Emergency Medical Treatment

Emergency Medical Treatment and Active Labor Act

Complying with the Emergency Medical Treatment and Active Labor Act (EMTALA) is a challenge in today's high-stress emergency departments. This article intends to provide you with a general overview of (1) EMTALA's history; (2) the 4 main requirements of EMTALA? which are medical screening examination? necessary stabilizing treatment? transferring to another medical facility? and accepting an appropriate transfer; and (3) other considerations. This article provides guidelines? not legal advice.

In 1986? Congress enacted the Emergency Medical Treatment and Active Labor Act (EMTALA)? part of the Consolidated Omnibus Budget Reconciliation Act of 1985? to ensure public access to emergency services regardless of ability to pay. The original language left a lot of questions unanswered? including what obligations hospitals had regarding use of their helipads. However? a technical assistance document published in 2001 and “EMTALA interpretive guidelines” published in May 2004 have clarified the obligations for hospital helipads.

These 2 documents clearly state that hospitals with helipads do not have an EMTALA obligation to provide medical screening examinations (MSEs) to patients who are using the helipad to get to another hospital? unless the emergency medical services (EMS) providers ask for their assistance. Below are the key excerpts from these documents (author's emphasis shown in bold).

In 2001? the Texas Department of Health asked the Centers for Medicare and Medicaid Services (CMS)? “Does the use of a hospital's helipad by an EMS provider rendezvousing with a medical helicopter place the hospital itself at risk for violating EMTALA guidelines?”

CMS answered? “The use of a hospital's helipad to effectuate a field transfer of a patient does not trigger that hospital's EMTALA obligation. We consider that hospital to be functioning as part of the local EMS service and is therefore deemed in compliance. If hospital staff come out and do something to the patient on the helipad (open an airway? start an IV)? then technically the EMTALA obligation is triggered? but we only require that you document that intervention and either send it with the patient or transmit the information to the receiving hospital.”

In the “CMS Letter to State Survey Agency Directors? Subject: Revised EMTALA Interpretative Guidelines” published on May 13? 2004? new guidelines were issued that included hospital helipads. The interpretative guidelines state? “The following 2 circumstances will not trigger EMTALA:”

• “If? as part of the EMS protocol? EMS activates helicopter evacuation of an individual with a potential emergency medical condition? the hospital that has the helipad does not have an EMTALA obligation 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 emergency medical condition.”

• “The use of a hospital's helipad by local ambulances 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 ...