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Emergency Medicine Treatment and Labor Act

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Emergency Medicine Treatment and Labor Act, EMTALA

  • See Also
  1. Emergency Medical Service (EMS)
  2. EMS Trauma Triage Protocol
  3. Trauma Center
  • Background
  1. Emergency Medicine Treatment and Labor Act (EMTALA) was Enacted in U.S. in 1986 as part of COBRA
  2. Ensures access to emergency services regardless of ability to pay
  3. Applies to most hospitals in the United States (those that accept CMS payment)
  • Criteria
  1. Includes an emergency medical screening to determine if a medical emergency exists
    1. Complete medical screening exam (MSE) must be performed by a medical provider (not a nurse)
      1. Physicians
      2. Nurse practitioners (if allowed by hospital bylaws)
      3. Physician assistant (if allowed by hospital bylaws)
  2. Defines obligations regarding medical stabilization, appropriate transfer, and active labor
    1. Medical providers must do their best, in line with their training, to stabilize the patient
    2. When higher level of care is required
      1. Sending provider is responsible for identifying most appropriate accepting facility and transport mode
      2. Sending provider is responsible for the patient until they arrive at the destination facility
      3. Accepting provider must determine if receiving hospital has needed resources and expert Consultation
      4. Accepting facility can not make their acceptance contingent on using their Critical Care Transport
    3. Transport
      1. Unstable Patients may be transported if they have been stablized to the capacity of the sending facility
      2. Stable patients may be transported by private vehicle if deemed appropriate by sending clinician
        1. Sending provider assumes responsibility for the patient en route
        2. Accepting provider may dictate transport contraints
  3. Ravenswood Rule (250 yard rule)
    1. Required to respond within 250 yards of the main hospital campus building to medical emergencies
    2. Exception (2010): Helipad emergencies if not receiving hospital (unless help requested by EMS or patient)
  • Resources
  1. https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/
  2. http://www.emtala.com/faq.htm
  • References
  1. Aydin, Fritz, Duncan and Cohen (2022) Crit Dec Emerg Med 36(10): 23-29
  2. Weinstock and Colucciello (2025) EM:Rap, published 12/1/2025