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impact of EMTALA on the interfacility transport populations. Williams offers an
excellent in-depth publication describing EMTALA. This act places clear duties
on both the referring and receiving hospitals. The referring clinicians must do
everything within their capabilities to stabilize the patient’s medical condition
before transport and may not transfer a patient against his or her will unless the
facility cannot provide the appropriate level of care. Furthermore, the referring
physician must obtain informed consent for transfer and, as part of this process,
must advise the patient or the guardians of a minor about the risks and benefits
associated with transfer. Of course, when consent is not practical/possible (absent
guardians), and the child’s condition is critical, the transport should not be
delayed.
Under EMTALA rules, emergent transport decision making should not include
the financial ramifications of the decision. It may seem prudent to disclose that a
refusal of transfer may potentially leave the patient/family responsible for a
hospital bill, however, under EMTALA rules, such information, though well
intentioned, may be construed as financial coercion to enable the transfer. Instead,
if the patient’s medical acuity does not preclude it, the parents of the patient may
be told to contact their insurance representatives, or the hospital financial
personnel to discuss these issues.
The referring team is also responsible for selecting an appropriate means of
transport. Obviously, the more critical the need for medical care and expertise, the
more sophisticated the transport capabilities required. This is an important point
for the referral physician to remember. The desire to transfer a child to a more
appropriate medical facility as soon as possible is understandable, but if the
method chosen places the child in a medical environment that does not offer at
least the level of care at the referral center, that center and physician may be
liable for any untoward effects that can be construed as having occurred because
of the choice of transport. Finally, EMTALA requires the receiving hospital to
accept the patient in transfer if the appropriate type and level of care are
available. Again, the ability of the patient to pay for medical care cannot be
considered by either the referring or the receiving facility. In addition to the

EMTALA, there are often local regulations that direct transport services. For
example, some cities have regulations designating certain agencies as official
providers of prehospital services. Such statutes must be considered when offering
transport services. It is important to note, that guidelines, such as trauma center
transfer protocols, do not negate or supersede EMTALA guidelines. Also, as
EMTALA does not apply to inpatients, temporarily admitting a patient to the
hospital to attempt to circumvent the ED-focused EMTALA requirements is not