Ambulances & EMTALA
Please read or re-read the information below that I sent out in June. The blue part is what I want to emphasize most. If a patient arrives by foot, ambulance, helicopter, donkey, or in any form onto our property and requests treatment, we must see them and can not turn them away. There is no opinion or decision to be made once they are on our property; they must receive an MSE then stabilized and transferred appropriately.
During this recent season where the main ED is having many hours/days of diversion, it is conceivable that AMR but more likely outlying community ambulance services could attempt to bring patients to the FEDs either after being told or having foreknowledge of the diversion at main. We want to increase and encourage more ambulance traffic to the FEDs; however, we only want this to happen in cases that are safe and do not pose a delay in needed care for the patient.
Therefore, when receiving report from an ambulance and there are conditions and vital signs (i.e. major trauma) that make you question the FED as the appropriate location for a patient, find the physician asap and give a quick report. The physician will decide to accept or divert the patient on a case by case basis. Make every effort to do this on your initial radio interaction with the ambulance; it would be advisable to attempt to find them and have them listen from the onset of most reports when possible. On the ambulance log, note the physician and reason for diverting and send me and Dr Poage an email about the situation. The reason must be based on the condition of the patient.
PLEASE NOTE THE FOLLOWING – once the ambulance has arrived on our property we can no longer divert them. It is an EMTALA violation to do so. There are additions to 489 below that make it clear that an FED counts in these guidelines. The physician on duty can personally be held responsible and fined as well as the hospital. This applies to any means of arrival. For example, if a pregnant female arrives and seeks care for abdominal pain and we don’t check her in but tell her that she needs to go to the hospital and they will take her up to OB… this would be an EMTALA violation. We are obligated to stabilize and transfer.
§ 489.24 Special responsibilities of Medicare hospitals in emergency cases.
(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 emergencydepartment, 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 § 482.55of this chapter concerning emergency services personnel and direction; and
(ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital's obligation under this section ends, as specified in paragraph (d)(2) of this section.
Link for more reading: eCFR :: 42 CFR 489.24 -- Special responsibilities of Medicare hospitals in emergency cases.
Please let me know if you need any clarification or have questions!
Thank you,
Andrea DeLoach
