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Over the past several decades, advancements in medical care and technology have led to significant specialization in medical practice in many areas. These specialized services are often offered only at tertiary care centers where the resources exist to support the practice. In much the same way as trauma center designation occurred several decades ago, designation of specialized centers for stroke and cardiac care is seen in many areas.1-4 Even when a formal designation process is not in place, consolidation of advanced services for many conditions is evident within regions and hospital systems. Smaller hospitals have taken on the role of identification and stabilization of conditions that require more advanced resources for definitive management.5 Once such a condition has been identified and the patient appropriately stabilized, transfer to the facility capable of providing definitive care is necessary.

Since the 1970s the emergency medical services (EMS) system has developed and evolved to meet the needs of patients requiring transport to the hospital from a prehospital environment. EMS providers have been trained to efficiently assess patients and provide stabilizing care and safe transport to the most appropriate facility. This ability to provide safe and expeditious transport makes the EMS system the most logical means to move a patient from one hospital to another in an emergent situation.

It may be obvious to some that the needs of a patient being moved from the scene of an accident to a hospital are significantly different than the needs of a patient who has been assessed and stabilized at a hospital and requires transport to a tertiary care center for further care. The hospitalized patient often will have a specific diagnosis and have advanced interventions in place at the time of transfer. Traditional training for EMS providers is focused on identification of symptoms and rapid stabilizing care during transport to the closest appropriate hospital. With rare exception, the ongoing management of specific diagnoses has not been addressed in standard EMS training.

EMS systems have begun to evolve to meet the needs of this new patient population. While there are recently published national guidelines for interfacility transfer (IFT), many areas are still evolving to meet the needs of this patient population.6 The involvement of a physician who understands the EMS system as well as the needs of the IFT patient is crucial in the development and management of a comprehensive IFT program. This chapter will review the history of interfacility transfers and discuss the different aspects of the system that the EMS physician must be familiar with.


  • Define interfacility transport.

  • Describe indications for patients to be transferred by EMS to other health care institutions.

  • Discuss how COBRA and EMTALA impact interfacility transfers.

  • Describe the development of interfacility transport specific protocols.

  • Discuss the role of advanced and ancillary medical providers used in specialty transport operations.


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