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EMS News in Focus
by Arthur Hsieh

Waiting at the ER is a dangerous game

When ambulances are delayed, the community’s safety net becomes a teetering house of cards

By Arthur Hsieh

Ambulance diversions and prolonged emergency department wait times continue to plague EMS systems across the country. Judging from the story of nine Calif. ambulances delayed, two for 3½ hours, it’s an issue that isn’t about to go away anytime soon.

It adds unnecessary complexity and uncertainty to system operations. Patients are less satisfied. Relations between EMS and ED staff strain. There is unnecessary risk to the critical patient who must wait for emergency care and/or transport.

When ambulances are delayed, the community’s safety net becomes a teetering house of cards.

I suppose it can be emblematic of a complex, bureaucratic, fractured national health care system that is facing an impending meltdown. But the article does a very good job pointing out that most of the other hospitals within the system appear to be handling the patients being transported by ambulances in a timely manner.

I’ve heard this is much more the case in most areas where ambulance diversions are an issue — only a very few hospitals appear to not be able to manage their internal operations in an efficient manner. 

Indeed, there are hospitals that have not only addressed their ED overload situations, but improved their overall patient throughput. They do it by seeing patients right away, getting them triaged to the right level of care, and moving them through the hospital system with data systems that every link in the care chain has access to quickly. More importantly, the medical staff develops a mindset that promotes rapid care implementation — it improves patient satisfaction and improves the bottom line.

There is nothing wrong with that. 

I am a bit concerned that the EMS provider in this story is trying a workaround to what is a hospital throughput issue. It will cost them money and resources to implement a “concierge” system — and clearly, they are desperate to try anything that will help their operations avoid response time penalties.

While noble, this is no long term fix. It may take a heavy-handed approach by county regulators to force changes to a poorly managed system.

In the meantime, I’d be interested in knowing if you are experiencing ED delays within your system. Let me know your issues in the comments below.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Jon Levine Jon Levine Tuesday, February 18, 2014 4:55:14 PM Undoubtedly Napoleon complained to Larrey that the ambulances were taking too long clearing the hospitals, even a few years later I remember standing before the admitting at Man's Greatest Hospital in Boston for hours in my sparkling white on white "intern's uniform". The problem continued as I attained rank and starts, with the ever revolving close one hospital over load the next, which in turn would close and the whole issue would inefficiently go on and on, while EMS playing booking agent and taxi service for the receiving hospitals. Finally at the end of my career enough was enough and EMS unilaterally declared, if you close you're closed to everything inclluding the sexy cases. Outraged at this the hospitals complained to the regulatory powers, who in an unusual display of "testosterone declared that a hospital could not close unless totally unable to handle any patient including their private walk in referrals, that the hospital had to be physically incapable, declare it to the world and be responsible to clear up issues and would be automatically re-opened with a few hours. Miraculously after years of new triage systems increased staffs etc, the problem dissapeared . in the World' Greatest Hospital Want the details look at the Massachusetts Department of Public Health Policy on Hospital Closure and Ambulance Diversion

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