Under what circumstances should a patient be referred to a tertiary care facility during a biological incident?

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During a biological incident, the decision to transfer a patient to a tertiary care facility rests on whether they need capabilities beyond what a local hospital can provide. These capabilities include intensive care, specialized isolation (such as negative-pressure environments and enhanced infection control), ventilatory support, and access to advanced diagnostics and treatments. Transfer is appropriate when illness is severe or deteriorating, when close monitoring and high-level support are required, or when the patient needs complex tests, imaging, or therapies that aren’t available locally. This approach helps ensure patient safety while preserving local surge capacity and maintaining proper infection control. Mild cases typically do not require tertiary services, and transferring all patients or never transferring would either waste resources or miss patients needing specialized care.