If an EMC is not identified, EMTALA regulations no longer apply, and the physician or health care professional generally should seek proper consent before further (nonemergent) care is provided. Although the ED should attempt to contact the unaccompanied patient's parent or legal guardian to seek consent for evaluation and treatment, the performance of the MSE and the stabilization of the patient with an identified EMC must not be delayed. The MSE might require the use of extensive ED resources, including laboratory testing, radiographic imaging, and subspecialty consultation, as needed for diagnosis. 18, –, 21 The purpose of the MSE is to determine if an emergency medical condition (EMC) exists, including life- or limb-threatening conditions, severe pain, or conditions with the potential for serious impairment or dysfunction if left untreated. In addition, current federal law under the Emergency Medical Treatment and Active Labor Act (EMTALA) mandates an MSE for every patient seeking treatment in an ED of any hospital that participates in programs that receive federal funding, regardless of consent or reimbursement issues.
Common and statutory law generally has supported the health care professional in evaluating these children and providing emergently needed care while attempts are made to locate a parent or legally authorized decision-maker. In most situations, however, the child or adolescent will either not have the authority to consent or will be unable to do so.
In some cases (discussed later in this statement), adolescents may have the legal authority to consent for treatment without a parent present. Children occasionally present to the ED unaccompanied by a parent or legal guardian. If a parent or legal guardian is present or available, the health care professional treating the child should make every reasonable effort to obtain and document informed consent.
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