the team must document why it was in the patient’s best interest to undertake transport at that time In some cases, transfer agreements exist between hospitals Typically, such agreements stipulate that the receiving hospital will accept all transfers from the referring hospital In the past, transfer agreements served to decrease the time needed to accept the patient by eliminating or shortening the approval process More recently, transfer agreements have become less important for two reasons First, the EMTALA places a duty on the receiving hospital to accept the patient as long as there is an appropriate bed location available Second, for patients who have undergone an EMTALA-mandated “Medical Screening Exam” by a “Qualified Medical Person,” and are determined to not have an “Emergent Medical Condition,” managed care organizations or insurance plans may stipulate certain receiving facilities In such cases, the transfer agreement may exist between the managed care organization and the receiving facility However, as above, the laws of EMTALA override these agreements for patients deemed to still have an Emergency Medical Condition There are important legal ramifications to transport teams who operate under specific guidelines or protocols Therefore, it is imperative that all guidelines represent the current standard of care Furthermore, guidelines should be designed to ensure that providers not exceed their scopes of practice as defined by state, local, and institutional regulations Routine review of existing protocols and guidelines is warranted New guidelines should be developed in conjunction with recognized authorities, and should be reviewed by risk-management specialists before implementation Use of protocols/guidelines is not a medical–legal shield regarding lawsuits, although adherence to evidence-based guidelines can help demonstrate state of the art and thoughtful care