Contra Costa County Grand Jury
• 2025-2026
Ambulance Patient Offload Delays: Time Is of the Essence
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 31 findings
F1
Ambulance Patient Offload Time (APOT) is the time it takes from ambulance arrival at a hospital until the patient is accepted by the emergency department.
No recommendations for this finding
F2
An Ambulance Patient Offload Delay (APOD) occurs when the time taken for an ambulance patient offload transfer to a hospital emergency department exceeds the required standard.
No recommendations for this finding
F3
California Health & Safety Code Section 1797.120.5 (b)(1) mandates that every Local Emergency Medical Services Agency (LEMSA) develop an APOT standard of not to exceed 30 minutes 90% of the time, measured monthly.
No recommendations for this finding
F4
The County LEMSA has adopted an APOT standard not to exceed 20 minutes 90% of the time, measured monthly.
No recommendations for this finding
F5
The County LEMSA Quarterly reports demonstrate that APODs in Contra Costa County have been occurring since at least 2020.
No recommendations for this finding
F6
The County LEMSA does not have the authority to enforce compliance with its APOT standard.
No recommendations for this finding
F7
County Emergency Medical Services (EMS) Standard Policy 4010 requires that ambulance personnel provide continuity of care to patients until they are accepted into the emergency department.
No recommendations for this finding
F8
APODs prevent EMS personnel from responding to other emergencies in the County.
No recommendations for this finding
F9
ConFire’s ambulance transports have increased 14% from 2021 to 2025.
No recommendations for this finding
F10
Emergency department usage at Contra Costa Regional Medical Center (CCRMC) has increased 15% from 2021 through 2024.
No recommendations for this finding
F11
CCRMC’s average monthly APOTs have consistently exceeded the County LEMSA standard of not to exceed 20 minutes 90% of the time since January 2020.
Related Recommendations (1)
R1
By April 1, 2027, the Board should consider retaining a consultant to evaluate CCRMC’s emergency department throughput and to make recommendations on how to reduce or eliminate APODs.
F12
Contra Costa County Psychiatric Emergency Services (PES) has the highest APODs in the County, with monthly 90th percentile averages exceeding one hour for each year from 2020 to 2025.
No recommendations for this finding
F13
PES does not have a prescreening area to triage patients who might not need a complete behavioral assessment.
No recommendations for this finding
F14
PES has physical limitations that only allow one patient at a time to be given an intake assessment.
No recommendations for this finding
F15
PES currently has unbudgeted architectural plans for expansion.
No recommendations for this finding
F16
PES expansion would reduce the frequency and duration of APODs by providing additional screening and intake space.
Related Recommendations (1)
R5
By April 1, 2027, the Board should consider exploring sources of funding for construction of the proposed PES expansion.
F17
The County EMS system is being used by low-acuity patients.
Related Recommendations (3)
R3
By April 1, 2027, the Board should consider directing the County LEMSA to assess whether any current County LEMSA regulations and policies limit EMS personnel’s ability to redirect low-acuity patients to appropriate levels of care.
R6
By April 1, 2027, the Contra Costa County Fire Protection District should consider expanding the use of its Nurse Navigation Programs to divert low-acuity callers from 911 ambulance responses when clinically appropriate.
R7
By April 1, 2027, the Board should consider using the County LEMSA’s ambulance response exceedance fines to expand the County’s “Right Care, Right Way” initiative countywide to reduce unnecessary emergency department usage.
F18
Low acuity usage of the County emergency medical services system increases the risk of APODs.
Related Recommendations (3)
R3
By April 1, 2027, the Board should consider directing the County LEMSA to assess whether any current County LEMSA regulations and policies limit EMS personnel’s ability to redirect low-acuity patients to appropriate levels of care.
R6
By April 1, 2027, the Contra Costa County Fire Protection District should consider expanding the use of its Nurse Navigation Programs to divert low-acuity callers from 911 ambulance responses when clinically appropriate.
R7
By April 1, 2027, the Board should consider using the County LEMSA’s ambulance response exceedance fines to expand the County’s “Right Care, Right Way” initiative countywide to reduce unnecessary emergency department usage.
F19
Redirecting people who do not require emergency medical services to appropriate alternative care reduces the risk of APODs.
No recommendations for this finding
F20
County emergency medical and behavioral health responders use an ambulance with life support equipment to transport persons having a behavioral crisis and/or who are on a 5150 hold to PES when law enforcement does not do so.
Related Recommendations (1)
R4
By April 1, 2027, the Board should direct the County A3 Program to consider using non- ambulance vehicles to transport persons in a behavioral crisis and/or who are on a 5150 hold and not having a medical emergency, as recommended in the Fitch & Associates Report, titled EMS System Assessment Summary Briefing Report.
F21
The County does not have a sobering center.
No recommendations for this finding
F22
The County has plans and funding to build the Los Medanos Recovery Center.
No recommendations for this finding
F23
The Board of Supervisors has a goal to reduce emergency department usage by building the Los Medanos Recovery Center.
No recommendations for this finding
F24
The Contra Costa County Fire Protection District’s Nurse Navigation Program can divert low-acuity patients from the emergency medical system by redirecting them to appropriate non- emergency care.
No recommendations for this finding
F25
The County’s “Right Care, Right Way” initiative is designed to reduce low-acuity patient usage of ambulances and emergency departments by giving the public information about appropriate non-emergency alternatives.
No recommendations for this finding
F26
CCRMC uses a dedicated nurse to triage patients arriving by ambulance with a goal of improving APOTs.
No recommendations for this finding
F27
CCRMC’s APOT Reduction Protocol, implemented on September 1, 2024, does not cite the County LEMSA APOT standard not to exceed 20 minutes 90% of the time.
No recommendations for this finding
F28
CCRMC’s APOT Reduction Protocol does not provide specific criteria for activation of the protocol, as required by California Code of Regulations, Title 22, Division 9, Chapter 1.2, Section 100002.03.
Related Recommendations (1)
R8
By April 1, 2027, the Board should consider requiring CCRMC to update its APOT Reduction Protocol to meet the requirements of California Code of Regulations, Title 22, Division 9, Chapter 1.2, Section 100002.03.
F29
The County LEMSA has not notified the hospitals in the County that their APOT Reduction Protocols do not cite the applicable County LEMSA standard.
Related Recommendations (2)
R9
By April 1, 2027, the Board should consider requiring the County LEMSA to notify CCRMC that its APOT Reduction Protocol does not cite the applicable LEMSA APOT standard of not to exceed 20 minutes 90% of the time.
R10
By April 1, 2027, the Board should consider requiring the County LEMSA to notify any hospital in the County when its APOT Reduction Protocol cites a standard longer than the County LEMSA standard.
F30
As of March 2026, the County LEMSA has a current balance of $1,062,715 from fire district fines assessed when ambulance response times exceeded contracted times.
Related Recommendations (1)
R2
By April 1, 2027, the Board should consider using the County LEMSA’s ambulance exceedance fine collections for the cost of an emergency department throughput consultant.
F31
The Board of Supervisors (Board) does not have the County LEMSA’s quarterly APOT reports as a standing agenda Board item.
Related Recommendations (1)
R11
By April 1, 2027, the Board should consider requiring the County LEMSA to provide the Board with its quarterly reporting on the status of APOTs in the County.
In the News 1
News coverage of this report, automatically tracked.
When Every Minute Counts: Grand Jury Says Ambulances Are Waiting Too Long At Contra Costa Hospitals
CLAYCORD
· June 15, 2026