EMTALA/COBRA

[emmit233]

A hospital based ambulance service(let's call it hospital A) that is subsidized by the county...Hospital owns the supplies and pays the EMT with subsidies from county. County owns the trucks, the uniforms, pagers, and any item on the truck that cost over $500.

Ambulance gets called to an MVA 20 miles from the hospital with long extrication and critical pt. Ambulance crew decides to call for a helicopter transport from the scene. Pt is flown to trauma center(hospital B) 60 miles away from the scene of the MVA.

1. Does the pt. fall under the care of the hospital since the EMT's are employed by the hospital?

2. Is it a COBRA violation to fly a pt. from the scene of a MVA or other critical type scenario?

3. If it is, has an ambulace crew ever been fined for doing so?

Just wondering if anyone has any insight into this sticky situation.

Thanks!

[IAMedic]

1) The liability falls under whomevers EMT's are providing treatment of that patient, until the helicopter crew has taken responsibility for that patient. That usually occurs as soon as the begin their assessment or have started treating.

2) No it is not a violation of any COBRA/EMTALA laws that I know of. I know several services that are hospital based, municipality, and wholley volunteer that call that helicopter to the scene. In fact, many services have it in their policies and procedures.

3) Don't know.

[smurfe]

This particularly pertains to Landing pads at hospitals, but does address hospital employed EMS as an extension of the hospital. To me though the way I read this if your service is the county wide EMS provider then these rules don't apply. There are many informative sites to read up on this.

Smurfe :D


Helicopter Landing Pads and EMTALA

One of the most frequently asked questions about helicopters is whether an ambulance may meet a helicopter at a hospital landing pad without triggering the hospital's EMTALA obligations to provide an MSE and manage the patient and transport.

CMS has been very uniform on this issue:

Helicopters and ambulances entering hospital grounds for the sole purpose of conveying a patient from or to another hospital DO NOT trigger EMTALA obligations for the hospital owning the landing pad UNLESS the ambulance or helicopter crew requests assistance with the medical management of a patient.

AN IMPORTANT EXCEPTION TO THIS RULE: Where the vehicle transporting the patient responded and an EMS unit to the scene to pick up the patient is hospital-owned and operated, the patient is deemed to have arrived at the hospital, and becomes the patient of the owner hospital and is to be transported to the owner-hospital for MSE and appropriate EMTALA transfer management before sending to another facility via the helipad. An exception to the exception is allowed if the ambulance/helicopter EMS unit is operating under community-wide protocols that determine the destination of the patient based on condition or acuity.

[rory_el]

right on smurfe