[Editor’s note: This column is part of an ongoing series that will address reader questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you’d like answered, contact Staci Kusterbeck, Editor, ED Management, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: StaciKusterbeck@aol.com.]

Question: Is it necessary to send a nurse on a transfer of a stable myocardial infarction patient to another facility for cardiac catheterization/percutaneous transluminal coronary recanalization who recently has received thrombolytics? Or is a paramedic sufficient?

Answer: The answer to the question of paramedic vs. nurse on a transfer revolves around skill levels, says John D. Lipson, MD, MBA, principal of Columbus, IN-based Medical Staff Support Services, which assists medical staff leaders and administrators with EMTALA compliance. If the paramedics are skilled at cardiac rhythm interpretation, have communications with medical command, and are trained to give appropriate medication, then paramedic transport is appropriate, he says. However, if the patient’s condition is more complex — for instance, if the patient is being titrated on an anti-arrhythmia medication — then a cardiac nurse would be appropriate, Lipson says.

"It is therefore important that the ED physician know the skills, talents, training, and protocols of the paramedics, so the physician can make an informed decision as to the most appropriate personnel for transport," he explains.

The transfer requirements of EMTALA demand that adequate equipment and personnel suitable for the condition of the patient be utilized, according to Jonathan D. Lawrence, MD, JD, FACEP, an ED physician and medical staff risk management liaison at St. Mary Medical Center in Long Beach, CA. "I question how stable’ a patient is who has recently received thrombolytics," he says. The potential of dysrhythmias, blood pressure lability, bleeding complications, and recurrence of thrombosis makes these patients inherently "unstable" for at least eight to 12 hours after the treatment, Lawrence explains. "While some paramedics may be up to the task, I think the more prudent course would be for a critical care nurse to accompany the patient," he says. "Their training is far more comprehensive than a paramedic’s," Lawrence adds.

Sources

For more information about the Emergency Medical Treatment and Labor Act, contact:

Jonathan D. Lawrence, MD, JD, FACEP, Emergency Department, St. Mary Medical Center, 1050 Linden Ave., Long Beach, CA 30813. Telephone: (562) 491-9090. E-mail: jdl28@cornell.edu.

John D. Lipson, MD, MBA, Medical Staff Support Services, 6043 Chinkapin Drive, Columbus, IN 47201. Telephone: (812) 342-2658. E-mail: lipsonj@medstaff.net. Web: www.medstaff.net.