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allowable Any law that contradicts or conflicts with EMTALA is considered preempted by EMTALA The HIPAA of 1996 also impacts the traditional transport system Limitations are placed on information dispersion that could be potentially linked to a specific patient Although this should not impact patient information flow between primary providers or the assessment of services by an established CQI system, the generic follow-up letters that many systems used for feedback and as marketing tools are no longer permitted Legal advice should be sought on how to replace this time-honored, but now outdated, method of generic communications As noted, traditional tort law also applies to the transport team Most of these issues are similar to those encountered in other healthcare venues However, one potential source of medical–legal risk is unique to the transport team As stated earlier, the transport team gradually becomes more and more involved in the care of the patient At first, this involvement is limited to giving advice and management suggestions It is the referring physician’s responsibility to consider these suggestions as he or she deems appropriate At this stage in the transport process, transport personnel should try to gain the clearest possible picture of the patient’s condition so the most appropriate suggestions may be given Furthermore, advice may be best prefaced with general phrases such as “Most patients with this condition” or “We often manage this problem by …” The transport team should clearly document any advice given, in writing or recorded conversations, in case disagreements regarding what advice was given arise later The next stage of involvement occurs when the transport team arrives at the referral facility and begins to care for the patient, often along with one or more members of the referring hospital’s staff At this point, the greatest medical–legal risks are conflicts over management and difficulties in determining who gave or carried out medical orders Written consent and permission for disseminating medical-related information should be obtained, and if the patient/guardian is unable to provide it, alternative means of approving the transport should be considered ( Figs 11.12 and 11.13 ) When management conflicts arise, the medical control physician should be contacted, and he or she should help resolve these conflicts by speaking directly with the referring physician In these situations, the referring provider is ultimately in charge of the patient, and the transport providers are considered onsite consultants The medical record should clearly reflect who gave and who carried out each order The transport team assumes total responsibility for the care of the patient when they leave the referral center Consequently, the team should assure that the patient is as stable as possible before leaving If an unstable patient is transported,