STUCK ON THE WALL

Dangerous ambulance delays creating a crisis in EMS system

On a brisk January evening last year, Sacramento City firefighters responded on a life-threatening cardiac arrest five minutes from a hospital. Bystander CPR and a quick fire medic response offered good odds for the patient once the ambulance arrived.

Problem was, there were no Sac City ambulances available. All of them were stuck at hospital emergency departments waiting to offload other patients. Eventually an ambulance had to be summoned from three cities and eight miles away – a 45-minute wait on a cardiac arrest blocks away from a hospital ER.

The incident is far from unique in California. Firefighters and paramedics up and down the state are increasingly being frozen in place in hospital emergency departments. Currently, they must continue providing care until the hospital takes charge. But hospitals aren’t taking charge, at least not right away. Ambulance patient offload times (APOT) that should take 20 to 30 minutes now frequently stretch for hours.

“We are treating patients in emergency rooms on our gurneys literally next to a wall,” said Long Beach Firefighters President Rex Pritchard. “That’s why they call it ‘wall time.’”

Dangerously long “wall times”, said one Southern California fire chief, “are arguably the most significant emergency medical crisis in our state’s history.”

• In Sacramento, paramedics were held on the wall for 2+ hours 700 times in 2021.

• In Long Beach, paramedic wall times can stretch to eight hours.

• In Los Angeles County, according to the fire department medical director, one crew was forced to wait on the wall for 24 hours.

• In Chula Vista, three- to four-hour wall times are “routine.”

• In San Diego, it’s not unusual to see a camp chair on the back of a gurney – something to sit on for the expected long wait.

“I’m on hospital property with my patient on a gurney, and I can see the ER, but I can’t go in because of the hospital wall times,” said San Jose firefighter-paramedic Corey Condren. “I’ve got ambulances behind us, and ambulances in front of us, and I’m stuck.”

Putting patients at risk

Extended APOT has been an issue in the EMS system for well over a decade. The problem came into sharper focus during the COVID-19 pandemic, notably in 2020, when already understaffed hospitals were maxed out. Yet, even as the pandemic eased, wall times have continued to grow in many areas well beyond the 20 minutes that is recognized within the industry as the target.

The impact of these delays ripples like dominoes through the entire EMS response system.

• Patients brought to the hospital have to wait, even in cases where a bed is available, because of short staffing.

• Firefighter-paramedics with those patients have to wait, meaning they are not available to respond to other calls.

• Critical patients in the field have to wait, as ambulances are summoned from far away while closer units are pinned to the wall.

“When ambulances are stuck on the wall, they can’t do their jobs protecting the public,” said CPF President Brian Rice. “That means longer and longer response times for other patients when seconds count. It can, literally, be a matter of life and death.”

Padding profits at taxpayer expense

Depending on when you ask them, hospitals have blamed epic wall times on employee shortages, labor issues, lack of bed space, unreimbursed care and, most recently, the COVID-19 pandemic. As recently as 2022, however, the Kaiser Family Foundation found profits at private hospitals in the U.S. were approaching record levels.

Firefighters on the front lines see a different problem: chronic understaffing in emergency rooms. The result: taxpayer-funded firefighters and paramedics are subsidizing private hospital staffs at public expense. “There’s not a lack of beds – there’s a lack of personnel next to those beds,” said Vista Firefighters President Miles Sweeney.

“It’s true that hospitals have struggled with COVID-19 and increasing demands on the healthcare system,” said President Rice, “but this can’t be an excuse for putting an endless tap on the taxpayer-funded emergency response system.”

AB 40: Holding hospitals accountable

Amid the gathering frustration among firefighters, fire management and many in the health care and EMS system, CPF is sponsoring legislation to impose upon hospitals the same kinds of accountability standards firefighters themselves must meet. Assembly Bill 40, authored by Assemblymember Freddie Rodriguez (D-Pomona) would, if enacted:

• Establish an enforceable statewide standard for ambulance patient offload times.

• Require a specific action plan from hospitals that fail to meet the standard

• Establish new data collection systems to track excessive wall times (and potential bad actors)

“Our firefighters are held to a very high standard as far as response times and patient care,” said Sweeney. “It’s time hospitals were held to a standard so they can keep their end of the bargain.”

Wall Time: Stories From the Front Lines