Where medically necessary, in a critically injured or ill patient, a level of inter-facility services provide beyond the scope of the paramedic as defined in the National EMS Education and Practice Blueprint. This is necessary when a patient’s condition requires ongoing care that must be provided by one or more health professionals in an appropriate specialty area, e.g., nursing, medicine, respiratory care, cardiovascular care, or a paramedic with additional training, (In Georgia, this training should be beyond the scope of pre-hospital emergencies, and specifically address the clinical needs of patients being transferred between hospitals for a higher level of care not available at the sending hospital and training to operate and monitor equipment not normally used in that standard EMS operation.

One of the problem areas in the growth of ambulance expenditures has been billings for non-emergency transportation that is not medically necessary, medically necessary transports to and from ESRD facilities for maintenance dialysis is scheduled, and therefore is non-emergency ambulance services.  In areas which require ALS vehicles by local ordinance, the transportation may be reported as ALS ambulance transportation.