Tips on those gray areas within the 250-yard rule
The key to complying with the Emergency Treatment and Active Labor Act (EMTALA) 250-yard rule is to have a specific policy and to inservice staff on responding properly to these situations. Here are some suggestions from the experts:
- Prepare a written policy. The policy should indicate that the hospital intends to comply with EMTALA and will make reasonable efforts to assist people in need near the campus.
- Indicate the physical parameters to your staff. But emphasize that judgment calls may be necessary. It might be permissible to go a little farther in some cases, or not as far in other cases, says Mark Kadzielski, JD, head of the West Coast health practice for the law firm of Fulbright & Jaworski in Los Angeles.
"Do you have to run a gurney down the street in six feet of snow? Maybe not," Kadzielski says. "Let people know you don’t expect them to run 250 yards no matter what’s going on."
- Include hospital security in your inservices. Because security officers may be the ones to receive notice that help is needed, they need to understand when EMTALA applies and how to initiate the hospital’s response.
- Designate certain staff members to respond. You might need to say that certain nurses would respond from the emergency department, for instance. It’s probably not a good idea to let a physician leave the emergency department because that could leave the area uncovered, says John C. West, JD, MHA, DFASHRM, senior health care consultant with AIG Consulting in Atlanta.
- Provide necessary supplies. It’s a good idea to set aside a gurney and a basic emergency kit that responders can grab and go.
- Always call 911. The protocol should require that the hospital call 911 whenever staff go out for a patient, unless the patient is immediately outside the door. This ensures that there is no delay in case the hospital staff cannot help the person for some reason.
- Always enlist the aid of hospital security. When staff must leave the hospital to get the patient, make sure hospital security responds as a safety measure.
- Caution your staff not to take unnecessary risks. EMTALA does not require that your staff forge into danger. Make sure your staff knows that they should not put themselves at unnecessary risk.
"If there’s a brawl in the bar across the street, call 911 and let them handle it. Someone’s going to be hurt, and it might be your people," West says. "Make sure your people are trained to avoid violence. They shouldn’t try to be medics on a battlefield."
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