EMS Discussion - Urban Hospital Wait Time vs. Wall Time

Emergency Department (ED) delays are nothing new, but for EMS Providers, “wall time” is a unique challenge.

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?

The Life-Saving Evolution of Tourniquet Use: From Battlefield to EMS

The use of tourniquets has transformed trauma care, moving from a once-feared intervention to a cornerstone of life-saving strategies, both on the battlefield and in civilian emergency response.

Navy Captain (Ret.) Dr. Frank Butler, the architect of Tactical Combat Casualty Care (TCCC), helped shift the perception of tourniquets in the 1990s.

Earlier trauma care teachings viewed tourniquets as dangerous due to the risk of limb loss. However, research from past conflicts, and practical experience, revealed that failure to control extremity bleeding was a leading cause of preventable death.

With the rise of TCCC in military settings, particularly during the wars in Afghanistan and Iraq, the widespread adoption of tourniquets helped save thousands of lives by controlling life-threatening hemorrhage early.

This success led to updated guidelines emphasizing tourniquet conversion, replacing the tourniquet with other bleeding control methods within two hours to avoid complications when possible.

Despite its military success, civilian EMS was initially slow to adopt tourniquet use. That changed following the Hartford Consensus and the creation of the Stop the Bleed campaign after the Sandy Hook tragedy.

These efforts brought battlefield lessons to the civilian sector, empowering both the public and EMS providers to take swift action in bleeding emergencies.

The key takeaway for EMS providers is clear:

👉 Uncontrolled bleeding is a time-sensitive emergency

👉 Tourniquets, when used correctly, are a safe and essential tool in prehospital care

👉 Every EMS provider should be trained, equipped, and ready to use a tourniquet when needed

For a deeper dive into the history, science, and best practices behind tourniquet use, you can read the full article here: 

The Evolution of Tourniquet Use in Trauma Care by Public Safety Group, 2025