Paramedic Inter Facility Transfer Training (Section 1 PIFT Overview) Medical/Legal Aspects of Inter Facility Transfer

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Paramedic Inter Facility Transfer Training
(Section 1 PIFT Overview)Medical/Legal Aspects
of Inter Facility Transfer
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Overriding Principals

• The law requires that patients who are being
  transferred from one facility to another facility
  for a higher level of care continue to receive
  appropriate medical care during transport.

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Overriding Principals

• Sending facility legal responsibilities
• Ensure appropriate mode of transport
• Ensure appropriate personnel accompany the
  patient during the transport

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Emergency Medical Treatment and Active Labor Act
(EMTALA)

• Originally passed in 1985 as part of The
  Consolidated Omnibus Budget Reconciliation Act
  (COBRA)

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Emergency Medical Treatment and Active Labor Act
(EMTALA)

• Sometimes referred to as the Anti-Dumping law
• Passed to prevent hospitals from refusing to
  treat indigent persons or transferring them
  inappropriately to other facilities.

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Principals of EMTALA

• Requires hospitals to provide a medical screening
  examination for all patients seeking medical
  attention in order to determine if a medical
  emergency situation exists.

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Principals of EMTALA

• A patient may not be transferred to another
  facility if they are at risk to deteriorate from
  or during transfer
• Unless the current hospital cannot meet the needs
  of the patient.

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Principals of EMTALA

• The patient may not be transferred if they are
  unstable and remain at risk of deterioration
  unless the sending physician certifies in writing
  that the benefits to be obtained at the receiving
  hospital justify the risks of transfer.

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Principals of EMTALA

• The patient must be accepted by the receiving
  hospital prior to transfer
• The receiving hospital must accept the patient if
  it has the space and the skills necessary to care
  for the patient.

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Principals of EMTALA

• The patient or a legally responsible person must
  request the transfer after being advised of the
  risks and benefits of transfer.

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Principals of EMTALA

• The sending hospital must provide whatever
  treatment is within its capabilities to ensure
  that the patient is stabilized prior to transfer.

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Principals of EMTALA

• The sending hospital is required to make
  appropriate arrangements for transfer that
  include the following
• Appropriate personnel and equipment must be
  provided in certain cases it might be necessary
  for a physician or other healthcare specialist to
  accompany the patient
• All relevant medical records must be sent with
  the patient

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Scope of EMTALA

• An ambulance service may not be charged with an
  EMTALA violation unless it is a hospital-owned
  service.
• BUT

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Scope of EMTALA

• An ambulance service may still be sued by either
  the sending hospital or the patient for
  negligence or misrepresentation if it fails to
  provide the appropriate personnel and equipment
  requested by the sending facility.

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Example

• A sending facility requests an ALS equipped
  ambulance staffed by an ACLS certified paramedic
  to transfer a cardiac patient to another
  hospital.
• The service provides only a BLS ambulance with an
  EMT and fails to advise the sending facility that
  it is not providing the equipment and personnel
  that were requested.
• If the patient requires ALS treatment during
  transport and suffers damages, the EMS service
  may be liable.