r/Paramedics • u/Dowcastle-medic Paramedic • Jun 25 '25

US EMTALA and bypassing a hospital

So I had a pt today totally stable but she has an injury I know the local type 4 community hospital (20min) is not going to be able to fix. It was suggested by the clinic staff where I picked her up to go to the type 3, 1.5 hours away. But one of the ER drs for the community hospital happened to be there and looked at the injury and said no just take her to our hospital.

She said the type 3 couldn’t deal with that either and she would need to go to One 3.5 hours away so go and get her c spine cleared…

So we did and then I get chewed out by the ER drs on call saying I can NEVER bypass them based on EMTALA. I always have to stop and let them stabilize the pt and cat scan and such…

That’s not true is it?

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101

u/ggrnw27 FP-C Jun 25 '25

Nope. Assuming you don’t actually work for the hospital, EMTALA doesn’t apply to you at all

21

u/Dowcastle-medic Paramedic Jun 25 '25

That’s what I thought.

24

u/MisterEmergency Jun 25 '25

Absolute trash. Closest appropriate. Stand your ground, you did what was best for the patient. I've had this same exact conversation with a doctor at a local band Aid station. The only thing they have there we don't have on the truck is imaging. I'll drive right past to get to a real level 1 trauma center, egos be damned.

7

u/Dowcastle-medic Paramedic Jun 26 '25

Reply yeah my protocols state closest appropriate facility.

1

u/InstructionSalt360 Jun 27 '25

Imaging, chest tubes, thoracotomy tray, blood, basic surgery tray, invasive lines, antibiotics just to name a few things you don’t have lol

2

u/MisterEmergency Jun 27 '25

Our had a GP part time, and sometimes a NP. It's literally a band Aid station. They transfer out patients that require stitches.

2

u/InstructionSalt360 Jun 27 '25

Gotcha. Nevermind then. I strongly oppose family medicine in the ED and anything to do with midlevels. Emergency medicine is a specialist field that requires board certification regardless what non EM docs want people to think.

2

u/Medic1997 Paramedic Jun 28 '25

You realize many of those things are in fact available in the prehospital arena in many circumstances? And prehospital providers should be well equipped to decide what the most appropriate destination is? Plus there’s a big difference between something being technically available in a given hospital and it being promptly available to a critical patient

12

u/dezstern Jun 26 '25

Might be worth an incident report. Depending on your medical director and their relationship with the hospital, they might be able to do some education with the staff so they are corrected in their understanding. Or at least stand up for you. Chewing you out is unprofessional.

You don't work for them. They are your colleagues not your bosses.

2

u/PerrinAyybara Captain CQI Narc Jun 25 '25

That's the only answer you need if you aren't hospital based. The better question is why does the ER doc matter? What did your OMD and supervision say?

2

u/Dowcastle-medic Paramedic Jun 25 '25

Our online medical control is the ER Dr I can choose which hospital to call for that though…

3

u/PerrinAyybara Captain CQI Narc Jun 26 '25

Wait, your state doesn't have a medical director for each agency?

4

u/Dowcastle-medic Paramedic Jun 26 '25

My medical director is an ER Dr who lives 9 hours away and is the medical director for probably 20 different agencies. He’s a great guy but very busy. And will answer my questions but not necessarily while I am on a call.