EMTALA and bypassing a hospital

[u/Dowcastle-medic]

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?

[u/No_Occasion_4658]

Most protocols state “closest APPROPRIATE facility” I’m not stopping at my local critical access hospital with something I know needs higher care unless they’re totally unstable.

[u/Mediocre_Daikon6935 → u/No_Occasion_4658]

I’m also not taking an EMS unit out of service for 3 hours to go to the big boy hospital.

They’re going local, and they’ll get them transferred out. 

My state is pretty clear that 45 minutes is the maximum acceptable transportation tune to get to a speciality hospital. 

And that the ability to get back in service to cover your primary response area is a priority consideration.

If hospital A is 30 minutes away, and hospital B is 35, but I came from the direction of hospital B, they’re going to B because I need to be able to respond when someone calls 911,  and that isn’t ideal from 50 minutes away. 

Obviously there would be exceptions l&d, stroke center, etc) but that’s about it.

[u/bleach_tastes_bad → u/Mediocre_Daikon6935]

you must live in a small state, or one with a lot of hospitals everywhere, because there’s a very large portion of the country where you need to drive 45+ minutes to even get to a hospital at all, let alone a specialty center

[u/Mediocre_Daikon6935 → u/bleach_tastes_bad]

Oh….I didn’t say the transport was going to be only 45 minutes.

But you’re not going past the closest critical access hospital if it is.