250-yard rule

A reader asks this question:

I was wondering if you can answer a question on the 250-yard rule. I work in an emergency room and heard on the radio there was a stabbing in the same block as the hospital. Is it my obligation to leave the ER with a the physician and run to the site.? EMS was called and the police were responding.

We have much debate over this situation. Some employees feel it fits into the 250-yard rule, others feel it does not. Can you help us answer this question and set the record straight?

I have no idea. Can anyone help answer this question?

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  • Bimal

    IANAL, but the 250 yard rule isn’t AS complicated as people think it is (the real complication is that you can get dinged even when obeying the letter of the law if you LOOK bad in the newspaper).

    The key consideration in applying the 250 yard rule is where, in relation to other medical facilities related to the ER in questions, the stabbing victim presented.

    That is, the 250 yards is not meant to be an all-encompassing radius within which the ER must rush out to collect and care for patients. What it means is that medical facilities within 250 yards of the main ER have similar EMTALA responsibilities as the main ER and its IMMEDIATE surroundings (ie the ambulance bay, across the street, the alley around the corner).

    So, for this particular case the issue is where the stabbing took place in relation to the ER (not an artificial cut off of 250 yards) and a realistic assessment of EMS capabilities. Depending on your city, a ‘block’ can be a significant distance and depending on the EMS service, it may be that EMS can ‘scoop and run’ much faster than an ER doc can run to the victim. If, on the other hand, the victim is radioed in as being within shouting distance of the ER (and thus likely legally qualifying as ‘presenting’ per EMTALA) and EMS was, for some reason, unable to respond the ER could be fined for not heading out and performing an evaluation.

    Intersting caveat: the original question says the stabbing was the same block as the HOSPITAL, not the ER. This doesn’t matter much from an EMTALA legal perspective, but it does point out that hospitals need to have procedures in place for responding to medical emergencies adjacent to campus as well as on campus. FYI, at least one of the major ED/Trauma centers in Boston actually has a separate response system/team specifically for these cases so that ED/Trauma staff aren’t running all over campus.

  • Anonymous

    This is a great example of how simple regulations written to obstruct perfidy, end up getting bloated as they then try to remedy the lack of common sense.

    As I read the regulation, it doesn’t mean 250 yards confers and absolute obligation, but rather parts of hospital property that are within 150 yards of the main building. Not even all parts at that. EMTALA does not create an obligation to the patient who collapses in the psychiatrist office rented from the hospital 150 yards away, or the person shot in the MacDonalds on campus next to the ER, or on public property across the street.

    But common sense, simple humanity, medical ethics, and possibly common law do create obligations in these situations.

    The 250 yard rule, as I read it, if taken overly literally, would mean no EMTALA obligation to the patient lying on the grass begging for help on hospital property out by the duck pond but 251 yards from the main building. And when and if that ever happens, and the patient is not responded to, and a complaint is made, then the rule will once again be revised to attempt the undoable–to make a people conditioned for 3 generations to look to law and regulation for guidance exercise good sense.

  • Anonymous

    Screw the “letter of the law” and “looking bad in the newspaper.” Just do what is right.

    Is the gunshot victim going to get care much more quickly if you roll a stretcher down and get him, and can you do so safely? If yes then just do it!

  • w.h.a.t.s.y.e.l.l.o.w.a.n.d.g.r.e.e.n.a.n.d.e.a.t.s.n.u.t.s@gmail.com

    EMS and police responded, therefore you do not have an obligation to do so.

    If they hadn’t, would you be required to?

    Well, I can’t say whether it’s accurate, but this is what EMTALA.com (which isn’t official) quotes the law to be:


    “A person who presents anywhere on the hospital campus and requests emergency services, or who would appear to a reasonably prudent person to be in need of medical attention, must be handled under EMTALA. Other presentations outside the emergency room do not invoke EMTALA.”

    The point of contention here would of course be “on the hospital campus”.

    “Campus means the physical area immediately adjacent to the provider’s main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the HCFA regional office, to be part of the provider’s campus.”

    At first glance this might seem to state that any building or area within 250 years of a hospital is part of “the hospital campus”. But it does not say this at all. It’s badly written legalese (a redundancy, surely), and what it actually means is that, given that hospitals often locate medical personnel and resources near-but-not-within a hospital (like a smaller down the street building), those buildings are part of the “campus” if they are within 250 yards of the hospital, as the crow flies. Not just any building, but buildings which WOULD clearly be part of the hospital if they were located adjacent to it. In addition, there is a small “buffer zone” around these buildings, within the reasonable definition of “immediately adjacent”, that requires response to presentations within it, on the premise that they “intended” to reach the ER, but were physically incapable of it.

    I also generally agree with the above post which states that if you *can* do it faster and better than the EMS, then you probably *should*, even if it isn’t strictly required by the 250-yard rule. Which it isn’t.

    I’m neither a lawyer nor a doctor.

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