{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:19:06Z","timestamp":1787894346544,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>The Emergency Medical Treatment and Active Labor Act (EMTALA), enacted in 1986, established the legal foundation for access to emergency medical care in the United States. This review examines EMTALA\u2019s historical origins, core requirements, and implications for pediatric emergency practice. The law emerged in response to widespread patient dumping practices in the 1980s, when hospitals routinely transferred or refused care to uninsured patients. In the 4 decades since, amendments and regulatory clarifications have expanded the law\u2019s scope and strengthened enforcement mechanisms. The modern iteration of EMTALA imposes 3 fundamental obligations on Medicare-participating hospitals with dedicated emergency departments: providing an appropriate medical screening examination, stabilizing emergency medical conditions, and facilitating appropriate transfers when necessary. Pediatric-specific considerations include the \u201creverse dumping\u201d provision, which requires hospitals with specialized pediatric capabilities to accept appropriate transfers when capacity exists, and standards for pediatric transport during interfacility transfers. While EMTALA provides critical protections, its narrow focus on emergency care raises ethical questions about whether this minimal standard adequately meets broader child health needs. Understanding EMTALA\u2019s requirements and limitations is essential for pediatric emergency providers navigating both clinical and legal obligations in contemporary practice.<\/jats:p>","DOI":"10.1097\/pec.0000000000003591","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:00:23Z","timestamp":1787893223000},"page":"721-727","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["The Emergency Medical Treatment and Active Labor Act"],"prefix":"10.1097","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4138-0142","authenticated-orcid":false,"given":"Maneesha","family":"Sakhuja","sequence":"first","affiliation":[{"name":"Pediatric Hospital Medicine Attending, Children\u2019s National Hospital, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb","family":"Ward","sequence":"additional","affiliation":[{"name":"Attending Physician, Division of Emergency Medicine, Children\u2019s National Hospital, Washington, DC; Associate Professor of Pediatrics & Emergency Medicine, The George Washington University School of Medicine and Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Madrigal","sequence":"additional","affiliation":[{"name":"Director Pediatric Ethics Program, Pediatric Critical Care Medicine, Children\u2019s National Hospital, Associate Professor, The George Washington University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Medicine Attending & Associate Director Ethics Program, Children\u2019s National Hospital, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"R1-20260828","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1001\/jama.1987.03390110076030","article-title":"Patient dumping: status, implications, and policy recommendations","volume":"257","author":"Ansell","year":"1987","journal-title":"JAMA"},{"key":"R2-20260828","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1056\/NEJM198602273140905","article-title":"Transfers to a public hospital. a prospective study of 467 patients","volume":"314","author":"Schiff","year":"1986","journal-title":"N Engl J Med"},{"key":"R3-20260828","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1378\/chest.14-2046","article-title":"Emergency Medical Treatment and Labor Act: what every physician should know about the federal antidumping law","volume":"147","author":"Hyman","year":"2015","journal-title":"Chest"},{"key":"R6-20260828","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.emc.2006.05.003","article-title":"EMTALA and the ethical delivery of hospital emergency services","volume":"24","author":"Bitterman","year":"2006","journal-title":"Emerg Med Clin North Am"},{"key":"R8-20260828","article-title":"Emergency Medical Treatment and Labor Act (EMTALA)","author":"Alder","year":"2025","journal-title":"HIPAA J"},{"key":"R9-20260828","first-page":"48428","article-title":"Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2009","volume":"73","year":"2008","journal-title":"Fed Regist"},{"key":"R11-20260828","first-page":"60796","article-title":"Annual civil monetary penalties inflation adjustment","volume":"89","year":"2024","journal-title":"Federal Register"},{"key":"R12-20260828","first-page":"47818","article-title":"Medicare and Medicaid Programs; hospital and critical access hospital changes to promote health equity and access: proposed rule","volume":"89","year":"2024","journal-title":"Federal Register"},{"key":"R13-20260828","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1542\/hpeds.2024-007732","article-title":"Civil monetary penalties for EMTALA violations involving minors, 2002\u20132023","volume":"14","author":"Terp","year":"2024","journal-title":"Hosp Pediatr"},{"key":"R22-20260828","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.annemergmed.2013.07.017","article-title":"EMTALA and on-call responsibility for emergency department patients (policy statement)","volume":"62","year":"2013","journal-title":"Ann Emerg Med"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/PEC.0000000000003591","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:00:25Z","timestamp":1787893225000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/PEC.0000000000003591"}},"subtitle":["Clinical Practice and Ethical Considerations"],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":10,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003591","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"value":"0749-5161","type":"print"},{"value":"1535-1815","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"2025-12-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}