In U.S. academic emergency departments, decisions to accept patients is typically easy, because you have ready access to on-call physicians. When in doubt, accept transfer patients and sort things out later.

  • What are the obligations for those transferring patients to other EDs?
  • What do the EMTALA (a.k.a. “anti-dumping”) rules say?
  • When can you transfer unstable patients?

As a general rule, the liability falls upon the transferring site and physician. So be sure that your patient won’t decompensate in the ambulance during transfer. So, don’t transfer that CP patient who is getting ruled-out for an MI or ACS no matter how good they look. Patients need to be stable for transfer.

Anyone with pearls to share?
Thanks to @EMurgentologist for tweeting me the idea!

PV Card: EMTALA Transfer Rules

Go to ALiEM (PV) Cards for more resources.

Further Reading:

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD