Unlike a walk-in patient who simply waits for triage, EMS crews remain fully responsible for their patient until the hospital formally accepts care.
This Ambulance Patient Offload Time (APOT) often ties up both crews and ambulances, straining already thin resources.
Studies show that in some systems, wall times regularly exceed one, two, or even three hours.
Beyond frustration, this means fewer available units, longer response times, and increased operational risk.
For EMS providers on the ground, it also raises questions about supply readiness, patient monitoring, and when exactly responsibility transfers to the hospital under EMTALA.
Some regions, like Sacramento County, CA, are experimenting with solutions, such as streamlined protocols that allow paramedics to place stable patients in waiting rooms, expanded surge plans, and telehealth pilots.
Legislation in California (AB-40) now requires standardized APOT reporting, bringing new transparency and accountability to the issue.
For providers, the takeaways are clear:
- Track your own wall times to build local data.
- Work collaboratively with ED staff and administrators.
- Confirm local protocols for patient care responsibilities during wall delays.
- Be operationally prepared for long waits by keeping supplies stocked and equipment ready.
Wall time isn’t just a hospital problem — it’s a system problem.
By understanding, measuring, and addressing it together, EMS providers can help push for solutions that keep both patients and ambulances moving.
This is a summary of an article written by Bob Elling for the Public Safety Group in August.
Further Reading:
https://www.psglearning.com/blog/psg/2025/08/15/urban-hospital-wait-time-and-wall-time?
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