Interfacility transportation is a complex component of the out-of-hospital EMS system, serving to provide medical care and transportation when a patient needs to be transferred from one facility to another. There are many considerations that go into a successful interfacility transportation program. Perhaps the most important of these is the level of care provided during the transport, which takes into account both the capabilities of the personnel and the type of vehicle. Most commonly, the indication for interfacility transport revolves around specialized services provided only by select facilities. Interfacility transportation shares the hazards of all out-of-hospital care, plus the added concerns associated with removing a patient from a fixed, controlled facility to the variable, uncontrolled out-of-hospital environment. The legal issues surrounding interfacility transportation are complex and somewhat vague as few laws specifically address this special niche of EMS. Medical oversight of interfacility transportation is a unique facet of medical direction that requires specialized knowledge and systems to ensure success.