Tertiary care facilities should be identified by every EMS system to provide specialty care that is not available in typical community hospitals. These facilities may be either within the EMS service area or, more commonly, outside the area. Usually, patients are initially transported to a local hospital for assessment and treatment and then transferred to a tertiary center. In some EMS regions, it may be possible to develop criteria for the transport of patients requiring tertiary specialty care directly from the scene to these centers. The most common reasons for tertiary care emergency transfer are trauma, neonatal intensive care, high-risk obstetrics, burns, spinal cord injury, and neurosurgical and cardiac care. It is not cost effective or feasible for every community to support all of these specialty services.
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