Council Connect Articles

EMSA Releases Policy Revisions related to Ambulance Patient Offload Times (APOT), Receiving Hospital Standards, and Diversion


  • Hospital Council
  • San Francisco Emergency Medical Services Agency (EMSA) 
  • San Francisco Department of Public Health
  • San Francisco Fire and Ambulance Providers


San Francisco EMSA recently released policy revisions related to APOT, receiving hospital standards, and diversion. As proposed, these policies shift the burden of resolving long-standing challenges with offload times and level-loading directly on the hospitals. Policies include ill-conceived penalties such as taking an entire emergency department offline for 24 hours, should it fail to meet articulated APOT standards. EMSA leadership planned initially to implement these policies quickly and without much engagement with hospitals. San Francisco hospital CEOs met directly with the EMSA medical director and the acting agency director to communicate deep concern about lack of a multi-stakeholder process that will facilitate a root cause analysis. As well, hospital teams are participating in advisory committee meetings where concerns and recommendations have been strongly voiced. It appears these efforts have yielded some measure of success — Hospital Council has received communication from EMSA offering some alternatives and timelines that allow for more substantive analysis and collaboration.

Takeaway/Next Steps

Hospitals will review EMSA’s proposal and determine appropriate and timely next steps. San Francisco hospitals are committed to working in partnership with all stakeholders to ensure effective policies and practices are created through consensus.