I don't know VPSD's specific policies, but based on my experience on a volunteer fire department in VA, It's probably "The nearest appropriate facility". The key word is appropriate. If you have a minor injury or undefined illness, you'd likely go to the standalone ER. If you have major trauma, they may go to the nearest trauma center, HCA Ocala. If you're having a heart attack or stroke, they'll go to the nearest facility certified for those treatments. If you have significant burn injuries they may go to a burn center in Orlando, Gainesville, or Tampa, (though for us a ride that long that would likely prompt a helicopter) etc, etc.
All that being said, we could sometimes be convinced to go to a further facility if the patient seemed stable enough and requested it because their doctor was there or they were recently discharged and the Drs and staff most familiar with their care were there and the area had sufficient coverage (ie, there wasn't a house fire or some major accident draining the dept's resources at the time)
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