I've recently been thinking about the differences in protocal from my county to the one directly north of me. I make runs in Mercer County, but if I was based in that county, my rules would be different. Here, in Darke County, we can call CareFlight directly to the scene if we think a level I trauma center or cath-lab is warranted. Based on the nature of the 9-1-1 call, dispatch can launch a bird as well. Sometimes, CareFlight is on the ground before we have a patient extricated! But in Mercer County, the hospitals have sole control over helicopters. When working a scene mutual with a Mercer EMS agency, we package the patient and drive 25 minutes to the hospital, where staff there will evaluate and call CareFlight. That adds around forty minutes to response time! I feel so fortunate that our county values patient care over hospital revenue, and I can't imagine the frustration of being forced to delay care.