Why Ambulances Are Stuck Waiting Instead of Saving Lives

A new medical drama called The Pitt premiered last month to widespread acclaim for its moving plotlines and medical accuracy. Yet, while Hollywood often gets the big moments right — like life-saving surgeries and dramatic rescues — it rarely portrays one of the most pressing issues in emergency care: wall times.

Wall time refers to the period an ambulance crew has to wait in an ambulance bay or ER hallway (with patients on gurneys) before hospital staff can assume responsibility for the patient. While long emergency department wait times — patients sitting for hours before being “roomed” and seen by a doctor — are well known, few realize that ambulances, too, are stuck in line.

TV shows depict paramedics rushing into trauma bays and seamlessly handing off patients to hospital staff after arriving at the ER following a 911 call. But in reality, emergency department crowding, a symptom of a deeply strained healthcare system, has become so dire that even ambulances are now waiting for nurses and doctors to transfer care of these patients.

The consequences of these prolonged wall times, also known as ambulance patient offload times (APOT), are severe. The longer a patient with a heart attack, stroke or undiagnosed abdominal pain waits in an ambulance rather than receiving immediate hospital care, the worse their outcomes.

But APOT is not just a hospital problem, it’s a system-wide crisis. Every minute an ambulance is stuck waiting, it is unavailable to respond to the next 911 call. With fewer ambulances in service, entire communities face increased emergency response times. Beyond patient care, prolonged APOT impacts the financial viability of emergency medical services, which rely on transporting patients to fund and sustain operations.

How often does this happen? A few months ago, my team and I published a report looking at more than 5.9 million patient transports from January 2021 to June 2023 in California. Per the California Health and Safety Code Section 1797.120, the standard offload time for patients arriving by ambulance should be no more than 30 minutes in 90% of cases. Instead, we found that the statewide average of these times was 42.8 minutes — far exceeding the standard. That means that the ambulance crew had to wait, on average, 42.8 minutes after arriving at the emergency department to transfer care of that patient to hospital staff. Seventy-nine percent of all the patients transported to emergency departments waited longer than 30 minutes, and nearly half of California’s 34 local emergency medical services agencies reported average wait times exceeding the state benchmark. Even more alarming, the majority of EMS agencies reported that their patient offload times have been getting worse, not better, over the past few years.

What about the rest of the country? Unfortunately, we have little information since California is the only state to mandate this reporting for all EMS agencies. What we do know is that neither EMS agencies nor emergency departments are to blame. Some policymakers suggest requiring more detailed APOT reporting. Others propose appointing ambulance offload nurses or patient flow coordinators to expedite transfers. But these are temporary fixes that fail to address the root cause: a healthcare system that is failing to match the supply with demand. Truly addressing these increasingly long ambulance patient offload times requires addressing comprehensive, system-level causes of hospital crowding.

What does this look like in real life? A member of my lab also works as a part-time emergency medical technician with a local ambulance company. A few weeks ago, he described a chilling experience that highlights this crisis. He received a call for a “traumatic arrest,” meaning that the patient’s heart had stopped beating and that the mechanism of injury had been trauma-related. En route to the nearest trauma center, the ambulance crew was simultaneously performing CPR while also calling the hospital to inform them they were coming in with “lights and sirens,” also known as “Code 3,” with a priority-one traumatic arrest patient. Yet, when they reached the emergency department, still actively performing chest compressions and managing the patient’s airway, no one was there to meet them.

The reality is that America’s healthcare system is suffocating. Longer APOT times are like the canary in the coal mine — they show us that there is very little oxygen in the healthcare mine that we’re in. It is a warning that hospitals, emergency medical services and our healthcare system itself are being stretched beyond capacity. Rather than treating the symptom, we must address the root cause of hospital overcrowding — whether through better patient flow management, working to reduce preventable hospitalizations or ensuring post-hospital care to free up beds.

You likely won’t see ambulances waiting in hospital hallways in the next ER drama you watch on TV. But unfortunately, you might experience it.