A conference session report from the 2025 EMS Administrators Association of California (EMSAAC) Conference with speakers Gregory Kahn, MD, EMS director, Sacramento County EMS; Jon Rudniki, assistant chief, Sacramento Metro Fire; and Kim Adams, ED director, Kaiser Roseville (Calif.) Medical Center offered proved strategies to reduce ambulance patient offload times.
|More: Ambulances held hostage: EMS strategies for reducing ambulance offload times
Bottom line up front
From December 2023 to April 2025, Sacramento County slashed average ambulance patient offload times (APOT) from 73 to 33 minutes. Kaiser Roseville, one of California鈥檚busiest EDs, dropped below 30 minutes and became a model for the region. The changes didn鈥檛 require a state mandate, expensive tech or finger-pointing.
This transformation required leaders willing to show up, collaborate and hand over the mic to the people doing the work.
Ambulance patient offload time 鈥� or APOT 鈥� isn鈥檛 just a metric. It鈥檚 a measure of our system鈥檚 ability to respond, reset and reach the next patient in need.
And in Sacramento County, APOT was once so dire, it earned a spot at the bottom of the state鈥檚 performance rankings. But through leadership, collaboration and laser focus on what truly matters 鈥� the patient 鈥� this region went from worst to among the best in under a year.
This is the story of how Sacramento broke the cycle. It鈥檚 a blueprint others can follow, and it starts not with a dashboard, but with a room full of people.
Patient offload times: Starting at rock bottom
When Dr. Gregory Kahn took over as EMS medical director for Sacramento County in late 2023, he inherited an APOT crisis: average offload times had reached 73 minutes and weren鈥檛 improving. EMS crews were stuck on the wall. Emergency departments were overwhelmed. Morale was low.
鈥淭here was no light at the end of the tunnel,鈥� Kahn told a packed room at this year鈥檚 EMSAAC conference. 鈥淲e had call volume records, transport records and zero slack in the system.鈥�
But instead of blaming the problem on hospitals or fire departments, Kahn picked up the phone and started building a coalition.
Summit strategy: Getting the family in the room
On Feb. 13, 2024, leaders from EMS, fire, hospitals, county government, union reps, private ambulance partners and behavioral health met for a full-day APOT summit, which was standing-room only.
鈥淲e treated it like a family meeting,鈥� Sacramento Metro Fire Assistant Chief Jon Rudniki recalled. 鈥淵es, there was pain. But we hugged it out and got on the same page.鈥�
And the unifying theme? The next patient.
鈥淭hat鈥檚 what ties us together,鈥� Rudnicki added. 鈥淲e may have different uniforms and roles, but we all care about the next call 鈥� the person who hasn鈥檛 dialed 911 yet, but will.鈥�
Empowering the front line
While high-level discussions were taking place, frontline change was already brewing. Kaiser Roseville ED Director Kim Adams left the summit inspired, and with her EMS liaison, launched an internal APOT task force. With no new budget, they redesigned their intake process using their own nurses to create 鈥淎mi Road鈥� 鈥� a designated care lane that absorbed patients quickly and started their treatment right away.
From over 70 minutes in February, Kaiser Roseville鈥檚 offload time dropped to 24 minutes by November 鈥� and stayed there, even during high census months.
The secret? Staff ownership, storytelling, and a clear message: 鈥淲e do this for the next patient.鈥�
Fire鈥檚 fixes and field empowerment
Meanwhile, Sacramento鈥檚 911 fire agencies implemented major operational changes:
- Dispatch drawdowns to avoid tying up resources on low-acuity calls
- 50/50 protocols giving paramedics decision-making power to move stable patients directly to waiting rooms 鈥� without waiting for nurse permission
- Surge plans activating private partners to cover when EMS system capacity dropped
- BLS units and telehealth pilots to absorb and redirect volume appropriately
鈥淚t wasn鈥檛 just about asking hospitals to do better,鈥� Rudnicki said. 鈥淲e had to step up, too 鈥� and we did.鈥�
Insert internal promo: Ambulances held hostage: EMS strategies for reducing ambulance offload times
The culture shift that stuck
Improving metrics is one thing. Sustaining momentum is another.
鈥淲e made storytelling a part of the culture,鈥� Adams said. 鈥淲hether it鈥檚 a cardiac arrest save or a new grad nurse moving a patient in under 5 minutes, we celebrate the wins and tie them back to our mission.鈥�
The team even shared a powerful case study: a Folsom man collapsed after a run, was reached quickly by EMS (because crews weren鈥檛 stuck at hospitals), and survived a cardiac arrest neurologically intact.
That, they say, is why this matters.
A global roadmap to reducing APOT
As I noted in the session Q&A, I鈥檝e run an ambulance service in the U.K. and faced the same APOT battle. What Sacramento has done isn鈥檛 just a California success 鈥� it鈥檚 a global roadmap to reducing patient offload times. They鈥檝e proven what happens when you stop arguing about who鈥檚 at fault and start focusing on who鈥檚 at risk: the patient still waiting for help.
To borrow this year鈥檚 EMSAAC theme, Sacramento is truly 鈥淯nited in mission.鈥�
Fill out the form on this page to download the Ambulance Patient Offload Time (APOT) Redesign Checklist based on Sacramento鈥檚 success story and built around the shared goal of 鈥渃aring for the next patient鈥� for every stakeholder group, including:
- EMS agency/fire departments
- Hospital emergency departments
- EMS agencies (regulatory/local EMS agencies [LEMSA])
- Private ambulance providers
- Hospital executive/administrative leadership
- Culture & communication strategies (all stakeholders)
References
- Kerr JF. (2022, March 23). 鈥淭he great resignation didn鈥檛 start with the pandemic.鈥� Human Resource Management.
- Kouzes JM, Posner BP. (2017). 鈥淭he Leadership Challenge鈥�. Hoboken: John Wiley & Sons, Inc.
- Robeano K. (2017). 鈥淪tay interviews to improve retention.鈥� Nursing Management, 48(9), 7-8.
