Interfacility Transport, Including Ground Critical Care Transport

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What is an interfacility transport?

Interfacility transport is the movement of a patient from one healthcare facility to another by licensed EMS personnel.

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What are the reasons patients may need to be transferred between healthcare facilities?

Interfacility transports in the healthcare industry take place for many reasons. They may be as simple as a wheelchair van transport of a patient from a long-term care facility to a scheduled appointment or as complex as the transfer of a critically ill intubated patient on multiple drips and advanced devices by rotor-wing aircraft to a quaternary care center. The decision for transfer should always be based upon the benefits of care versus the risks involved.

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What does the term “regionalization of care” mean, and what are the implications for EMS?

Regionalization of care is a method to provide high-quality, cost-efficient healthcare to the largest number of patients. In 2006, the Institute of Medicine (IOM) supported the process of regionalization of emergency care services in their white paper entitled “Emergency Medical Services: At the Crossroads”. This paper defined regionalization as the “process of improving patient outcomes by directing patients to facilities with experience and optimal capabilities for any given type of illness or injury.” The benefits of this strategy include improved outcomes through increased volumes and decreased costs through economies of scale. One challenge of this strategy has been an increased strain on the EMS system through increased numbers of interfacility transports.

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How should hospitals without specialty services plan for interfacility transport of critically ill or injured patients?

Hospitals that transfer critically ill or injured patients with time-sensitive conditions should have preexisting transfer agreements with EMS agencies and receiving hospitals to minimize the time necessary for transfer. For example, a local hospital without trauma services should have agreements with regional air medical transport services and trauma centers to ensure that critically injured patients have rapid access to critical care transport and definitive care. This requires that EMS agencies must ensure adequate capability to perform such transfers, and receiving facilities must ensure availability of sufficient personnel and resources to rapidly receive these patients.

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Is there a federal law that requires the provision of emergency medical care in the United States and provides rules for interfacility transport?

Enacted by Congress in 1986, the Emergency Medical Treatment and Labor Act (EMTALA) requires that anyone presenting to an emergency department to be stabilized and treated regardless of their insurance status or ability to pay. This was designed to prevent hospitals from not treating uninsured patients or transferring them to other hospitals for care based upon the ability to pay. EMTALA also provides specific rules for how patients are transferred from one hospital to another.

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