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Tue Jun 12 21:24:42 BST 2007

EMTALA is intended to ensure an appropriate screening exam.  While it
has been said that its meaning is "always one appeals court decision
from the truth," what is clear is that Congress took great pains to
avoid defining what a "screening exam" must entail -- and has, for
almost a quarter of a century, repeatedly decided not to improve on that
non-definition.

As such, EMTALA defaults to state destination protocols in every case --
provided those protocols exist.  If your doctor is working within the
parameters of a trauma system, he suffers exposure only to frivolous or
malicious prosecution, and the state will assume responsibility to the
extent that his actions were in keeping with protocol.  I can't help
with that; but fear of bullshit litigation is hardly an excuse to
underserve an injured patient.  

The ED clinician can and should eyeball the patient on the helipad and
intervene as necessary on behalf of the patient and the system.  It's
the right thing to do.  Are we really disagreeing over this?

As for HIPAA, see the previous response.  If a doctor in Corpus Christi
tells me that a lawyer shot in the neck during a quail hunting accident
in Kenedy County in February of 1996 had a blood alcohol of 0.85, that
value is protected information, and its divulgence is a violation of
federal law --    especially if you're the poor drunk bag of birdshot.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Moore, Rick
Sent: Tuesday, June 12, 2007 2:25 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: EMS management/crush injury

Pulling into the ambulance bay and having the ED physician take a quick
look and say, "we can't handle that" is an EMTALA violation. Using the
helipad as a safe area to land, meet and transfer patient care from
ground crew to the air crew has long had the backing of CMS. A CMS
letter of opinion has been posted on the website for 7-8 years that I am
aware of. CMS has even stated that the ED staff and/or physician may
attend the patient at the pad, as long as documentation of that "care"
is sent with the patient, all without putting EMTALA compliance issues
on the hospital which owns the pad.
I do agree with you on your assertion that this is a HIPPA violation or
even borders on it is BS. As far as goggling a photo of the accident
scene. Anybody can take a photo on a public roadway and publish it where
ever they want. HIPPA only concerns the release of patient identified
information without appropriate need or consent by the care providers.
Rick Moore, RN, LP
College Station Medical Center
College Station, Texas

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Roy Danks
Sent: Tuesday, June 12, 2007 1:11 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: EMS management/crush injury

Pret,

I'm not sure we can come to any conclusion as yet.  I don't think the
EMS people communicated effectively.  The general notion that "bigger is
better" (University v community setting) has little weight.  They (EMS)
need to keep medical control informed in a situation such as this.  It
doesn't sound as if it was  moving at break-neck speed and they had a
good handle on what was going on at the scene. And, don't get me started
on helicopters.  I love aircraft of all kinds, esp rotor wing.  Aeromed
saves lives, but are, in general, over priced flying billboards for many
hospitals and for their own private gain when not affiliated with a
hospital.  Ever see a aeromed crew get to the scene and say "this pt
doesn't need us...take him by ground"???  Nope.  Doesn't happen.

As for HIPPA.  B.S.!  Why even bother Googling anything?  I'm pretty net
savvy and never even considered it.  I don't see any patient identifiers
AND the patient never went to Phil's hospital.  That's crap.  You sound
like one of "them" (Gov't folks).

But, since you went there (HIPPA).  Are you familiar with another gov't
ape known as EMTALA?  Having a surgeon or EM doc stroll out to the
helipad at the hospital  to "eyeball" the patient then send them on is,
as far as I understand it, a violation of EMTALA.  We had a surgeon do
that "Somewhere in Missouri where I trained"...meeting the ambulance in
the bay and telling them "we can't handle that here"...and were fined a
substantial penalty.  The presence of the helipad at the hospital and
using it as a "meeting point" is of concern as well.  One might argue,
convincingly: you pulled into the parking lot of a level III trauma
center, with a surgeon inside....perhaps 100? or 50? yards away and
didn't get the patient evaluated?  Ohhhhh....I don't know...sounds likes
a nice bonus for some blood sucking attorney when the patient
exsanguinates en route to the university.

Phil:  This is how I see it.  Sit down with EMS and talk communications.
EMS people on this thread are going to come to the defense of their
colleagues.  I'm going to play the devil's advocate and tell you that
they over-stepped their boundaries.  The reason you and your hospital
are called "medical control" is because you are there to help them make
decisions.  Not all the time...not for every patient.  This was hardly
and "every patient" encounter and they would be wise to learn from this
situation.

Roy
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