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EMS response times and times from the scene to definitive care is almost always longer in rural areas. On average, response times can be two or three times as long as in urban or suburban areas. This is due to sparse populations, long distances, poor roads, severe climate conditions, inadequate public education, and insufficient infrastructure resources to support advanced emergency call systems. In fact, the further one is from an emergency medical facility the more one needs a higher level of local EMS capacity and the less likely that EMS capability will be available. In particular, barriers exist to the provision of advanced life support, especially paramedic in rural areas. Often transportation between health care facilities is required because a patient’s needs may exceed the capabilities of a health care facility.  Transfer of patients of all ages by ground or air requires a coordination of resources.  This section of the toolkit will focus on how to develop quality pre-hospital clinical care using transport and transfer protocols following state and national guidelines, integration of health care delivery systems services, laws and regulations affecting the transfer of patients between facilities, outcomes evaluation, and medical direction reflecting all levels of care and modes of transfer.


Emergency Medical Treatment & Labor Act (EMTALA)


Triage & Transfer Protocols


Referral & Transfer Protocols
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