title: Interfacility Transports Utilizing the 9-1-1 Emergency Medical Services System.
abstract: BACKGROUND
  With the increasing development of regional specialty centers, emergency physicians are often confronted with patients needing definitive care unavailable at their hospital. Interfacility transports (IFTs) may be a useful option to ensure timely, definitive patient care. However, since traditional IFT can be a challenging and time-consuming process, some EMS agencies that have previously limited their service to 9-1-1 emergency responses are now performing emergency IFTs.
  
  
  OBJECTIVE
  We sought to determine the frequency and nature of transfers provided by a local fire-based 9-1-1 EMS agency that recently began to provide limited IFT for time-critical emergencies.
  
  
  METHODS
  A retrospective review of paramedic reports for all IFTs between April 2007 and March 2014 in the City of Los Angeles, California. All IFTs initiated by 9-1-1 call from an emergency department (ED) and performed by Los Angeles Fire Department paramedics were included. Reason for transfer, patient demographics, and key time metrics were captured.
  
  
  RESULTS
  There were 919 IFTs during the study period, out of approximately 1,160,000 total ambulance transports (0.1%). The most frequent reason for IFT request was for transport of patients with ST segment elevation MI (STEMI) to a STEMI receiving center, followed by major trauma to a trauma center, and intracranial hemorrhage to a center with neurosurgical capability. Less common reasons included vascular emergencies, acute stroke, obstetric emergencies, and transfers to pediatric critical care facilities. Median transport time was 8 minutes (IQR 6-13 minutes) and median total time for IFT was 51 minutes (IQR 39-69 minutes). All IFTs involved a potentially life-threatening condition requiring a higher level of care than was available at the referring hospital.
  
  
  CONCLUSIONS
  Emergent ED-to-ED interfacility transport can provide access to time critical definitive care. EMS agencies that have limited the scope of their response to community 9-1-1 emergencies should have policies in place to assure timely response for emergent IFT requests.
authors.forename: Marc
authors.initials: M
authors.lastname: Eckstein
authors.forename: Shira A
authors.initials: SA
authors.lastname: Schlesinger
authors.forename: Stephen
authors.initials: S
authors.lastname: Sanko
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D002648:Child; D002675:Child, Preschool; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000458:organization & administration*; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
keywords: EMS; STEMI; higher level of care; interfacility transports