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/Topper-Harly Jun 25 '25

Depends on the state. Ours is hospital based, but hospital and pre hospital are two very different things according to my state board.

State-to-state differences would be governed by other regulations not EMTALA, as EMTALA is federal.

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u/Robot-Tom Jun 25 '25

My bad I don't get too caught up in EMTALA because I know it doesn't affect me.

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u/FullCriticism9095 Jun 25 '25

If you work for a hospital owned or operated EMS service, there are scenarios where EMTALA can apply to you.

Say for instance you respond to a call for someone who burned themselves on the stove. The house is not in great condition, and you might suspect that the family is not particularly well off. You ask the patient which hospital they want to go to, and they say “I think I want to go to your hospital.” Even though your hospital is not on a sanctioned divert status, you say “I don’t know, it’s pretty busy there tonight, you should probably go to the other hospital across town because who knows how long it’ll take you to be seen at my hospital.”

If you do that, the patient could argue that you formed an impression that they might not be able to pay, so you steered them away from your hospital to avoid having to provide requires stabilizing assessment and treatment that your hospital wouldn’t get paid for. That would be an EMTALA violation. Depending on the details, it may or may not really end up being a violation, but there would probably be enough there for the patient to file a complaint and trigger an investigation.

If you work for a hospital-based ambulance service, you should get training on these kinds of issues.

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u/Robot-Tom Jun 25 '25

That scenario yes there is grey which I had not considered, my apologies. Mine is the only critical access hospital within 30 - 45 minutes any direction so it's either there or the pts choice if it's one of the other two (both different directions).