When considering an applicant hospital, MIEMSS shall take into account the number and distribution of specialty referral centers that will allow designated or contract specialty referral centers to: Minimize duplication of services; Achieve and sustain the volumes necessary for: Optimal outcome, Cost efficiency, Maintenance of expertise, Quality care, Research, and Physician and nurse education; and Minimize the potential adverse effect on quality of care that may result if patient volumes are reduced, Volume criteria will be evaluated for each specialty referral center based on the: Projected number of patients who would require access to that specialty referral center; and Number of physicians who would provide medical care for that population.