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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u/FullCriticism9095 Jun 25 '25

What kind do agency do you work for? Is it owned or operated by a hospital?

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u/Robot-Tom Jun 25 '25

Even then, at least my state that doesn't matter, the hospital and pre hospital are two different animals. I know because I work for a hospital service, my state even says transfer are the hospitals problem not the EMS services.

With that said being owned and operated by the hospital you do have to follow the policies and procedures they approve, but as for as your medical license at least in my state they only care that we run the 911 calls and are doing things by the (pre hospital) book while the pt is in your care.

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u/FullCriticism9095 Jun 25 '25

The question is about EMTALA, which is a federal law. This has nothing to do with your state or your license.

If you don’t work for an agency that is owned or operated by a hospital with emergency services, there is no question that EMTALA does not apply. There isn’t even anything to discuss.

If the ambulance service is owned or operated by a hospital, EMTALA considerations can come into play. There are potential scenarios where it actually can be a violation for a hospital-owned ambulance service to take a patient to another hospital. State protocols provide some protection, and it’s highly unlikely that EMTALA was violated in the OP’s case, but you can’t just wave your hand and say “EMTALA doesn’t matter at all” like you can when the ambulance service is not owned or operated by a hospital.

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u/Dowcastle-medic Paramedic Jun 25 '25

No city owned. No hospital in our town.