Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses

Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses

February 14, 2022

Douglas F. Kupas, Matt Zavadsky, Brooke Burton, Shawn Baird, Jeff J. Clawson, Chip Decker, Peter Dworsky, Bruce Evans, Dave Finger, Jeffrey M. Goodloe, Brian LaCroix, Gary G. Ludwig, Michael McEvoy, David K. Tan, Kyle L. Thornton, Kevin Smith, Bryan R. Wilson

Download PDF Position Statement

The National Association of EMS Physicians and the then National Association of State EMS Directors created a position statement on emergency medical vehicle use of lights and siren in 1994 (1). This document updates and replaces this previous statement and is now a joint position statement with the Academy of International Mobile Healthcare Integration, American Ambulance Association, American College of Emergency Physicians, Center for Patient Safety, International Academies of Emergency Dispatch, International Association of EMS Chiefs, International Association of Fire Chiefs, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National EMS Management Association, National EMS Quality Alliance, National Volunteer Fire Council and Paramedic Chiefs of Canada.

In 2009, there were 1,579 ambulance crash injuries (2), and most EMS vehicle crashes occur when driving with lights and siren (L&S) (3). When compared with other similar-sized vehicles, ambulance crashes are more often at intersections, more often at traffic signals, and more often with multiple injuries, including 84% involving three or more people (4).

From 1996 to 2012, there were 137 civilian fatalities and 228 civilian injuries resulting from fire service vehicle incidents and 64 civilian fatalities and 217 civilian injuries resulting from ambulance incidents. According to the

U.S. Fire Administration (USFA), 179 firefighters died as the result of vehicle crashes from 2004 to 2013 (5). The National EMS Memorial Service reports that approximately 97 EMS practitioners were killed in ambulance collisions from 1993 to 2010 in the United States (6).

Traffic-related fatality rates for law enforcement officers, firefighters, and EMS practitioners are estimated to be 2.5 to 4.8 times higher than the national average among all occupations (7). In a recent survey of 675 EMS practitioners, 7.7% reported being involved in an EMS vehicle crash, with 100% of those occurring in clear weather and while using L&S. 80% reported a broadside strike as the type of MVC (8). Additionally, one survey found estimates of approximately four “wake effect” collisions (defined as collisions caused by, but not involving the L&S operating emergency vehicle) for every crash involving an emergency vehicle (9).

For EMS, the purpose of using L&S is to improve patient outcomes by decreasing the time to care at the scene or to arrival at a hospital for additional care, but only a small percentage of medical emergencies have better outcomes from L&S use. Over a dozen studies show that the average time saved with L&S response or transport ranges from 42 seconds to 3.8 minutes. Alternatively, L&S response increases the chance of an EMS vehicle crash by 50% and almost triples the chance of crash during patient transport (11). Emergency vehicle crashes cause delays to care and injuries to patients, EMS practitioners, and the public. These crashes also increase emergency vehicle resource use through the need for additional vehicle responses, have long-lasting effects on the reputation of an emergency organization, and increases stress and anxiety among emergency services personnel.

Despite these alarming statistics, L&S continue to be used in 74% of EMS responses, and 21.6% of EMS transports, with a wide variation in L&S use among agencies and among census districts in the United States (10).

Although L&S response is currently common to medical calls, few (6.9%) of these result in a potentially lifesaving intervention by emergency practitioners (12). Some agencies have used an evidence-based or quality improvement approach to reduce their use of L&S during responses to medical calls to 20-33%, without any discernable harmful effect on patient outcome. Additionally, many EMS agencies transport very few patients to the hospital with L&S.

Emergency medical dispatch (EMD) protocols have been proven to safely and effectively categorize requests for medical response by types of call and level of medical acuity and urgency. Emergency response agencies have successfully used these EMD categorizations to prioritize the calls that justify a L&S response. Physician medical oversight, formal quality improvement programs, and collaboration with responding emergency services agencies to understand outcomes is essential to effective, safe, consistent, and high-quality EMD.

The sponsoring organizations of this statement believe that the following principles should guide L&S use during emergency vehicle response to medical calls and initiatives to safely decrease the use of L&S when appropriate:

  • The primary mission of the EMS system is to provide out-of-hospital health care, saving lives and improving patient outcomes, when possible, while promoting safety and health in communities. In selected time-sensitive medical conditions, the difference in response time with L&S may improve the patient’s
  • EMS vehicle operations using L&S pose a significant risk to both EMS practitioners and the public. Therefore, during response to emergencies or transport of patients by EMS, L&S should only be used for situations where the time saved by L&S operations is anticipated to be clinically important to a patient’s outcome. They should not be used when returning to station or posting on stand-by
  • Communication centers should use EMD programs developed, maintained, and approved by national standard-setting organizations with structured call triage and call categorization to identify subsets of calls based upon response resources needed and medical urgency of the call. Active physician medical oversight is critical in developing response configurations and modes for these EMD protocols. These programs should be closely monitored by a formal quality assurance (QA) program for accurate use and response outcomes, with such QA programs being in collaboration with the EMS agency physician medical
  • Responding emergency agencies should use response based EMD categories and other local policies to further identify and operationalize the situations where L&S response or transport are clinically Response agencies should use these dispatch categories to prioritize expected L&S response modes. The EMS agency physician medical director and QA programs must be engaged in developing these agency operational policies/guidelines.
  • Emergency response agency leaderships, including physician medical oversight and QA personnel should monitor the rates of use, appropriateness, EMD protocol compliance, and medical outcomes related to L&S use during response and patient
  • Emergency response assignments based upon approved protocols should be developed at the local/department/agency level. A thorough community risk assessment, including risk reduction analysis, should be conducted, and used in conjunction with local physician medical oversight to develop and establish safe response
  • All emergency vehicle operators should successfully complete a robust initial emergency vehicle driver training program, and all operators should have required regular continuing education on emergency vehicle driving and appropriate L&S
  • Municipal government leaders should be aware of the increased risk of crashes associated with L&S response to the public, emergency responders, and patients. Service agreements with emergency medical response agencies can mitigate this risk by using tiered response time expectations based upon EMD categorization of calls. Quality care metrics, rather than time metrics, should drive these contract
  • Emergency vehicle crashes and near misses should trigger clinical and operational QA reviews. States and provinces should monitor and report on emergency medical vehicle crashes for better understanding of the use and risks of these warning devices.
  • EMS and fire agency leaders should work to understand public perceptions and expectations regarding L&S use. These leaders should work toward improving public education about the risks of L&S use to create safer expectations of the public and government

In most settings, L&S response or transport saves less than a few minutes during an emergency medical response, and there are few time-sensitive medical emergencies where an immediate intervention or treatment in those minutes is lifesaving. These time-sensitive emergencies can usually be identified through utilization of high-quality dispatcher call prioritization using approved EMD protocols. For many medical calls, a prompt response by EMS practitioners without L&S provides high-quality patient care without the risk of L&S-related crashes. EMS care is part of the much broader spectrum of acute health care, and efficiencies in the emergency department, operative, and hospital phases of care can compensate for any minutes lost with non-L&S response or transport.

Sponsoring Organizations and Representatives:

Academy of International Mobile Healthcare Integration
American Ambulance Association
American College of Emergency Physicians
Center for Patient Safety
International Academies of Emergency Dispatch
International Association of EMS Chiefs
International Association of Fire Chiefs
National Association of EMS Physicians
National Association of Emergency Medical Technicians
National Association of State EMS Officials
National EMS Management Association
National EMS Quality Alliance
National Volunteer Fire Council


References:

  1. Use of warning lights and siren in emergency medical vehicle response and patient transport. Prehosp and Disaster Med. 1994;9(2):133-136.
  2. Grant CC, Merrifield Analysis of ambulance crash data. The Fire Protection Research Foundation. 2011. Quincy, MA.
  3. Kahn CA, Pirallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective Prehosp Emerg Care. 2001;5(3):261-269.
  4. Ray AF, Kupas DF. Comparison of crashes involving ambulances with those of similar-sized vehicles. Prehosp Emerg Care. 2005;9(4):412-415.
  5. S. Fire Administration. Firefighter fatalities in the United States in 2013. 2014. Emmitsburg, MD.
  6. Maguire Transportation-related injuries and fatalities among emergency medical technicians and paramedics.

Prehosp Disaster Med. 2011;26(5): 346-352.

  1. Maguire BJ, Hunting KL, Smith GS, Levick Occupational fatalities in emergency medical services: A hidden crisis.

Ann Emerg Med, 2002;40: 625-632.

  1. Drucker C, Gerberich SG, Manser MP, Alexander BH, Church TR, Ryan AD, Becic Factors associated with civilian drivers involved in crashes with emergency vehicles. Accident Analysis & Prevention. 2013; 55:116-23.
  2. Clawson JJ, Martin RL, Cady GA, Maio RF. The wake effect: emergency vehicle-related collisions. Prehosp Disaster Med. 1997; 12 (4):274-277.
  3. Kupas DF. Lights and siren use by emergency medical services: Above all, do no harm. National Highway Traffic Safety Administration. 2017. Available online at https://www.ems.gov/pdf/Lights_and_Sirens_Use_by_EMS_May_2017.pdf
  4. Watanabe BL, Patterson GS, Kempema JM, Magailanes O, Brown LH. Is use of warning lights and sirens associated with increased risk of ambulance crashes? A contemporary analysis using national EMS information system (NEMSIS) Ann Emerg Med. 2019;74(1):101-109.
  5. Jarvis JL, Hamilton V, Taigman M, Brown LH. Using red lights and sirens for emergency ambulance response: How often are potentially life-saving interventions performed? Prehosp Emerg Care. 2021; 25(4): 549-555.

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Bloomberg Radio | President Baird on the Workforce Shortage

Fantastic Bloomberg Radio interview with President Shawn Baird covering key causes and impacts of the EMS workforce shortage.

Balance of Power Podcast • Browse all episodes
https://www.bloomberg.com/news/audio/2022-02-11/balance-of-power-ems-worker…
Balance of Power: EMS Worker Shortage Crisis (Radio)

Shawn Baird, President of the American Ambulance Association, discusses the shortage of emergency medical workers and paramedics. He spoke with Bloomberg’s David Westin.

Listen Now

EMS Gives Life | EMT Reid Needs a Living Kidney Donor

URGENT:  Fellow first responder Reid Cappel is in kidney failure and needs a kidney transplant.  A living donor is his best chance at survival. 


For years, Reid Cappel has selflessly served his New Jersey community as an emergency medical technician. Now, it is his turn to ask for a lifeline from his fellow public health and public safety professionals. Help Reid find a living kidney donor, so that he can get back to doing what he does best: caring for others.

Anyone who is healthy and eligible to be a kidney donor can give Reid the gift of life.  A donor does not have to be a direct match, can live anywhere in the US, and will have access to donor protections and resources.  EMS Gives Life, a nonprofit organization for first responders, by first responders, will provide guidance to our EMS, fire, and police brethren who are considering living donation.

All inquiries will be held in complete confidence.  There is no commitment required to learn more.  Meet Reid and learn more about living kidney donation at  www.emsgiveslife.org/Reid.

 

Statement for House Ways & Means Hearing on America’s Mental Health Crisis

Committee on Ways and Means

U.S. House of Representatives Hearing on “America’s Mental Health Crisis”

Statement of Shawn Baird, President, American Ambulance Association

February 2, 2022

Chairman Neal, Ranking Member Brady, and members of the Committee, on behalf of the members of the American Ambulance Association (AAA), I greatly appreciate the opportunity to provide you with a written statement on America’s Mental Health Crisis. Simply put, America’s hometown heroes who provide emergency medical services and transitional care need the Congress to recognize the significant stress and trauma paramedics and emergency medical technicians (EMTs) have experienced as a result of this pandemic. The AAA urges members of Congress not to forget these heroes and to expressly include all ground ambulance service personnel in efforts to address America’s Mental Health Crisis.

Emergency medical services (EMS) professionals are ready at a moment’s notice to provide life-saving and life-sustaining treatment and medical transportation for conditions ranging from heart attack, stroke, and trauma to childbirth and overdose. These first responders proudly serve their communities with on-demand mobile healthcare around the clock. Ground ambulance service professionals have been at the forefront of our country’s response to the mental health crisis in their local communities. Often, emergency calls related to mental health services are triaged to the local ground ambulance service to address.

While paramedics and EMTs provide important emergency health care services to those individuals suffering from a mental or behavioral health crisis, these front-line workers have been struggling to access the federal assistance they need to address the mental health strain that providing 24-hour care, especially during a COVID-19 pandemic, has placed on them. We need to ensure that there is equal access to mental health funding for all EMS agencies, regardless of their form of corporate ownership so that all first responders can receive the help and support they need.

EMS’s Enhanced Role in the Pandemic

As if traditional ambulance service responsibilities were not enough, paramedics and EMTs have taken on an even greater role on the very front lines of the COVID-19 pandemic. In many areas, EMS professionals lead Coronavirus vaccination, testing, and patient navigation. As part of the federal disaster response subcontract, EMS personnel even deploy to other areas around the country to pandemic hotspots and natural disasters to bolster local healthcare resources in the face of extraordinarily challenging circumstances.

Mental & Behavioral Health Challenges Drive Staffing Shortages on the Front Line

Myriad studies show that first responders face much higher-than-average rates of post- traumatic stress disorder[1], burnout[2], and suicidal ideation[3]. These selfless professionals work in the field every day at great risk to their personal health and safety—and under extreme stress.

Ambulance service agencies and fire departments do not keep bankers’ hours. By their very nature, EMS operations do not close during pandemic lockdowns or during extreme weather emergencies. “Working from home” is not an option for paramedics and EMTs who serve at the intersection of public health and public safety. Many communities face a greater than 25% annual turnover[4] of EMS staff because of these factors. In fact, across the nation EMS agencies face a 20% staffing shortage compounded by near 20% of employees on sick leave from COVID-19. This crisis-level staffing is unsustainable and threatens the public safety net of our cities and towns.

Sadly, to date, too few resources have been allocated to support the mental and behavioral health of our hometown heroes. I write today to ask for Congressional assistance to help the helpers as they face the challenges of 2022 and beyond.

Equity for All Provider Types

Due to the inherently local nature of EMS, each American community chooses the ambulance service provider model that represents the best fit for its specific population, geography, and budget. From for-profit entities to municipally-funded fire departments to volunteer rescue squads, EMS professionals share the same duties and responsibilities regardless of their organizational tax structure. They face the same mental health challenges and should have equal access to available behavioral health programs and services.

Many current federal first responder grant programs and resources exclude the tens of thousands of paramedics and EMTs employed by for-profit entities from access. These individuals respond to the same 911 calls and provide the same interfacility mobile healthcare as their governmental brethren without receiving the same behavioral health support from

Federal agencies. To remedy this and ensure equitable mental healthcare access for all first responders, we recommend that:

  • During the current public health emergency and for at least two years thereafter, eligibility for first responder training and staffing grant programs administered by the U.S. Department of Health and Human Services (such as SAMHSA Rural EMS Training Grants and HHS Occupational Safety and Health Training Project Grants) should be expanded to include for-profit entities. Spending on training and services for mental health should also be included as eligible program
  • Congress should authorize the establishment of a new HHS grant program open to public and private nonprofit and for-profit ambulance service providers to fund paramedic and EMT recruitment and training, including employee education and peer-support programming to reduce and prevent suicide, burnout, mental health conditions and substance use
  • Any initiatives to fund hero pay or death benefits for first responders should be inclusive of all provider models—for-profit, non-profit, and

The rationale for the above requests is twofold. First, ensuring the mental health and wellness of all EMS professionals—regardless of their employer’s tax status—is the right thing to do.

Second, because keeping paramedics and EMTs employed by private ambulance agencies who are on the frontlines of providing vital medical care and vaccinations during this pandemic is the smart thing to do.

Thank you for considering this request to support ALL of our nation’s frontline heroes. They are ready to answer your call for help, 24/7—two years into this devastating pandemic, will Congress answer theirs?

Please do not hesitate to contact American Ambulance Association Senior Vice President of Government Affairs, Tristan North, at tnorth@ambulance.org or 202-486-4888 should you have any questions.


  • Prevalence of PTSD and common mental disorders amongst ambulance personnel: A systematic review and meta-analysis. Soc Psychiatry Psychiatr 2018;53(9):897-909.
  • ALmutairi MN, El Mahalli AA. Burnout and Coping Methods among Emergency Medical Services Professionals. J Multidiscip Healthc. 2020;13:271-279. Published 2020 Mar 16. doi:10.2147/JMDH.S244303
  • Stanley, I. H., Hom, M. A., & Joiner, T. E. (2016). A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and Clinical Psychology Review, 44, 25–44. https://doi.org/10.1016/j. cpr.2015.12.002
  • Doverspike D, Moore S. 2021 Ambulance Industry Employee Turnover Study. 3rd Washington, DC: American Ambulance Association; 2021.

New for Members | 2022 Human Resources Manual!

The 2022 Human Resources Toolkit includes the addition of numerous practice notes intended to provide EMS leaders with a more practical understanding of the legal principles that necessitate much of the language found in many of the sample policies in the HR Manual. Additionally, the practice notes provide suggestions for EMS agencies to better insulate the organization from legal liability.

Members, Download Your Free PDF Copy!

Wall Time Toolkit

Extended ambulance patient offload times (APOT), or “wall times,” at hospitals are causing long waits for 911 and interfacility patients and exacerbating the EMS workforce shortage. Ambulance services across the country are continually trying to meet demand with fewer resources; when EMS providers are kept out of service for extended periods of time because they are unable to transfer patient care at the hospital, wait times for both 911 and inter-facility patients increase and both emergency and non-emergency calls pile up. 

We recognize that the issue of extended wall times is not new, but an existing problem exacerbated by the ongoing battle with COVID-19 across the country. Increased wall times are a symptom of a much larger problem for which there is no easy solution.

This toolkit will provide an overview of EMTALA, highlight the intersection between EMTALA and APOT, and address some frequently asked questions along with links to resources and examples of how services are addressing this issue across the country.

EMTALA – Emergency Medical Treatment and Labor Act
Summary of Major Provisions

  • The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that was enacted as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (42 U.S.C. §1395dd).
  • EMTALA provides that when an individual comes to an emergency department, he/she/they must be stabilized and treated, regardless of their insurance status or ability to pay.
  • EMTALA is often referred to as the “anti-dumping” law and was designed to prevent hospitals from transferring uninsured or Medicaid patients to another hospital without, at a minimum, providing a medical screening examination to ensure they were stable for transfer.
  • EMTALA requires the hospital to provide a screening examination to determine if an emergency medical condition exists and, if so, provide stabilizing treatment to resolve the patient’s emergency medical condition.
  • EMTALA requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner to anyone, regardless of their ability to pay, insurance status, national origin, race, creed, or color.

EMTALA & Ambulance Patient Offloading Times (APOT)

  • EMS agencies have been struggling with extended Emergency Department patient offload times. This has been exacerbated over the last few years of the COVID-19 pandemic.
  • This has impacted the ability of EMS agencies to provide services and respond to ambulance service requests. Additionally, it is impacting many public safety agencies that are responding to medical emergencies.
  • Centers for Medicare & Medicaid Services (CMS) issued a memorandum on extended ambulance patient offload times and EMTALA in July 2006.
    • In the memorandum, CMS noted “Many of the hospital staff engaged in such practice believe that unless the hospital “takes responsibility” for the patient, the hospital is not obligated to provide care or accommodate the patient”
    • CMS stated that this practice may result in a violation of the Emergency Medical Treatment and Labor Act (EMTALA) and “raises serious concerns for patient care and the provision of emergency services in a community.”
    • Additionally, CMS notes that this practice may also result in a violation of 42 CFR 482.55, the Conditions of Participation for Hospitals for Emergency Services, which requires that a hospital meet the emergency needs of patients in accordance with acceptable standards of practice.
    • EMTALA defines[1] when a patient “presents” at an emergency department in the following way:

(1) Has presented at a hospital’s dedicated emergency department, as defined in this section, and requests examination or treatment for a medical condition, or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual’s appearance or behavior, that the individual needs examination or treatment for a medical condition;

(2) Has presented on hospital property, as defined in this section, other than the dedicated emergency department, and requests examination or treatment for what may be an emergency medical condition, or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual’s appearance or behavior, that the individual needs emergency examination or treatment;

(3) Is in a ground or air ambulance owned and operated by the hospital for purposes of examination and treatment for a medical condition at a hospital’s dedicated emergency department, even if the ambulance is not on hospital grounds. However, an individual in an ambulance owned and operated by the hospital is not considered to have “come to the hospital’s emergency department” if –

(i) The ambulance is operated under communitywide emergency medical service (EMS) protocols that direct it to transport the individual to a hospital other than the hospital that owns the ambulance; for example, to the closest appropriate facility. In this case, the individual is considered to have come to the emergency department of the hospital to which the individual is transported, at the time the individual is brought onto hospital property;

(ii) The ambulance is operated at the direction of a physician who is not employed or otherwise affiliated with the hospital that owns the ambulance; or

(4) Is in a ground or air nonhospital-owned ambulance on hospital property for presentation for examination and treatment for a medical condition at a hospital’s dedicated emergency department. However, an individual in a nonhospital-owned ambulance off hospital property is not considered to have come to the hospital’s emergency department, even if a member of the ambulance staff contacts the hospital by telephone or telemetry communications and informs the hospital that they want to transport the individual to the hospital for examination and treatment. The hospital may direct the ambulance to another facility if it is in “diversionary status,” that is, it does not have the staff or facilities to accept any additional emergency patients. If, however, the ambulance staff disregards the hospital’s diversion instructions and transports the individual onto hospital property, the individual is considered to have come to the emergency department.

[1] 42 CFR § 489.24(b) – Special responsibilities of Medicare hospitals in emergency cases.

APOT Strategies

  • EMS agencies who are experiencing extended ambulance patient offload times should engage the hospital leadership to collaborate to identify possible solutions. Often, we assume that the hospital leadership is aware that the EMS crews are being held for extended periods of time. Also, the hospital may not understand how APOT is impacting your organization and the overall EMS and public safety response.  Emphasize that EMS is one piece of a larger EMS system.
  • EMS agencies should consider educating or reminding the hospital leadership about their obligations under EMTALA.
  • Consider placing a transfer coordinator or another member of your staff to stay with patients during the transition between EMS and ED care. The EMS agency is under no obligation to do this and could set a precedent or expectation by the hospital that extended APOT is the EMS agency’s responsibility.  However, it may serve to free up valuable EMS resources.

EMTALA & APOT Frequently Asked Questions

  1. Are EMS personnel required to remain with the patient until an emergency department personnel “accept” report or “takes over care” of the patient?

Answer: No, the EMS crew is not legally required to remain with the patient until the hospital personnel take a report or take over patient care.  As the EMTALA provisions above cite, the EMS crew may choose to remain with the patient but, as soon as that patient arrives on hospital property or enters the emergency department, the hospital is legally responsible for the patient.

  1. What if the patient’s condition requires constant attention and the patient cannot be left alone without causing the patient harm?

Answer:  If the patient’s condition dictates that the patient cannot be safely left alone, the crew would have an ethical obligation to continue to care for the patient until care can be safely transferred to the appropriate caregiver. The EMS crew should continue to provide patient care and should contact a supervisor or Officer in Charge (OIC) at their agency to inform them of the situation and request assistance with facilitating the transfer of care.

  1. What do I do if the emergency department staff fail/refuse to take a report or take over care of the patient?

Answer:  The EMS crew should attempt to provide a verbal report to an emergency department staff member if possible.  If no one is available, or the hospital staff will not make someone available to take a verbal report, the crew should tell an ED staff member that the EMS crew will be leaving the patient, where the patient was left and the patient’s general condition.  EMS providers should document how long they waited after arriving at the ED, where they left the patient, which ED staff member they notified, and the patient’s condition when they left in their patient care report.  EMS providers should be sure to leave a copy of their patient care report or an abbreviated patient care report with the hospital staff or with the patient.

In some states, extended APOT may be reportable to the state-level oversight agency, such as the state EMS Office or the Department of Public Health.

If hospitals are unresponsive to the initial conversation, you could also consider escalating the issue to your State Survey Agency, the agency primarily charged with taking EMTALA complaints.

We have created a draft letter for use in communicating with your State Survey Agency; be sure to update the draft letter to include specific examples and data that illustrate the particular issues your service is facing and the steps you’ve taken to try and resolve the issue so far.

  1. Can I be accused of patient abandonment if I leave a patient in the ED without a member of the ED staff taking over the care of the patient?

Answer:  Because the legally becomes the hospital’s responsibility upon arrival on hospital property or upon arrival in the ED, it is highly unlikely that a claim of abandonment could be sustained.  The most important thing EMS providers can do is to exercise reasonable care of the patient before, upon, and after arrival at the ED.  EMS providers who reasonably attempt to furnish a report to the ED staff or who ensure that the patient can be safely left at the ED with either an abbreviated or full patient care report will likely be protected from liability.

Additional Resources

Best Practices for Mitigating Ambulance ED Delays webinar

California Emergency Medical Services Authority Ambulance Patient Offload Time (APOT) webpage

CMS Regional Office Directory

Statewide Method of Measuring Ambulance Patient Offload Times

State Survey Agency Directory
This is the agency primarily charged with receiving EMTALA complaints.

Wall time Collaborative a partnership to reduce ambulance patient off-load delays
presentation from 2013

In the News:

EMS crews forced to wait hours to drop patients at overwhelmed hospitals

National EMS Advisory Council Meeting Webcast Feb. 9-10

From EMS.gov on January 27, 2022

Register Now for the National EMS Advisory Council Meeting Webcast Feb. 9-10

The National EMS Advisory Council will be holding a virtual meeting on Wednesday and Thursday, February 9-10. Members of the public can register for the webcast here.

NEMSAC meets several times each year to discuss issues facing the EMS community and provide advice and recommendations regarding EMS to the National Highway Traffic Safety Administration in the Department of Transportation and to the Federal Interagency Committee on EMS.

The agenda for each day includes time for NEMSAC subcommittee deliberations in the morning, with the webcast council meeting convening at 12:00 pm ET on Wednesday, February 9, 2022, and 1 pm ET on Thursday, February 10, 2022. Items on the council’s agenda include:

– FICEMS COVID-19 Response

– National Suicide Hotline Update

– Reviewing the Need for EMS and Obstetric Collaboration

– Rural, Tribal and Frontier EMS Challenges

– Improving Stroke Triage and Transport Protocols for EMS

– Public Comment

Individuals registered for the meeting interested in addressing the council during the public comment periods must submit their comments in writing to Clary Mole at clary.mole@dot.gov by 5pm ET on February, 3, 2022.

This meeting will be open to the public. NHTSA is committed to provide equal access to this meeting for all program participants.  Persons with disabilities in need of an accommodation should send your request to Clary Mole by phone at (202) 868-3275 or by email at Clary.Mole@DOT.gov no later than February 3, 2022. A sign language interpreter will be provided, and closed captioning services will be provided for this meeting through the WebEx virtual meeting platform.