Conclusions of the State Interfacility Transport Task Force
By Scott Sholes
EMS Chief, Durango Fire-Rescue

According to a first-of-its-kind study of interfacility transport (IFT) in Colorado, EMS systems have experienced sharp increases in IFT demand in the past 5 years. Not only has the number of trips increased by 25% during that period, the time required to complete each trip now averages close to 2 hours.  The study, a combination of data analysis by CDPHE and statewide research by Sarah Weatherred (CMRETAC) and Austin Wingate (Grand County EMS), revealed in addition to putting a significant strain on Colorado EMS systems, IFTs present significant safety concerns for patients and providers.

In August 2025, CDPHE convened its first meeting of the State Interfacility Transport Task Force.  These 11 subject matter experts represented Rural and Urban EMS, Rural and Urban Facilities, Rural Trauma, SEMTAC, RETACs and EMSAC.  The commitment was to meet monthly for 10 months to explore and identify issues related to IFT, then develop an actionable plan to address them.

As we do when stepping into new territory, the Task Force first sought clarity around statutory authority, including CDPHE limitations specific to rulemaking in IFT.  Although providers and agencies fall clearly under the state’s authority for regulation, broad language within those regulations limits the actual authority to set rules specific to the moving of patients between facilities.  Our goal, then, did not include additional rulemaking, only to convey best practices and guidelines, as well as to develop technical assistance and outreach.

Although the Task Force identified numerous issues affecting IFT, the predominant concerns included: patient and staff safety, appropriate allocation of resources, IFT funding, and the need to educate sending facility personnel. As discussions ensued, it quickly became clear that only the highest priority deliverables could be achieved under the established project timeline. However, the team also identified numerous potential issues for future work.  Ultimately, our decision was to focus on an IFT Risk Assessment Tool, as well as the accompanying Guidance Document.

One of the more significant challenges identified by the Task Force is that the “transport interval,” that is, everything associated with the actual moving of the patient between facilities by ambulance, is poorly understood, and often disregarded by sending facilities and staff. Any failure to fully appreciate and consider the significance of the transport interval may lead to patient and provider safety concerns, as well as unnecessary EMS system demands. Further, we found that pressures based on receiving facility bed availability routinely result in ground ambulance trips that could have been scheduled during periods with less impact on both safety and resource availability.  

The intent of the Risk Assessment Tool is to provide a mechanism for sending facilities and transporting agencies to jointly evaluate potential IFTs based on several factors:

Each factor has subcategories that, when checked, result in a points system producing an overall score.  The proposed IFT is then categorized as “low, moderate, or high risk.”  The Guidance Document provides risk mitigation strategies for each category, as well as suggestions on how to proceed given the overall score within the context of patient transfer urgency and clinical care needs.

The Guidance Document also advises sending facilities and (reminds?) transporting agencies that under C.R.S.6CCR 1015-3 Chapter Two 16.2 transporting EMS providers may decline to transport any patient if the level of care is beyond their capabilities, another common area of concern expressed by the EMS representatives on the Task Force.  And finally, the Guidance Document provides a list of quality improvement reporting topics to assist agencies to better understand trends and adaptations potentially needed over time.

The IFT Task Force completed work in June 2025, and the Risk Assessment Tool and Guidance Document was formally approved by SEMTAC at their quarterly meeting in July. Both should be made available after final approval by CDPHE.

Although the Task Force accomplished some solid work with the IFT Tool and Guidance Document, clearly much more work is needed on this topic.  The issues around mental health IFTs, including the limited availability of in-patient care, are significant enough to be an entirely stand-alone project.  And then there’s funding…  IFTs are largely mischaracterized as a “less expensive” service than emergency response and transport, thus even more poorly reimbursed, yet the actual costs—particularly in rural areas—are much the same. And let’s not forget the issues that come with hospital networks. Closer appropriate facilities are routinely bypassed, resulting in longer transport intervals, more strain on resources, higher patient and staff risk, and another set of reimbursement problems.

Scott Sholes served as the EMSAC representative to the State Interfacility Transport Task Force and is the Immediate Past President of EMSAC.