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