trauma response within the hospital and EMTALA

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Dr. Swain makes a good point. In fact EMTALA covers patients found
anywhere on owned or leased hospital property including ambulances,
grounds, driveways, as well as outside clinics (external satellites).
That means that if the patient/visitor/walk-in has a problem anywhere on
your premises you should have adequate policies and procedures for their
safe transportation to your ED for the requisite medical screening.  .

Connie Potter, RN, MBA

-----Original Message-----
From: Bryan Boling [mailto:bryanboling at gmail.com] 
Sent: Monday, August 03, 2009 1:00 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: trauma response within the hospital

Before I became an RN, I was a tech in the ER of a Level I Trauma
Center.
 We were NOT required to be EMTs (although several were).  As far as
response outside the ER, we handled any code/fall/"weird incident"
anywhere
in the house if the victim was not a patient (ie family member gets
woozy
and passes out in the hallway, visitor collapses in the lobby, etc).  A
call
would come to the ER charge nurse and she would send the appropriate
people.
 Often that was 2 techs (and typically by sheer chance, one of them
would be
an EMT) unless it was something that was clearly going to need an RN.
Our
EMTs were NOT allowed to practice under the EMT scope however.  There
were
several things that they could do in the field that they were not
allowed to
do in the hospital (start IVs, hold C-spines, etc).
We would go outside the building to get people if they had been brought
to
the ER.  I never saw someone dumped in the parking lot, but I had my
share
of times when a family member comes in and says, "Can you help me get
mom
out of the car? she passed out." only to find mom was pulseless and
unresponsive.  So, an RN always went with a tech if it might be
something
like that.  It was almost always right outside the door, although I went
a
few times to the parking garage adjacent to the hospital.  If there was
something like an MVC in front of the hospital, EMS was called.

I never got any "formal" training in immobilization and other
prehospital
skills, but the EMTs taught me on the job.  Looking back, a little
scary...
Bryan

On Mon, Aug 3, 2009 at 12:39 AM, <htaed_rd at 123mail.org> wrote:

> I wasn't aware of any claim that EMTALA has any effect on by-passing
> hospitals, only on turning patients away from hospitals once the
> patients are withing however many yards of the hospital entrance. If
the
> patient is already on the hospital grounds, as appears to be the case
in
> this topic of discussion, doesn't EMTALA still apply? I am not
> suggesting that this is the best way to handle things and can give
> examples of patients endangered by this interpretation, but that is
the
> way the doctors tell us to act.
>
> Even if the local protocols allowed EMS to transport patients off of
the
> hospital grounds to the trauma center, which may be better for
patients,
> how would that be interpreted as excusing the hospital from any
> responsibility for a person, who appears to be a patient, on the
> hospital grounds?
>
> If the hospital is a trauma center, would there be any reason to allow
> the patient to by-pass the hospital to get to a trauma center? There
are
> almost regular drop-offs of patients in the parking lot of trauma
> centers. How does a trauma center justify leaving the patient in the
> parking lot in if EMS is not already there? If there is concern about
> the safety of hospital personnel, waiting for armed security/police is
> reasonable, should be expected, and is justification for having armed
> security and/or police on the premises.
>
> Trauma center staff/ED staff should be capable of moving a patient
from
> the ground to a long board without increasing the patient's injuries.
> Immobilization is part of ATLS.
>
> Are techs working in the trauma center required to have any EMS
> certification as a job requirement.
>
> Tim Noonan.
>
> On Sun, 02 Aug 2009 21:10 -0500, "McSwain, Norman E Jr."
> <nmcswai at tulane.edu> wrote:
> > Local protocols can override the EMTALA rules if they are equally
> > enforced through the area and well accepted. i.e. EMS units
bypassing
> > local hospitals and going directly to the trauma center per protocol
> >
> > Norman
> >
> > Norman McSwain MD
> > Trauma Director, Charity Hospital
> > Professor of Surgery, Tulane University
> > New Orleans LA
> > 504 988 5111
> > norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu>
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of Steven P. Rogers,
RN
> > Sent: Sun 8/2/2009 7:05 PM
> > To: 'Trauma-List [TRAUMA.ORG]'
> > Subject: RE: trauma response within the hospital
> >
> >
> > By EMTALA standards aren't you responsible for all patients in and
around
> > your hospital, I seem to recall the figure of 200 yards.
> >
> > ________________________________
> --
> trauma-list : TRAUMA.ORG
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>

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