EMTALA - Flu

In anticipation of a possible significant increase in demand for emergency services due to H1N1 influenza resurgence this fall several federal agencies, state health departments, and hospitals have expressed significant concerns about compliance with EMTALA requirements during an outbreak. Many stakeholders perceive that EMTALA imposes significant restrictions on hospitals’ ability to provide adequate care when EDs experience extraordinary surges in demand. The information below clarifies options that are permissible under EMTALA and should reassure the provider community and public health officials that there is existing flexibility under EMTALA. Among other things, the fact sheet notes that an EMTALA-mandated medical screening examination (MSE) does not need to be an extensive work-up in every case, and that the MSE may take place outside the ED, at other sites on the hospital’s campus.

Emergency Medical Treatment and Labor Act (EMTALA) & Surges in Demand for Emergency Department (ED) Services During a Pandemic

I. What is EMTALA

• EMTALA is a Federal law that requires all Medicare-participating hospitals with dedicated EDs to perform the following for all individuals who come to their EDs, regardless of their ability to pay:
  • An appropriate medical screening exam (MSE) to determine if the individual has an Emergency Medical Condition (EMC). If there is no EMC, the hospital’s EMTALA obligations end.
    • If there is an EMC, the hospital must:
    • Treat and stabilize the EMC within its capability (including inpatient admission when necessary); OR
    • Transfer the individual to a hospital that has the capability and capacity to stabilize the EMC.
• Hospitals with specialized capabilities (with or without an ED) may not refuse an appropriate transfer under EMTALA if they have the capacity to treat the transferred individual.
• EMTALA ensures access to hospital emergency services; it need not be a barrier to providing care in a disaster.

II. Options for Managing Extraordinary ED Surges Under Existing EMTALA Requirements (No Waiver Required)

A. Hospitals may set up alternative screening sites on campus

• The MSE does not have to take place in the ED. A hospital may set up alternative sites on its campus to perform MSEs.
  • Individuals may be redirected to these sites after being logged in. The redirection and logging can even take place outside the entrance to the ED.
  • The person doing the directing should be qualified (e.g., an RN) to recognize individuals who are obviously in need of immediate treatment in the ED.
• The content of the MSE varies according to the individual’s presenting signs and symptoms. It can be as simple or as complex, as needed, to determine if an EMC exists.
• MSEs must be conducted by qualified personnel, which may include physicians, nurse practitioners, physician’s assistants, or RNs trained to perform MSEs and acting within the scope of their State Practice Act.
• The hospital must provide stabilizing treatment (or appropriate transfer) to individuals found to have an EMC, including moving them as needed from the alternative site to another on-campus department.

B. Hospitals may set up screening at off-campus, hospital-controlled sites.

• Hospitals and community officials may encourage the public to go to these sites instead of the hospital for screening for influenza-like illness (ILI). However, a hospital may not tell individuals who have already come to its ED to go to the off-site location for the MSE.