Medlaw.com E-Bulletin September 15, 2006

I am constantly getting questions from folks about whether an ambulance meeting a helicopter on their helipad triggers EMTALA -- and when I tell them the answer, their response is "where does it say that?"

The answer to this question is found in the CMS Site Review
Guidelines -- the instructions for site surveyors -- which
is found on our website in the EMTALA resources section.

THE EXACT LANGUAGE IS:

Tag 406 §489.24(a)

(a) Applicability of provisions of this section.

(1) In the case of a hospital that has an emergency department,
if an individual (whether or not eligible for Medicare benefits
and regardless of ability to pay) "comes to the emergency
department", as defined in paragraph (b) of this section, the
hospital must--

(i) Provide an appropriate medical screening examination within
the capability of the hospital’s emergency department,
including ancillary services routinely available to the
emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; ...

"If an individual who is not a hospital patient comes elsewhereon hospital property (that is, the individual comes
to thehospital but not to the dedicated emergency department), an EMTALA obligation on the part of the hospital may be triggered if either the individual requests examination or treatment for an emergency medical condition or if a prudent layperson observer would believe that the individual is suffering from an emergency medical condition. The term "hospital property" means the entire main hospital campus as defined in § 413.65(a),including the parking lot, sidewalk and driveway or hospital departments, including any building owned by the hospital that are within 250 yards of the hospital)....

"The following two circumstances will not trigger EMTALA:

"The use of a hospital’s helipad by local ambulance services
or other hospitals for the transport of individuals to
tertiary hospitals located throughout the State does not
trigger an EMTALA obligation for the hospital that has the
helipad on its property when the helipad is being used for
the purpose of transit as long as the sending hospital
conducted the MSE prior to transporting the individual to
the helipad for medical helicopter transport to a
designated recipient hospital. The sending hospital is
responsible for conducting the MSE prior to transfer to
determine if an EMC exists and implementing stabilizing
treatment or conducting an appropriate transfer."

"Therefore, if the helipad serves simply as a point of transit
for individuals who have received a MSE performed prior to
transfer to the helipad, the hospital with the helipad is not
obligated to perform another MSE prior to the individual’s
continued travel to the recipient hospital. If, however,
while at the helipad, the individual’s condition
deteriorates, the hospital at which the helipad is located
must provide another MSE and stabilizing treatment within
its capacity if requested by medical personnel accompanying
the individual."

"If as part of the EMS protocol, EMS activates helicopter
evacuation of an individual with a potential EMC, the
hospital that has the helipad does not have an EMTALA
bligation if they are not the recipient hospital, unless a
request is made by EMS personnel, the individual or a
legally responsible person acting on the individual’s
behalf for the examination or treatment of an EMC."

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RESOURCES:

EMTALA Field Guide: www.emtalafieldguide.com -- Quick guide
to EMTALA rules, application, documentation and common risks
associated with the rule. Pocket size for lab coats.

Practical Guide To Risk Management For Clinics And Physician
Offices: www.clinicrm.com
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