Examining the Emergency Medical Treatment and Active Labor Act: impact on telemedicine for neurotrauma

Abstract

The Emergency Medical Treatment and Active Labor Act (EMTALA) protects patient access to emergency medical treatment regardless of insurance or socioeconomic status. A significant result of the COVID-19 pandemic has been the rapid acceleration in the adoption of telemedicine services across many facets of healthcare. However, very little literature exists regarding the use of telemedicine in the context of EMTALA. This work aimed to evaluate the potential to expand the usage of telemedicine services for neurotrauma to reduce transfer rates, minimize movement of patients across borders, and alleviate the burden on tertiary care hospitals involved in the care of patients with COVID-19 during a global pandemic. In this paper, the authors outline EMTALA provisions, provide examples of EMTALA violations involving neurosurgical care, and propose guidelines for the creation of telemedicine protocols between referring and consulting institutions.

Keywords: CMS = Centers for Medicare and Medicaid Services; COVID-19; ED = Emergency Department; EMC = emergency medical condition; EMTALA; EMTALA = Emergency Medical Treatment and Active Labor Act; MSE = medical screening examination; OIG = Office of the Inspector General; SDH = subdural hematoma; TBI; TBI = traumatic brain injury; coronavirus; mTBI = mild TBI; neurotrauma; subarachnoid hemorrhage; tSAH = traumatic subarachnoid hemorrhage; telemedicine; traumatic brain injury.