Healthcare Providers

EMSC Performance Measures 76 and 77: Making Transfers Work for Critically Ill and Injured Children

Performance measure 76 addresses the percentage of hospitals in the state/territory that have written interfacility transfer guidelines that cover pediatric patients and include pre-defined components of transfers. Performance measure 77 addresses the percent of hospitals in the state/territory that have written interfacility transfer agreements that cover pediatric patients. (2009)

Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures

This document contains information regarding the EMSC State Partnership performance measures, and includes best practices from state activities related to interfacility transfer agreements, in addition to facility categorization. (June 2009)

Webcast: Introduction to Interfacility Transfer Agreements and Guidelines

Developed by the NRC and presented online through the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), this webcast covers such topics as: the need for interfacility transfer agreements; the basic components of interfacility transfer guidelines; and the implications of transfer guidelines for pediatric outcomes. (February 2008)

EMSC State and Territorial Regulations Authorizing Pediatric Interfacility Transfer Guidelines or Agreements

Wide variations of state laws and regulations exist related to the provision of emergency care. In some instances, the interfacility transport process is specified in state regulations. In addition, when referral crosses state lines there may be specification in state regulation that apply.

Issue Brief June 2009

This fact sheet focuses on transfer agreements and guidelines through a discussion of Emergency Medical Treatment and Active Labor Act (EMTALA) implications when transferring both inpatients and unstable emergency department patients in the context of uncertainty with court rulings vs. CMS interpretations. (2009)

Issue Brief May 2010

This fact sheet discusses EMTALA liability issues that can arise in the case of an inter facility transfer. Supports transfer guidelines and agreements and their importance in establishing the terms of the transfer in order to clarify respective duties and methods for assuring the proper execution of those duties. (2010)

Joint Policy Statement for Guidelines for Care of Children in the Emergency Department

Endorsed by the American Academy of Pediatrics' (AAP) Committee on Pediatric Emergency Medicine, the American College of Emergency Physicians' (ACEP) Pediatric Committee, and the Emergency Nurses Association’s (ENA) Pediatric Committee, these guidelines outline the essential resources (medications, equipment, policies, and education) and staff to ensure that hospital emergency departments are prepared to care for and – when necessary — transfer children of all ages, from neonates to adolescents. The guidelines are consistent with the recommendations of the Institute of Medicine’s (IOM) 2006 report Future of Emergency Care in the United States Health System, and are also available online through the ACEP website. (Approved April 2009, published in Pediatrics September 2009)

AAP News: Policy Offers Blueprint for Care of Children in the ED

This AAP commentary piece provides background information and a concise summary of the key recommendations contained in the 2009 Guidelines for Care of Children in the ED endorsed by the AAP, ACEP, and the ENA. (November 2009)

Guidelines Checklist

In accordance with the AAP, ACEP, and ENA 2009 Guidelines for Care of Children in the ED, this checklist allows healthcare facilities to assess their own preparedness to manage pediatric emergencies. (Accessed February 2010)

Policy Statements

The AAP website includes a number of policy statements that relate directly or indirectly to interfacility transfer agreements. These include:

Access to Pediatric Emergency Medical Care, which encourages emergency departments to establish transfer agreements with facilities at higher levels of pediatric care to ensure timely access to pediatric emergency medical care for critically ill and injured children. (January 2007);
Pediatric Care Recommendations for Freestanding Urgent Care Facilities, which recommends that urgent care facilities have prearranged transfer and transport agreements. (May 2009); and
Facilities and Equipment for the Care of Pediatric Patients in a Community Hospital, which includes guidance to community hospitals on referral networks and transfer of pediatric patients. (September 2007)

Appropriate Interhospital Patient Transfer

This policy statement outlines the characteristics of an appropriate interfacility transfer, highlighting the legal requirements of the Emergency Medical Treatment and Active Labor Act (EMTALA). It specifically focuses on the medical screening exam and the patient stabilization requirement within the capabilities of each healthcare facility. (February 2009)

Interfacility Transportation of the Critical Care Patient and Its Medical Direction

Outlining the American College of Emergency Physicians’ (ACEP) position on transporting critically ill and injured patients, this document articulates the importance of ensuring that both transport teams and receiving facilities are capable of providing appropriate levels of care. (September 2005)

Regional Trauma Systems: Optional Elements, Integration, and Assessment

Focusing on trauma – the most extensively regionalized emergency care system in the United States – this resource from the American College of Surgeon’s Committee on Trauma includes sections on system coordination and patient flow that highlight that importance of interfacility transfer agreements and guidelines within regionally coordinated care systems. (Accessed October 2014)

Medical Direction of Interfacility Transports

Designed to serve as a tool to encourage optimal transport of patients between health care facilities, this position statement reviews the roles and responsibilities of those involved in the medical direction of an interfacility transport, and how regulations and accreditation affect them. (2000)

Guide for Interfacility Patient Transfer

This document is intended for EMS agencies providing interfacility transfers at the local, state, and regional levels, as well as those involved in transfer planning. It can be used to provide general guidance, references, and ideas for conducting a systematic assessment of the processes and personnel supporting interfacility transfers, and how they can be enhanced to provide optimal patient care. (April 2006)

Working Group Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances

These guidelines provide national, state, and local emergency medical services organizations with clear guidance on best practices for properly restraining children traveling by ambulance from the scene of a traffic crash or medical emergency to a hospital or medical facility. If widely adopted, the guidelines could serve as a tool for standardizing national child restraint protocols in ground ambulances across the United States. (September 2012)