The impact of the US federal regulations as outlined in the Emergency Medical Treatment and Labor Act (EMTALA) on the interhospital transfer of trauma patients is also discussed.īefore the development of trauma centers, victims of injury were generally transported to the closest hospital to the scene. In this chapter, the process of interhospital transfer is reviewed, both within the context of well-developed trauma systems and outside of such systems. Interhospital transfer of such patients to centers with the capability of rendering definitive care is therefore necessary, and the benefit of the efficient handling of such transfers is obvious. This may be intentional, owing to logistic concerns regarding weather or transport time (particularly in rural scenarios), or unintentional, as a result of field undertriage or arrival of the patient by private vehicle. There are still circumstances, however, where patients will arrive at facilities incapable of providing definitive treatment. 1 The development of regional trauma systems, both in Alabama and across the nation, has helped to improve field triage, whereby critically injured patients may be transported directly to designated trauma centers, possibly bypassing closer nontrauma hospitals. As an example, in the Birmingham, Alabama region (population 1.2 million), before the development of a regional trauma system, 60% of patients meeting physiologically unstable trauma triage criteria of the American College of Surgeons were being transported to hospitals that lacked any organized trauma response. In reality, however, patients are often taken to facilities that have neither the expertise nor resources to manage complex or life-threatening injuries. Ideally, any patient sustaining a significant injury would be promptly transported to a hospital capable of providing immediate and comprehensive trauma care.
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