A 67-year-old man is brought to the ED by EMS with a chief complaint of chest pain. He is found to be short of breath and diaphoretic. He reports that he vomited 1 hour ago and subsequently feels better.

A 67-year-old man is brought to the ED by EMS with a chief complaint of chest pain. He is found to be short of breath and diaphoretic. He reports that he vomited 1 hour ago and subsequently feels better. He describes substernal chest pressure that started while doing yard work. He has a history of coronary artery disease and hypertension. He has regularly scheduled appointments with a cardiologist at a neighboring hospital. He requested to be taken to that hospital, but EMS refused and brought him to your ED because it was only 5 minutes away. The patient is angry and requests a transfer to his cardiologist’s hospital, which is 20 minutes away. What is the best course of action?

a. You must politely refuse his request and work the patient up for acute coronary syndrome and admit him to your hospital if indicated.

b. Contact the neighboring hospital and speak to the patient’s cardiologist. If he agrees to accept the transfer, authorize an ambulance transfer for continuity of care.

c. Transfer the patient only if he has stable vital signs and his cardiologist is on-call at the neighboring hospital.

d. Transfer the patient immediately and inform EMS that they should have respected the patient’s wishes in the prehospital setting.

e. Perform the appropriate medical screening examination (MSE), in this case at least an electrocardiogram (ECG) and basic laboratory tests including a troponin, before considering a transfer.

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