The Ghana Health Service launched the Sustainable Emergency Referral Care (SERC) program in the Bongo District in 2012, and it was subsequently extended to a 12 district pilot in 2013.¹ The primary purpose of SERC was to enable a community and sub-district level emergency transport system which was supported by communication technology and community education. SERC was planned and implemented with substantial community input. The expanded pilot was supported by a fleet of 24 three-wheel motorcycles that were appropriately modified to include necessary medical and maintenance equipment. These motorcycles – called Motorkings – were distributed among the 12 districts using geographic information systems (GIS) data, and each was supported by two volunteer drivers. Health facilities, volunteer drivers, and community health officers were given mobile phones to ensure that all communities had communication capabilities. While payments were not required for pregnant women and children under five, other patients were charged a small fee determined by the District Health Management Team. Finally, awareness activities were planned during pre-existing community meetings called durbars. SERC was able to direct emergency care patients to facilities that had the capabilities to manage their acute needs, reducing facility-based mortality and accident-related mortality. However, in places where competent facilities were far from communities, patients often neglected to use SERC.¹ Thus, emergency transport systems should be coupled with efforts to improve capacity in first contact facilities, and this challenge may be more acute in countries where the quality of care is weaker than in Ghana.