You should be protected here provided your state governing body over pre-hospital care has guidelines stating what patients should go where. Presumably Virginia has such a body and you should be covered in your refusal of these patients, and that injured adult patients in the state of Virginia should not routinely go to Pediatric Trauma Centers.
EMTALA does not specifically cover the pre-hospital scenario unless the ambulance in question is owned by your hospital, which I presume it is not.
EMTALA is of course very open to interpretation, but even in its broadest interpretation, it would be my opinion that a Children's Hospital should not routinely receive adult trauma patients with perhaps the exception of the 250-yard rule, or some other unusual circumstance where a critically ill adult would have to travel a life-threatening distance to an adult trauma center rather than come to the Children's Hospital.
Jay Fisher MD FAAP FACEP
Medical Director, Peds EM
Children's Hospital of NV at UMC
Clinical Professor of EM and Pediatrics
UNLV School of Medicine
> On January 20, 2018 at 10:36 AM "Hughes, Michelle K" <[log in to unmask]> wrote:
> I appreciate as many responses as possible due to the urgency and seriousness of this matter:
> We are having a multi-disciplinary discussion in regards to adults and children involved in a serious MVC being brought being in as patients via EMS to our Emergency Department (free standing Children's Hospital). The issue is that the parents do not want to be separated from their child / children, and their child / children need to be brought to our facility for appropriate care. According to EMS,the parents are deemed "not so hurt, but should be seen by an MD". In this case, the call comes through the radio, and we have to "accept" or "refuse" the patient(s).
> We are aware of EMTLA, and when an adult has walked in or been dropped off at our facility, we stabilize and transfer, no questions asked. But what is the rule if EMS calls with an adult patient and asks for us to "accept" them as a patient. As it stands, trauma patients > 15 years old get deferred to the adult hospital (less than half a mile away). Our PEM group (including myself) is not comfortable with accepting these adult patients, and we identify this as a huge risk and liability.
> What is the practice at your facility, and does anyone know the legality of "accepting" patients involved in a traumatic event that you and your facility are not trained to treat? (ie adults not previously seen by any of your subspecialists)
> Michelle K. Arzubi-Hughes, D.O., FAAP
> Children’s Hospital of the Kings’ Daughters
> Pediatric Emergency Medicine Attending
> Associate Medical Director for Trauma
> Chair of Resuscitation Outcomes Committee
> Assistant Professor of Pediatrics
> Eastern Virginia Medical School, Department of Pediatrics
> [log in to unmask]
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: