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In many cases, optimal patient care mandates appropriate and safe extrication or rescue from the patient’s situation or environment It is critical that EMS personnel possess or have immediate access to the expertise, tools, and equipment necessary to safely remove patients from entrapment or hazardous environments It is beyond the scope of this document to describe the extent of these Local circumstances and regulations may affect both the expertise and tools that are maintained on an individual ground ambulance, and on any other rescue vehicle that may be needed to accompany an ambulance to an EMS scene The tools and equipment carried on an individual ground ambulance need to be thoughtfully determined by local features of the EMS system with explicit plans to deploy the needed resources when extrication or rescue is required a Latex-free equipment should be available From American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, et al Equipment for Ground Ambulances Prehosp Emerg Care 2014;18(1):92–97 Reprinted by permission of Taylor & Francis Ltd, www.tandfonline.com Financial considerations, importantly, may not influence the decision making on the part of either the transferring or receiving facility for patients whom have not been stabilized to the fullest capabilities and capacity of the referring institution The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, and the federal Emergency Medical Treatment and Active Labor Act (EMTALA) regulations, which were passed as part of COBRA, prevent financebased emergent transport decisions Interfacility transport cannot be used by the referring institution as a method to avoid initial assessment, stabilization, or intervention Similarly, the receiving institution cannot use a patient’s ability to pay to determine transport acceptance; if the receiving institution can provide the higher level of services needed by the patient, and has the current capacity to manage the patient, the transport cannot be declined To adequately prepare for interfacility critical care transport (CCT), a transport system should have access to specialized equipment, trained personnel, and appropriate certifications and licenses The transport system is responsible for ensuring the safety of the patient, team, and family members during the transport, as well as guaranteeing that the patient is cared for in the appropriate medical environment The transport system should have identifiable medical and program directors who are responsible for ensuring adequate training and education, as well as continuing competency assessment of personnel and process The medical and program directors are ultimately responsible for ensuring a safe, reliable transport system