APOT Page Draft Review ONLY

Ambulance Patient Offload Time (APOT)

Emergency Medical Services (EMS) and Hospital Coordination 

Ambulance Patient Offload Time, or APOT, is the time it takes to transfer a patient from an ambulance to a hospital emergency department (ED) and for the ED staff to assume responsibility for the patient's care. APOT begins when an ambulance arrives at the ED and ends when the patient is moved to a hospital bed, chair, or room in the ED. 

A combination of factors can increase patient offload times, including surges in patient volume in the ED, lack of beds and equipment, and staffing shortages. Whatever the cause, increased offload times can negatively impact patient care, reduce EMS unit availability to respond to emergencies or 911 calls, or to provide interfacility transports to other hospitals or specialty care facilities, such as stroke centers or trauma centers. 

Effective coordination between EMS systems and hospital emergency departments is vital to patient care and public health. Extended offload times can reduce the availability of EMS units to respond to 911 calls or provide interfacility transports for hospitals.

Key Definitions

  • Wall Time/Patient Offload Time: APOT is the time that begins when an EMS unit arrives at the hospital and ends when a full patient report is given to hospital staff, EMS equipment is returned, and the patient is placed in a hospital bed or chair, officially transferring care from EMS to the hospital.  During this time, the patient remains on the ambulance stretcher, and EMS personnel are unavailable to respond to new emergencies.
  • 90th Percentile: The number of minutes within which 90% of EMS patients are transferred to hospital care. The metric provides a valuable measure of system performance while excluding outlier delays. 

Statewide Goal

The statewide goal is to transfer EMS patients to hospital staff within 20 minutes or less, 90% of the time (90th percentile), after EMS arrival at a hospital. There is no federally mandated standard for APOT; however, a widely accepted national benchmark is 20 minutes or less. This target is supported by organizations such as the National Highway Traffic Safety Administration (NHTSA) and the National EMS Quality Alliance (NEMSQA). 

Reporting

APOT reports are published twice a year for the following periods:

  • January–June
  • July–December

All time elements used to determine APOT are based on national standard data elements defined by the National Emergency Medical Services Information System (NEMSIS). All EMS agencies are required to document and report these metrics. For more information, visit www.nemsis.org. 

Note: APOT data does not account for transport to a hospital that may be on diversion status. In some cases, EMS will transport a patient to a hospital, even if it is on diversion status, if the patient is critical and it is the closest most appropriate hospital, or if a patient is adamant about being transported to that hospital. 

DPH's Role

The Georgia Department of Public Health (DPH), Office of EMS and Trauma, compiles the APOT data to show how hospitals are performing and to foster improvement in offload times and communication between partners.  

For questions or additional information, please contact:
Office of EMS and Trauma at [email protected] or 770-996-3133.

 

Page Updated 7/31/2025