MedLaw E-Bulletin 8/23/2005
Topics:
1. Q&A: Hospital landing pad and EMTALA
2. Final edition of EMTALA Field Guide releases
Published Aug 23, 2005
Medlaw.com E-Bulletin August 23, 2005
Stephen A. Frew JD, Publisher
Topics:
1. Q&A: Hospital landing pad and EMTALA
2. Final edition of EMTALA Field Guide releases
--------------------- 1 --------------------------------
Hospital Owned Ambulances and Helipads:
Q? I am a paramedic that works for an ambulance service
that is hospital owned. By no means is the hospital a
trauma center. The hospital is probably a Level four center.
There are many times that we pick up a patient and they
require a level one trauma center and the hospital landing
pad is the closest, safest landing zone. My question is can
we still have the helicopter land at the hospital for transport
or would that mean that the patient would have to be brought
into the emergency room for evaluation first?
rules are incorporated in the site review guidelines that are
available in the emtala resources portion of
www.medlaw.com:
--------------->
Rule #1 -- All patients who enter a hospital-owned
ambulance are considered EMTALA patients of the owner
hospital and must receive a medical screening examination,
stabilizing care, and appropriate transfer arrangement,
support, and documentation prior to movement to the Truama
center. The fact that the destination is a designated center
does not all any deviation from EMTALA procedures.
Exception # 1 -- If the ambulance is: a. Participating in a community-wide EMS plan (i.e. involves
all hospitals in area, police, fire, rescue, EMS, and dispatch
agencies), the ambulance may follow the system protocol a
nd go to the designated destination without violating EMTALA
-- or --
b. If the medical director for the service is independant and
is not employed by the hospital, the ambulance may follow
system protocols of the medical director without violating
EMTALA.
CAUTION: case-by-case decisions by the online
medical control physician at your hospital would
NOT qualify in most instances.
Rule #2 -- If an ambulance ( or helicopter) cross onto
hospital grounds, the patient becomes the EMTALA
compliance obligation of the hospital.
Exception #2 -- SUBJECT TO RULE #1, if a helicopter
pad on hospital grounds is used for the sole purpose of
effecting a transfer of a patient from ambulance to
helicopter or helicopter to ambulance -- and without any
request to hospital personnel to provide any medical
assistance to the patient -- the hospital with the
helicopter pad does not incur any EMTALA obligations
to the patient.
So does that mean that a hospital owned ambulance
operating under a community-wide, regional, or state
trauma protocol can meet the helicopter on the pad?
My answer is that intuitively, the answer would be
"yes", BUT the rules do not unequivically say that.
CMS site surveyors are instructed to request copies
of the protocols, and assuming that all technicalities
are met, I would "predict" that no violation of EMTALA
would be found.
I must remind you, however, that the Paramedic's
decision to bypass an immediately available
emergency department a short distance away in
favor of a helicopter transfer which has its own
inherent risks should not be made lightly. This
decision could result in civil suits or licensure
review if the patient alleges that they sustained harm
from the decision to skip the nearest emergency
department in favor of the helicopter transfer.
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