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cautious and not absolute. Importantly, however, EMTALA states that the
receiving physician is an obligate consultant to referring physicians, so it is not
acceptable to refuse to offer assistance or advice due to a concern regarding
medical–legal consequences. The receiving physician must do his or her best to
offer clear and complete information, especially when specific information is
requested. Suggestions for care must be clearly and completely communicated.
For example, if the transport control physician believes that a fluid bolus is
needed, that advice should include type and amount of fluid and speed of infusion
to avoid any misinterpretation of advice or an inadvertent mistake in one of those
parameters. All advice should be documented in writing and/or by audio
recording. The referring physician is under no obligation to accept the advice of
the receiving physician, but he or she would be prudent to give it serious
consideration. If the referring physician is unable or unwilling to provide specific
care or perform suggested interventions because of disagreement, personnel
issues, equipment limitations, or other reasons, this should be discussed with the
receiving physician. As above, EMTALA also forbids the receiving institution
from placing “conditions” on acceptance. For example, the receiving institution
cannot demand that the referring physician manage the patient in a particular
fashion prior to transport “or else” the transfer will not be accepted, although a
team can refuse to participate in a transport where stabilization is possible, but not
allowed, by the referring team (i.e., stabilization of an airway, etc.). Finally,
results from interventions or marked changes in the patient’s condition during the
referral process should be communicated to the receiving physician and transport
service. Clear, precise, efficient, and frank communication is imperative for the
patient to receive the most appropriate care.
Communication with the patient and family is also important during the
transport process. Straightforward communications about disease process and
expectations can help prepare a family to accept the consequence of the illness or
injury. Inadequate communication or reluctance to give difficult news can lead a
family to expect different outcomes than they should and may pave the way for
anger and resentment.

Documentation and communication of all data regarding the patient’s care is
imperative. Patient summaries, copies of all medical paperwork, laboratory
values, and radiographs (copies of studies as well as the reports), should be
available for the transport team on their arrival at the referring location. A
transport referral checklist may be useful to help streamline the process. Adequate
preparation of these documents before arrival of the transport team can greatly
improve the efficiency of the transport process and the transition of care.