Which Hospital Will You Go To?
When you dial 911 for emergency medical services (EMS) your transport may route you to a hospital that is not near your home. While you have the right to ask to be transported to the hospital of your choice, either out of preference or to stay in your insurance network of doctors, you might not be permitted to do so. While you do have rights, you also have limitations, so it is best to understand how these decisions are made before experiencing a medical emergency.
First, it is worth understanding the difference between an Emergency Medical Technician (EMT) and a Paramedic (most commonly referred to as an EMT-P). An EMT can provide basic emergency medical care at the scene or en route to a hospital and can assess varying emergencies and determine what care is needed. A Paramedic has more extensive training beyond that of an EMT for comprehensive patient assessment and medical intervention. An EMT-P can make recommendations to dispatchers regarding your specific medical conditions that indicate which specialized facility would be best for you.
Before EMS makes physical contact with you, the decision where to route you may have already been automatically determined depending on the 911 system used in your area. A coordinator at the dispatch center may be distributing patients evenly among the regional hospitals or responding to overflow conditions in certain areas. In the event of a natural disaster where the local medical infrastructure may have collapsed, you might even be taken out of state. The point is there is a system in place that triages patient placement. Unless you or some advocate of yours provides ample rationale to change locations, you will be placed according to the methodology of the 911 system and its variants.
EMS systems vary widely among states and even at the county level. While parts of California will offer you a choice of hospital, other states may only advise you of the chosen hospital as you get underway in an EMS transport. Of course, you have the right to tell the driver specifically where you would prefer to be taken, and if it is safe for you and they can do so, they generally will accommodate your preference. However, some drivers are unable to transport patients to their desired hospital as drivers are assigned specific zones and are not permitted to operate out of those established areas. Even if you arrive at the hospital of your choice, you may still be turned away if the hospital is full. Being turned away often happens when a hospital is hit with numerous emergency patient situations because of a severe multiple-car accident or other adverse events.
Another determining factor as to where you will be taken is related to your injury or medical condition and the type of facility that can best treat it. There are many categories of facility specialization.
A trauma center is the most common of all specialty hospital types, and they have four (I-IV) levels that refer to the types of available resources at each location. A level I facility can address most cases, including severe cases. If it is warranted, a patient may be transported in a helicopter to a trauma facility because of its designated specialty.
Burn centers have specialty equipment that other hospitals do not have and can handle severely burned patients. Fifty-nine burn facilities are verified by the American Burn Association (ABA) in the US and another 65 are not.
Cardiac care centers number in the hundreds across the United States and are often referred to as STEMI centers (S-T elevated myocardial infarction), which is the heart attack type that is most commonly treated. Only 12 of these cardiac care centers are certified "STEMI receiving centers" by the American Heart Association and the American College of Cardiology.
A stroke center can care for the brain akin to what a STEMI center does for the heart. There are more than 1,100 facilities in the US that carry the designation of primary or comprehensive stroke centers. Like heart attack victims, stroke victims have a narrow window of time to receive specialized care to assure the best outcome of the medical event.
Children’s hospitals specialize in the care of young teens, children, and babies. 18 of the 220 children’s hospitals throughout the US exclusively treat people 18 years and younger. Many of the facilities are equipped with pediatric trauma centers.
If you are experiencing an emergency medical event, it is reasonable to request to be taken to your preferred hospital. Many older people are concerned about seeing someone outside their insurance network of doctors because of the burdensome costs associated with being out of network. If you do broach the insurance coverage topic with an EMS driver, be aware it is not legal of the driver to inquire about your insurance status as it may result in discriminatory practices like taking you to a substandard facility when a top-notch hospital may be closer.
Ultimately, the hospital you get routed to is not a random act. While you may prefer to be in a neighborhood facility, you may be better off taken to a specialized center for care. That determination is made by 911 methods and practices, as well as input from your attending paramedic. You should never hesitate to inquire about the reasons for selecting a specific hospital. Still, you can be sure the system in place is trying to create the best outcome possible for your medical condition or injury. Sometimes what seems the closest and most obvious choice will not adequately address your medical needs.
We hope you found this information helpful. If you have questions or would like to discuss a planning need for you or a loved one, please don’t hesitate to call us for assistance.