As mentioned earlier, transport in the pre-hospital setting by mobile EMS units is considered in a related WHO document. Also to be considered in the planning of systems for trauma management are arrangements for transport for inter-facility transfers, as mentioned above. This can be streamlined by including it in transfer protocols. There are, of course, several barriers to the transfer of injured patients to higher levels of the health care system. One of these may be a preference on the part of the injured person or the family to stay in the local area. Other such barriers include cost and logistical limitations (2, /0). For example, in many low-income settings, such transport must be arranged by relatives who hire a private vehicle, taxi or other means of commercial transport for this purpose. Economic barriers to formal EMS for such transport are obviously a huge consideration. Nevertheless, facilitating such transfer might reasonably be a component of an overall plan of systems for trauma management. Similar issues have been addressed by the Safe Motherhood Initiative, which has looked at how to assure emergency transport for patients with obstetric complications in more remote rural areas. Some potential solutions have included pre-existing arrangements with owners of private or commercial vehicles to provide emergency transport for reasonable prices.

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