I'm excited to be writing this column, which is directed toward EMS managers and administrators. EMS has two distinct sides: patient care and the business of running an ambulance service. There's a need for a place dedicated to the business side of the industry, and I hope you find that place here. In an effort to ensure that you do, we are asking that you be a part of this column. Please e-mail questions, comments or topics for discussion to nancy.perry@cygnusb2b.com.

     On July 13, 2006, the Centers for Medicare and Medicaid Services' Survey and Certification Group published a letter (#S&C-06-21) dealing with the issue of "parking" EMS patients in hospitals. CMS had learned that some hospitals try to circumvent caring for patients by refusing to accept, or "take responsibility" for, them, often literally refusing to allow EMS crews to transfer them from stretchers to hospital gurneys or beds. Apparently the hospital staff in these cases believe this practice leaves the patient in the "care" of the EMS crew and insulates the hospital from any responsibility for the patient.

     CMS seems to disagree. Its letter did not present a clear decision on this issue, but it did state that the "parking" of patients may result in a violation of both the Emergency Medical Treatment and Active Labor Act (EMTALA) and a hospital's Conditions of Participation for Hospitals for Emergency Services. Specifically, the letter pointed out that under EMTALA, hospitals have an obligation to assess the patient's condition once they "present" at a hospital's dedicated emergency department. Once a patient's condition is assessed, if there is a "medical emergency," then the hospital must provide the treatment necessary to stabilize the patient. Because the existence of an "emergency medical condition" is a subjective criteria, and because the duty to assess a patient is required to be done "within acceptable standards of care," there exists enough of a gray area that CMS's conclusion was merely that there "may" be a violation of the law. However, EMS crews should have the training necessary to understand whether the hospital staff is truly doing its best to get to the patients or whether it is merely using the crew as patient-sitters--or, worse, endangering a patient in need of immediate care.