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impact of EMTALA on the interfacility transport populations Williams offers an excellent in-depth publication describing EMTALA This act places clear duties on both the referring and receiving hospitals The referring clinicians must everything within their capabilities to stabilize the patient’s medical condition before transport and may not transfer a patient against his or her will unless the facility cannot provide the appropriate level of care Furthermore, the referring physician must obtain informed consent for transfer and, as part of this process, must advise the patient or the guardians of a minor about the risks and benefits associated with transfer Of course, when consent is not practical/possible (absent guardians), and the child’s condition is critical, the transport should not be delayed Under EMTALA rules, emergent transport decision making should not include the financial ramifications of the decision It may seem prudent to disclose that a refusal of transfer may potentially leave the patient/family responsible for a hospital bill, however, under EMTALA rules, such information, though well intentioned, may be construed as financial coercion to enable the transfer Instead, if the patient’s medical acuity does not preclude it, the parents of the patient may be told to contact their insurance representatives, or the hospital financial personnel to discuss these issues The referring team is also responsible for selecting an appropriate means of transport Obviously, the more critical the need for medical care and expertise, the more sophisticated the transport capabilities required This is an important point for the referral physician to remember The desire to transfer a child to a more appropriate medical facility as soon as possible is understandable, but if the method chosen places the child in a medical environment that does not offer at least the level of care at the referral center, that center and physician may be liable for any untoward effects that can be construed as having occurred because of the choice of transport Finally, EMTALA requires the receiving hospital to accept the patient in transfer if the appropriate type and level of care are available Again, the ability of the patient to pay for medical care cannot be considered by either the referring or the receiving facility In addition to the EMTALA, there are often local regulations that direct transport services For example, some cities have regulations designating certain agencies as official providers of prehospital services Such statutes must be considered when offering transport services It is important to note, that guidelines, such as trauma center transfer protocols, not negate or supersede EMTALA guidelines Also, as EMTALA does not apply to inpatients, temporarily admitting a patient to the hospital to attempt to circumvent the ED-focused EMTALA requirements is not