medicine
• Healthcare Policy
• Medical Ethics

Background:

• Ambulance diversion is a frequent practice in emergency departments (EDs).
• It aims to manage patient surges and bed capacity issues.
• Alternative coping mechanisms include 'boarding' and normalizing terminology.

Purpose of the Study:

• To examine the history, causes, and consequences of ambulance diversion.
• To analyze the ethical underpinnings of diversion policies.
• To propose recommendations for managing ED capacity challenges.

Main Methods:

• Review of historical data and causes of ambulance diversion.
• Ethical analysis of diversion's impact on patient care.
• Examination of practical consequences and alternative strategies.

Main Results:

• Diversion decisions are often relative, not absolute, making the individual patient the primary moral stakeholder.
• Current diversion practices can lead to maladaptive behaviors and normalization of suboptimal care.
• Existing policies often overlook patient preferences and institutional surge capacity.

Conclusions:

• Patient preferences, EMS laws, and surge capacity must guide diversion decisions.
• A regional or statewide ban on ambulance diversion may offer significant benefits.
• Re-evaluating diversion policies is crucial for equitable and effective emergency care.