# 一名無保險病人因胸痛到達急診。檢傷護理師確認病人無保險。哪一行動反映EMTALA遵從？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374913&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: MOC

## 題目

一名無保險病人因胸痛到達急診。檢傷護理師確認病人無保險。哪一行動反映EMTALA遵從？

## 選項

1. 告知病人無保險不能評估並請其前往郡立醫院。
2. 不論支付能力提供醫療篩檢檢查(MSE)以決定是否存在緊急醫療狀況；於考慮任何轉院前先穩定任何緊急狀況。 **✔ 正確答案**
3. 於允許病人進入治療區前收取$200保證金。
4. 於提供任何照護前要求病人簽署放棄所有醫院責任之文件。

**正確答案: 2**

## 解析

EMTALA(緊急醫療治療與活躍分娩法)要求參與Medicare且設有急診之醫院對來到急診之任何人提供醫療篩檢檢查，不論支付能力或保險狀態，並於任何轉院前穩定任何緊急醫療狀況。選項1、3、4皆為明確之EMTALA違規，可導致聯邦處罰。

## 深入解析

EMTALA兩大支柱為：所有人都進行MSE、轉院前穩定。要求先付費或基於保險拒絕篩檢為最常考之EMTALA違規。醫院可於穩定後收取保險資訊，但絕不可於MSE前。

## 臨床情境

無保險之成人因**胸痛**步行進入急診。檢傷護理師決定符合EMTALA之首要行動。

## 重要概念

- **EMTALA** — 聯邦法規定Medicare醫院須對所有來急診之人不論保險狀態提供醫療篩檢與穩定。
- **醫療篩檢檢查(MSE)** — 由合格醫療人員執行以判定是否存在緊急醫療狀況之檢查；於任何支付討論前對所有人皆為必須。
- **穩定要求** — 醫院須於轉院前穩定緊急狀況；轉至更高層級照護僅於穩定後或基於醫療需要方可。

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