The flu season is over. But the hospital crunch is not. Through March and April, Tristate hospitals continued to turn away life squads in far higher numbers than in years past, according to figures from the Greater Cincinnati Health Council.

        Local hospitals declared themselves overcrowded 78 times in March and 64 times in April. Those figures are down from the record-setting 112 diversions in February, but remained more than five times higher than March and April of last year.

        The diversions mean ongoing aggravation for sick and injured people who wind up spending hours in emergency departments waiting for available hospital beds. The diversions also mean slower response times for area life squads that have to drive farther to get patients to hospitals.

        Yet so far, there have been no reported disasters in care, such as an injured person dying because a hospital diversion kept a life squad out of service too long.

        “To my knowledge, that "Oh-my-God' case hasn't happened. But the potential is there,” said Trish Brooks, fire chief for the Forest Park Fire Department “We're dealing with it because we're an adept and overcome system and that's our job. But when I talk to other fire chiefs, they say their number one problem is diversions.”

        A diversion occurs when a hospital cannot handle more ambulance runs, either because all its beds are full or it cannot bring in enough workers to staff the units.

        When a hospital goes on diversion, it asks life squads to take as many patients as possible to other hospitals.

        Even during a diversion, ambulances are expected to carry the most unstable pa tients to the nearest hospital. Patients also can insist on going to a particular hospital.

        Hospital officials predict high numbers of diversions will continue because they see no quick solutions to the rising numbers of emergency department visits and ongoing trouble hiring enough nurses to meet demand.

        “I'm wondering if we're

        just beginning to see the effects of an aging population,” said Colleen O'Toole, vice president of the health council.

        Emergency department visits have been rising since 1996 and went up another 3 percent in 2000, from 807,427 visits to 831,922 visits, Ms. O'Toole said.

        Nurse staffing problems have become so severe that hundreds of nurses rallied in Columbus earlier this week to call for a state law to ban mandatory overtime and require hospitals to set mini mum staffing standards.

        So far, it appears that people who have needed immediate medical care have been able to get it. But hospital and fire department leaders agree the community dodged a bullet this winter because the flu season turned out to be milder than expected.

        Now, few dare predict how well the system will handle the next surge of patients.

        “We've been holding our own. But we are concerned that quality of care will start to deteriorate at some point,” Ms. O'Toole said.

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