Question: When an ambulance meets a helicopter at our helipad, they are on our property, so doesn’t that automatically trigger EMTALA?
Answer: No
Question: Shouldn’t our doctor go out and do a rapid assessment?
Answer: Hell, NO! (Unless help was requested)
REPRINT OF PRIOR ARTICLE FROM OUR ARCHIVES:
Medlaw.com E-Bulletin September 15, 2006
I am constantly getting questions from folks about whether an ambulance meeting a helicopter on their helipad triggers EMTALA — and when I tell them the answer, their response is “where does it say that?”
The answer to this question is found in the CMS Site Review Guidelines — the instructions for site surveyors — which is found on our website in the EMTALA resources section OF THE ARCHIVES.
THE EXACT LANGUAGE IS:
Tag 406 §489.24(a)
(a) Applicability of provisions of this section.
(1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must–
(i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; …
“If an individual who is not a hospital patient comes elsewhereon hospital property (that is, the individual comes to thehospital but not to the dedicated emergency department), an EMTALA obligation on the part of the hospital may be triggered if either the individual requests examination or treatment for an emergency medical condition or if a prudent layperson observer would believe that the individual is suffering from an emergency medical condition. The term “hospital property” means the entire main hospital campus as defined in § 413.65(a),including the parking lot, sidewalk and driveway or hospital departments, including any building owned by the hospital that are within 250 yards of the hospital)….
“The following two circumstances will not trigger EMTALA:
THIRD PARTY HOSPITAL MOVEMENT[editorial insert for clarity]
“The use of a hospital’s helipad by local ambulance services or other hospitals for the transport of individuals to tertiary hospitals located throughout the State does not trigger an EMTALA obligation for the hospital that has the helipad on its property when the helipad is being used for the purpose of transit as long as the sending hospital conducted the MSE prior to transporting the individual to the helipad for medical helicopter transport to a
designated recipient hospital. The sending hospital is responsible for conducting the MSE prior to transfer to determine if an EMC exists and implementing stabilizing treatment or conducting an appropriate transfer.”
“Therefore, if the helipad serves simply as a point of transit for individuals who have received a MSE performed prior to transfer to the helipad, the hospital with the helipad is not obligated to perform another MSE prior to the individual’s continued travel to the recipient hospital. If, however,
while at the helipad, the individual’s condition deteriorates, the hospital at which the helipad is located must provide another MSE and stabilizing treatment within its capacity if requested by medical personnel accompanying the individual.”
EMS/ HELICOPTER ACTIVATION
“If as part of the EMS protocol, EMS activates helicopter evacuation of an individual with a potential EMC, the hospital that has the helipad does not have an EMTALA bligation if they are not the recipient hospital, unless a request is made by EMS personnel, the individual or alegally responsible person acting on the individual’s behalf for the examination or treatment of an EMC.”
Would the EMS helicopter exemption extend to a transfer to a second ground unit instead of a helicopter. Sample scenario is that a county has had a multi-casualty incident. Weather is too bad for helicopter to fly but tertiary facility sends several ambulances to stage at hospital in sending county. Sending EMS meet staged ambulances at the county hospital solely for the purpose of transferring pt from one ground unit to another.
The helicopter rule is specific to helicopters being involved in the exchange. I am not aware of a CMS statement, ruling, or guidance on the ambulance/ambulance scenario. My OPINION based solely on logic (which is never a reliable standard for EMTALA) would be that if this is based on a written regional disaster/mutual aid EMS/ hospital protocol it would be likely to be acceptable to CMS, but I believe documentation of advanced notice of implementation of the plan activation to the local hospital would be an important element.