In this March 13, 2020, file photo, an associate nurse leader at Central Maine Medical Center,questions patients at the emergency entrance to the hospital in Lewiston. Credit: Robert F. Bukaty / AP

Central Maine Medical Center’s recent decision to suspend pediatric and trauma units is the biggest escalation of diversion tactics that Maine hospitals have employed in recent weeks facing understaffing during the COVID-19 pandemic.

A longstanding staffing shortage is being compounded by departures expected when Gov. Janet Mills’ vaccine mandate for health care workers goes into effect near the end of the month. Resignations of nursing staff led the hospital to close its neonatal intensive care unit at the end of the month and a contingency plan envisions slashing half of ICU beds if all staff leave, leading the hospital and lawmakers to lobby for a testing opt-out that Mills has resisted.

All large Maine hospitals were challenged by a late-summer COVID-19 surge that sapped ICU capacities. During that time, many were on temporary diversions that hospitals enter when they are unable to accommodate patients in certain areas and ask first responders to send new patients elsewhere. Hospitals rarely announce diversions publicly, making it hard to understand how often it happens.

But the suspension of services at the Lewiston hospital is different because of the scope and the uncertain length of time they will be suspended. Although its trauma capacity will be evaluated daily, pediatric services are expected to be closed indefinitely. The suspension of those services at one major hospital could create barriers to care for patients as hospitals across the state face capacity and staffing issues with lower COVID-19 hospitalizations.

The request to divert ambulances to another facility is nonbinding, and hospitals will usually stabilize a patient in crisis before sending them elsewhere, said Nate Mick, the vice chair of emergency medicine at Maine Medical Center in Portland. A smaller hospital might have to send patients elsewhere because they lack the equipment or space to care for someone, but Central Maine Medical Center is typically a receiving hospital in those scenarios.

“What they are saying right now is that they are struggling to support those services,” Mick said.

Mick said his hospital has requested diversion more frequently in the past six months due to a lack of available beds, although he did not give an exact number, saying the hospital was “bursting at the seams” in those instances.

Other hospitals reported variable instances of going on diversion, typically for short amounts of time. Suzanne Spruce, a Northern Light Maine spokesperson, said diversion requests have increased in the past year due to more acute cases of COVID-19 in patients.

On Tuesday, only Northern Light Maine Coast Hospital in Ellsworth entered into a short diversion due to a lack of space in an emergency department. St. Mary’s Regional Medical Center in Lewiston also experienced a recent need to divert critical care patients, spokesperson Stephen Costello said, but it was accepting those patients as of Tuesday.

When hospitals request diversion, it is up to emergency responders to figure out where to go next. Tom Judge, the director of Lifeflight, which provides helicopter emergency transportation for hospitals throughout Maine, said his service has taken COVID-19 patients out of state, largely to Boston but occasionally to places including Dartmouth-Hitchcock Medical Center in western New Hampshire if Maine hospitals are full.

Compounding the issue is the length of time COVID-19 patients might need care, he said. While a car crash victim may be in the emergency department for a few days, a very sick patient may require extensive time on a ventilator. Central Maine Medical Center is temporarily closing services, but Judge said all hospitals are making tough choices on managing care.

“It’s a reflection that hospitals are really stressed right now, and it’s not getting any easier,” Judge said.