cautious and not absolute Importantly, however, EMTALA states that the receiving physician is an obligate consultant to referring physicians, so it is not acceptable to refuse to offer assistance or advice due to a concern regarding medical–legal consequences The receiving physician must his or her best to offer clear and complete information, especially when specific information is requested Suggestions for care must be clearly and completely communicated For example, if the transport control physician believes that a fluid bolus is needed, that advice should include type and amount of fluid and speed of infusion to avoid any misinterpretation of advice or an inadvertent mistake in one of those parameters All advice should be documented in writing and/or by audio recording The referring physician is under no obligation to accept the advice of the receiving physician, but he or she would be prudent to give it serious consideration If the referring physician is unable or unwilling to provide specific care or perform suggested interventions because of disagreement, personnel issues, equipment limitations, or other reasons, this should be discussed with the receiving physician As above, EMTALA also forbids the receiving institution from placing “conditions” on acceptance For example, the receiving institution cannot demand that the referring physician manage the patient in a particular fashion prior to transport “or else” the transfer will not be accepted, although a team can refuse to participate in a transport where stabilization is possible, but not allowed, by the referring team (i.e., stabilization of an airway, etc.) Finally, results from interventions or marked changes in the patient’s condition during the referral process should be communicated to the receiving physician and transport service Clear, precise, efficient, and frank communication is imperative for the patient to receive the most appropriate care Communication with the patient and family is also important during the transport process Straightforward communications about disease process and expectations can help prepare a family to accept the consequence of the illness or injury Inadequate communication or reluctance to give difficult news can lead a family to expect different outcomes than they should and may pave the way for anger and resentment Documentation and communication of all data regarding the patient’s care is imperative Patient summaries, copies of all medical paperwork, laboratory values, and radiographs (copies of studies as well as the reports), should be available for the transport team on their arrival at the referring location A transport referral checklist may be useful to help streamline the process Adequate preparation of these documents before arrival of the transport team can greatly improve the efficiency of the transport process and the transition of care