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the team must document why it was in the patient’s best interest to undertake
transport at that time.
In some cases, transfer agreements exist between hospitals. Typically, such
agreements stipulate that the receiving hospital will accept all transfers from the
referring hospital. In the past, transfer agreements served to decrease the time
needed to accept the patient by eliminating or shortening the approval process.
More recently, transfer agreements have become less important for two reasons.
First, the EMTALA places a duty on the receiving hospital to accept the patient as
long as there is an appropriate bed location available. Second, for patients who
have undergone an EMTALA-mandated “Medical Screening Exam” by a
“Qualified Medical Person,” and are determined to not have an “Emergent
Medical Condition,” managed care organizations or insurance plans may stipulate
certain receiving facilities. In such cases, the transfer agreement may exist
between the managed care organization and the receiving facility. However, as
above, the laws of EMTALA override these agreements for patients deemed to
still have an Emergency Medical Condition.
There are important legal ramifications to transport teams who operate under
specific guidelines or protocols. Therefore, it is imperative that all guidelines
represent the current standard of care. Furthermore, guidelines should be designed
to ensure that providers do not exceed their scopes of practice as defined by state,
local, and institutional regulations. Routine review of existing protocols and
guidelines is warranted. New guidelines should be developed in conjunction with
recognized authorities, and should be reviewed by risk-management specialists
before implementation. Use of protocols/guidelines is not a medical–legal shield
regarding lawsuits, although adherence to evidence-based guidelines can help
demonstrate state of the art and thoughtful care.