The flu outbreak has kept EMS services and emergency departments in the region busy, and in the early evening hours, Attack One is dispatched to another call for a "person ill." But the elderly gentleman they find at his home is not ill with influenza. He has had a progressive onset of shortness of breath throughout the day, and is having chest discomfort. He notes his urine output has been less than usual, and his weight was up 5 lbs. over his baseline when he got on his bathroom scale today. A call by his wife to his physician resulted in the doctor's office calling EMS for transport to the hospital. He is having no chest pain, palpitations, nausea, sweating or other symptoms.

   The patient and his wife request he be transported to a hospital with extensive heart services where he has received care in the past. His physician practices at that hospital, and has advised him that his symptoms are due to a worsening of his chronic congestive heart failure—he will need to be seen by the cardiologist who has done his prior heart catheterizations.

   The paramedic starts an intravenous lock. The patient gets oxygen and nitroglycerin, and is placed in a sitting position on the stretcher. He is not in respiratory distress, so continuous positive airway pressure is not needed. New medical protocols have also decreased the importance of giving a diuretic in the prehospital environment, so none is given. The patient says good-bye to his wife as the house is locked up, then he's loaded into the ambulance, and the wife gets into their car to drive to the hospital.

   The paramedic calls his report ahead to the hospital, and as he completes his patient assessment and gives a short ETA, he hears those evil words: "Sorry, sir, the emergency department has just gone on diversion. You will have to take that patient somewhere else."

   Oh, no! At least the patient is stable. But giving him the diversion news means he is now upset that he cannot go to his preferred hospital and be cared for by his doctor. What's more, his wife is already en route there in the car, with no cell phone. The paramedic has to quickly prioritize calling the medical report to other hospitals, finding out if anyone else is on diversion, calling dispatch to try to find the wife, and notifying the ambulance driver about where to drive. He simply asks for the ambulance to pull over.