“…In critical transfers such as Type A AD, STEMI, epidural hemorrhage, or major trauma, official emergency medical services (EMS) should be integrated into the inter-facility transfer to ensure that the response time interval is sufficiently short [31]. Moreover, established protocols are needed to guide each inter-facility transfer, whether official or private EMS, including staff composition, whether ALS could be provided, and advanced directives by medical directors [12,27]. Furthermore, improvement in the quality of inter-facility transfers can only be achieved by following established transfer protocols.…”