Sacramento County has some of the highest ER wait times in the state

Sacramento County’s Emergency Medical Services medical director says the county has some of the longest wait times in the state for patients who are seeking care in emergency departments. 

Dr. Greg Kann reported to the Sacramento County Board of Supervisors on Tuesday that, in September, the average time it took for a patient to be transferred from an ambulance to a bed in an emergency department was 56 minutes, the second worst rate in the state. 

Since October 2022, according to data shared at the supervisors’ meeting, that time has averaged at about 69 minutes. The wait time is worse during the holidays: Last December, it took an average of 84 minutes for someone to be accepted into an emergency department bed. 

Kann said people who are having obvious heart attacks, strokes or physical trauma are triaged more quickly. However, people who call 911 with an undetermined cause for their chest or abdominal pain or shortness of breath could be waiting for over an hour to get care. 

“You don't know who the ticking time bomb is,” he said. “Those ticking time bombs are sitting on the wall in our emergency departments right now — this very second.”

The length of time someone has to wait for care is referred to as Ambulance Patient Offload Time, or APOT. According to Kann, the average national APOT is about 25 minutes, and in California it’s about 40 minutes. 

One consequence of long offload times is that emergency responders can become tied up waiting with their patients until the emergency department staff take responsibility for them. 

Kann said recently, local dispatchers got a 911 call from Galt, and the nearest available fire medic was from Folsom, about 40 miles away. He said other paramedics who might have responded to the call were “waiting on the wall” for their patients to be admitted into the ED.   

“We are nowhere near what we need to do or where we need to be in order to provide the people who live in this county with the care that they deserve,” Kann said.

A new state law would require all local emergency medical services providers to develop a plan by July 2024 to get their ambulance patient offload time to 30 minutes 90% of the time. The law, Assembly Bill 40, was opposed by the California Hospital Association. The association agreed emergency departments are backed up, but argued about 77% of calls to the emergency room don’t require emergency care, and are for ailments like back pain, a sore throat or minor cuts. They said the suggested time of 30 minutes was an unrealistic expectation. 

“With many communities lacking primary care resources, many patients turn to the [emergency department] for non-emergency needs,” they said in a letter to Governor Gavin Newsom, urging his veto of the bill. “At the same time, the lack of community care discharge options, shortages of health care workers, and an increase in patients in a behavioral health crisis have led to unprecedented overall [emergency department] volumes — a 42% increase in the last seven years.”

Among other things, the association called for a public education campaign on the correct use of 911 and increased community-based behavioral health resources.

Despite the association's opposition, Newsom signed the bill into law last month. Now, Sacramento County is experimenting with possible ways to reduce offload times. 

Kann said emergency responders will have more locations to bring people to in 2024, thanks to another state law that allows for more on-site care and permits emergency responders to take patients straight to mental health facilities or sobering centers, instead of to the emergency department first. 

Meanwhile, members of the Sacramento Metropolitan Fire District say one of their initiatives, Mobile Integrated Health, is already reducing reliance on emergency departments by dealing with health issues in the field. 

Sac Metro’s program pairs a physician’s assistant or nurse practitioner with a paramedic, allowing the teams to provide targeted care and even write prescriptions in the field. Sac Metro Battalion Chief Scott Perryman says the unit is also helping treat people for the county jail, so they don’t need to travel to the emergency room. 

“We can do those sutures, we can do the taser removals. We can do the dog bite fixes, we can do so many different things where we avoid the emergency room,” he said.

District 2 Supervisor Patrick Kennedy said he believed Mobile Integrated Health units were not technically permitted by the state. That’s true, said EMS administrator Dave Magnino. 

“It's that old saying; do it and then ask for forgiveness,” he said, adding that the state has not sent cease and desist letters to any of the other counties operating similar programs, so they are operating on that precedent. 

Supervisors said they were eager to help address the APOT issue, including by advocating for the approval and funding of mobile integrated health units on the state level.