As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers' family increases commitment to work. These factors should be considered in emergency planning.

Objectives: To describe the characteristics and feasibility of a physician-directed ambulance destinationcontrol program to reduce emergency department (ED) overcrowding, as measured by hospital ambulance diversion hours.Methods: This controlled trial took place in Rochester, New York and included a university hospital and a university-affiliated community hospital. During July 2003, emergency medical services (EMS) providers were asked to call an EMS destination-control physician for patients requesting transport to either hospital. The destination-control physician determined the optimal patient destination by using patient and system variables as well as EMS providers' and patients' input. Program process measures were evaluated to characterize the program. Administrative data were reviewed to compare system characteristics between the intervention program month and a control month.Results: During the intervention month, 2,708 patients were transported to the participating hospitals. EMS providers contacted the destination-control physician for 1,866 (69%) patients. The original destination was changed for 253 (14%) patients. Reasons for redirecting patients included system needs, patient needs, physician affiliation, recent ED or hospital care, patient wishes, and primary care physician wishes. During the intervention month, EMS diversion decreased 190 (41%) hours at the university hospital and 62 (61%) hours at the community hospital, as compared with the control month.Conclusions: A voluntary, physician-directed destination-control program that directs EMS units to the ED most able to provide appropriate and timely care is feasible. Patients were redirected to maximize continuity of care and optimally use available emergency health care resources. This type of program may be effective in reducing overcrowding.ACADEMIC EMERGENCY MEDICINE 2006; 13:54-60 ª

Objectives: To describe the characteristics and feasibility of a physician-directed ambulance destinationcontrol program to reduce emergency department (ED) overcrowding, as measured by hospital ambulance diversion hours.Methods: This controlled trial took place in Rochester, New York and included a university hospital and a university-affiliated community hospital. During July 2003, emergency medical services (EMS) providers were asked to call an EMS destination-control physician for patients requesting transport to either hospital. The destination-control physician determined the optimal patient destination by using patient and system variables as well as EMS providers' and patients' input. Program process measures were evaluated to characterize the program. Administrative data were reviewed to compare system characteristics between the intervention program month and a control month.Results: During the intervention month, 2,708 patients were transported to the participating hospitals. EMS providers contacted the destination-control physician for 1,866 (69%) patients. The original destination was changed for 253 (14%) patients. Reasons for redirecting patients included system needs, patient needs, physician affiliation, recent ED or hospital care, patient wishes, and primary care physician wishes. During the intervention month, EMS diversion decreased 190 (41%) hours at the university hospital and 62 (61%) hours at the community hospital, as compared with the control month.Conclusions: A voluntary, physician-directed destination-control program that directs EMS units to the ED most able to provide appropriate and timely care is feasible. Patients were redirected to maximize continuity of care and optimally use available emergency health care resources. This type of program may be effective in reducing overcrowding.ACADEMIC EMERGENCY MEDICINE 2006; 13:54-60 ª

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