diff --git a/src/MIMIC_IV_MEDS/__main__.py b/src/MIMIC_IV_MEDS/__main__.py
index 9d17bc3..250a19d 100644
--- a/src/MIMIC_IV_MEDS/__main__.py
+++ b/src/MIMIC_IV_MEDS/__main__.py
@@ -9,7 +9,7 @@
 
 from . import ETL_CFG, EVENT_CFG, HAS_PRE_MEDS, MAIN_CFG, dataset_info
 from . import __version__ as PKG_VERSION
-from .commands import run_command
+from .commands import resolve_console_script, run_command
 from .download import coerce_download_workers, download_data
 
 if HAS_PRE_MEDS:
@@ -104,7 +104,11 @@ def _sigint_handler(signum, frame):
         "PRE_MEDS_DIR": str(pre_MEDS_dir.resolve()),
     }
 
-    command_parts = ["MEDS_transform-pipeline", str(ETL_CFG.resolve())]
+    # Resolve via the venv's bin/ next to sys.executable rather than relying on PATH —
+    # users who invoke `./venvs/.../MEDS_extract-MIMIC_IV` without first activating the
+    # venv would otherwise hit FileNotFoundError on this subprocess even though the
+    # script is installed in the same environment as the python interpreter calling it.
+    command_parts = [resolve_console_script("MEDS_transform-pipeline"), str(ETL_CFG.resolve())]
 
     if stage_runner_fp:
         command_parts.append(f"--stage_runner_fp={stage_runner_fp}")
diff --git a/src/MIMIC_IV_MEDS/commands.py b/src/MIMIC_IV_MEDS/commands.py
index 78965a3..be389a0 100644
--- a/src/MIMIC_IV_MEDS/commands.py
+++ b/src/MIMIC_IV_MEDS/commands.py
@@ -1,10 +1,64 @@
 import logging
 import os
+import shutil
 import subprocess
+import sys
+from pathlib import Path
 
 logger = logging.getLogger(__name__)
 
 
+def resolve_console_script(name: str) -> str:
+    """Locate a console script that pip / uv installed alongside the running Python.
+
+    `subprocess.run([name, ...])` does a `PATH` lookup. When the user runs the bundled
+    `MEDS_extract-MIMIC_IV` directly via its venv path (without first activating the
+    venv), the venv's `bin/` is not on `PATH`, and `subprocess` raises
+    `FileNotFoundError` even though the script is installed in the same venv as the
+    Python interpreter that's calling it. Looking next to `sys.executable` first
+    sidesteps the PATH coupling — that's where pip / uv guarantee console scripts land.
+
+    Args:
+        name: The console script's basename (e.g. ``"MEDS_transform-pipeline"``).
+
+    Returns:
+        Absolute path to the executable.
+
+    Raises:
+        FileNotFoundError: If the script is neither next to `sys.executable` nor on PATH.
+
+    Examples:
+        Found next to `sys.executable` — works without an activated venv:
+
+        >>> import sys
+        >>> resolve_console_script(Path(sys.executable).name)  # the python itself
+        ... # doctest: +ELLIPSIS
+        '...'
+
+        Falls back to PATH for tools installed elsewhere (e.g. via `apt`):
+
+        >>> resolve_console_script("ls")  # doctest: +ELLIPSIS
+        '/.../ls'
+
+        Missing scripts raise with a useful message that names the lookup it tried:
+
+        >>> resolve_console_script("definitely-not-a-real-script-xyz")
+        Traceback (most recent call last):
+            ...
+        FileNotFoundError: 'definitely-not-a-real-script-xyz' not found next to ... or on PATH...
+    """
+    candidate = Path(sys.executable).parent / name
+    if candidate.is_file():
+        return str(candidate)
+    found = shutil.which(name)
+    if found:
+        return found
+    raise FileNotFoundError(
+        f"{name!r} not found next to {sys.executable} or on PATH. "
+        f"Reinstall the package that provides it in this environment."
+    )
+
+
 def run_command(
     command_parts: list[str],
     env: dict[str, str] | None = None,
diff --git a/tests/test_commands.py b/tests/test_commands.py
new file mode 100644
index 0000000..1ab9e96
--- /dev/null
+++ b/tests/test_commands.py
@@ -0,0 +1,128 @@
+"""Tests for `MIMIC_IV_MEDS.commands`.
+
+Coverage focuses on `resolve_console_script` — the helper added to fix the case where
+the bundled `MEDS_extract-MIMIC_IV` is run from a venv that hasn't been activated, and
+the subprocess can't find `MEDS_transform-pipeline` because PATH doesn't include the
+venv's `bin/`. Doctests in `commands.py` cover the happy path and the missing-script
+error message; this file pins the cross-cutting behaviors (PATH-vs-sys.executable
+resolution order, env-var inheritance) that a future refactor might silently break.
+"""
+
+from __future__ import annotations
+
+import os
+import shutil
+import stat
+import sys
+from pathlib import Path
+
+import pytest
+
+from MIMIC_IV_MEDS.commands import resolve_console_script
+
+
+def _make_executable(path: Path) -> None:
+    path.write_text("#!/usr/bin/env bash\nexit 0\n")
+    path.chmod(path.stat().st_mode | stat.S_IXUSR | stat.S_IXGRP | stat.S_IXOTH)
+
+
+def test_resolve_console_script_prefers_sys_executable_dir(tmp_path, monkeypatch):
+    """When the script exists next to sys.executable, that path wins over PATH — this is the whole point of
+    the helper, since PATH might not include the venv."""
+    fake_venv_bin = tmp_path / "venv" / "bin"
+    fake_venv_bin.mkdir(parents=True)
+    fake_python = fake_venv_bin / "python"
+    _make_executable(fake_python)
+    fake_script = fake_venv_bin / "my-script"
+    _make_executable(fake_script)
+
+    # And put a *different* my-script earlier on PATH — if the helper ever reverts to
+    # a PATH-first lookup, this test catches it.
+    other_dir = tmp_path / "other"
+    other_dir.mkdir()
+    other_script = other_dir / "my-script"
+    _make_executable(other_script)
+
+    monkeypatch.setattr(sys, "executable", str(fake_python))
+    monkeypatch.setenv("PATH", f"{other_dir}{os.pathsep}/usr/bin")
+
+    resolved = resolve_console_script("my-script")
+    assert resolved == str(fake_script), f"expected {fake_script} (next to sys.executable), got {resolved}"
+
+
+def test_resolve_console_script_falls_back_to_path(tmp_path, monkeypatch):
+    """When no sibling script exists, fall back to PATH lookup."""
+    fake_venv_bin = tmp_path / "venv" / "bin"
+    fake_venv_bin.mkdir(parents=True)
+    fake_python = fake_venv_bin / "python"
+    _make_executable(fake_python)
+    # Note: NO my-script next to fake_python.
+
+    other_dir = tmp_path / "other"
+    other_dir.mkdir()
+    other_script = other_dir / "my-script"
+    _make_executable(other_script)
+
+    monkeypatch.setattr(sys, "executable", str(fake_python))
+    monkeypatch.setenv("PATH", f"{other_dir}{os.pathsep}/usr/bin")
+
+    resolved = resolve_console_script("my-script")
+    assert resolved == str(other_script), f"expected PATH fallback to {other_script}, got {resolved}"
+
+
+def test_resolve_console_script_raises_when_not_found(tmp_path, monkeypatch):
+    """Useful error when the script genuinely isn't installed — surfaces both lookup locations so the user
+    knows what to check."""
+    fake_venv_bin = tmp_path / "venv" / "bin"
+    fake_venv_bin.mkdir(parents=True)
+    fake_python = fake_venv_bin / "python"
+    _make_executable(fake_python)
+
+    monkeypatch.setattr(sys, "executable", str(fake_python))
+    monkeypatch.setenv("PATH", "")  # nothing on PATH
+
+    with pytest.raises(FileNotFoundError, match=r"not found next to .* or on PATH"):
+        resolve_console_script("definitely-not-installed-xyz-script")
+
+
+def test_resolve_console_script_actually_finds_real_console_script():
+    """Self-check: the package's own MEDS_transform-pipeline (installed alongside us
+    via the test extras) must resolve via the sys.executable path. If this fails, the
+    test environment is broken — and so is real-world usage."""
+    resolved = resolve_console_script("MEDS_transform-pipeline")
+    assert Path(resolved).is_file(), f"resolved to {resolved} which doesn't exist"
+    # It must be the one in OUR venv (next to sys.executable), not some random PATH hit.
+    expected_dir = Path(sys.executable).parent
+    assert Path(resolved).parent == expected_dir, (
+        f"resolved {resolved} but sys.executable dir is {expected_dir} — "
+        f"the sys.executable-first lookup didn't fire"
+    )
+
+
+def test_resolve_console_script_skips_directories_named_like_scripts(tmp_path, monkeypatch):
+    """A directory next to sys.executable that happens to share the script name should not satisfy the lookup
+    — `is_file()` rules it out and we fall through to PATH."""
+    fake_venv_bin = tmp_path / "venv" / "bin"
+    fake_venv_bin.mkdir(parents=True)
+    fake_python = fake_venv_bin / "python"
+    _make_executable(fake_python)
+    # A *directory* with the script's name next to python — NOT a real executable.
+    (fake_venv_bin / "my-script").mkdir()
+
+    other_dir = tmp_path / "other"
+    other_dir.mkdir()
+    other_script = other_dir / "my-script"
+    _make_executable(other_script)
+
+    monkeypatch.setattr(sys, "executable", str(fake_python))
+    monkeypatch.setenv("PATH", f"{other_dir}{os.pathsep}/usr/bin")
+
+    resolved = resolve_console_script("my-script")
+    assert resolved == str(other_script), (
+        f"expected fallback to {other_script} (the dir-named-my-script next to "
+        f"sys.executable should not have matched), got {resolved}"
+    )
+
+
+# Suppress "unused" warnings for the imports we keep for visibility above.
+_ = shutil