Having retired from a town owned and operated "9-1-1" system I can truly feel your frustration when having to do a simple transfer ties up your ALS resources. We have a local "care facility" owned and operated by a hospital from the another state (ie 15 mles away). It often seemed like when they needed a patient transferred and the "private" service they generally use had a long wait for time they would call our system to do the transfer. This would leave our town temporarily unprotected and reliant on "mutual aid" from another town.