ABSTRACT

The American emergency medical system (EMS) has struggled since its inception to remain true to its original mission to handle emergent cases. Initially a site of acute care, the emergency department (ED) has quickly become a site where nonurgent, urgent, and acute cases meet with few options for patients and providers alike to seek alternative and perhaps even more appropriate care. As a result, patients of all acuity levels present to the ED (McCaig and Nawar, 2006). A major policy intervention in the history of emergency medicine was the passage of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986. This prevented hospitals from refusing to treat patients or transferring them to charity or county hospitals because they are unable to pay or covered under Medicare or Medicaid. Enforced by the federal government, EMTALA poses two requirements on hospitals: (1) a hospital must provide an appropriate medical screening exam to anyone who comes to the ED and requests care, and (2) if the ED determines the person has an emergency medical condition, appropriate stabilization treatment and hospitalizations as necessary must be provided. The passage of EMTALA quickly poised the ED to become an integral component of the U.S. health care safety net (Hadley and Cunningham, 2004; Siegel, 2004).