EMS Offload Policy

Section 1 - ADMINISTRATIVE POLICIES

1.16 EMS OFFLOAD POLICY

It is EMS’ intent to offload patients immediately upon arrival to the Emergency Department so that the units are available to their service area and their community in a timely manner. We also understand that upon arrival to the emergency departments, that the care of the patient is the hospital’s responsibility.

There are times we recognize that offload delays may occur due to:

• Capacity issues in the department/hospital
• Number of EMS units arriving in the department at the same time
• Acuity of patients arriving by EMS or walk-in.

EMS wait time: Actual time from EMS unit entering department to the offload of the patient from the EMS stretcher to a hospital location including waiting room. This coincides with the EMS unit’s arrival time to transfer time radio reports. Under ideal conditions, the expectation is that this will take 15 minutes.

NOTE: These time parameters apply when the patient is stable. In the event the patient is unstable and the offload time exceeds fifteen (15) minutes, the crew will make immediate notification of this offload delay to their respective Battalion Chief.

IN CONDITION GREEN: (45 MINUTE MAXIMUM)

• Upon arrival to the department, The EMS crew member will meet with the charge RN, EMS triage RN, or designated RN so this nurse can provide a primary triage assessment of the patient.
• If patient care has not been turned over to the ED staff at 15 minutes from arrival, the crew will notify the Seminole County Communications Center of “DELAYED OFFLOAD” in accordance with SC Practice Parameter 1.15.
• When 20 minutes have elapsed from time of arrival, the EMS crew will notify the charge RN that they have waited 20 minutes of the 45 minute maximum wait time and the EMS crew will be required to leave at or before 45 minutes.
• If the wait for offload continues to 30 minutes, the EMS crew will again notify the charge RN that they have now waited 30 minutes of the 45 minute maximum wait time and the EMS crew will be required to leave at or before 45 minutes.
• If the wait for offload continues to 45 minutes, the EMS unit may leave the patient in the department and return to service. The EMS crew member will notify the charge RN that they are leaving and returning to service. It is recommended that the ED charge RN should immediately provide staff and a stretcher prior to the EMS staff leaving the department. If a stretcher or location is not provided, the EMS crew will create an offload option which may include triage chair, triage stretcher, vacant stretcher, wheel chair or foldable cot.

IN CONDITION YELLOW: (30 MINUTE MAXIMUM)

• Upon arrival to the department, The EMS crew member will meet with the charge RN, EMS triage RN, or designated RN so this nurse can provide a primary triage assessment of the patient. The crew will advise them that Seminole County EMS is in condition yellow which mandated a 30 minute maximum offload delay time.
• If patient care has not been turned over to the ED staff at 15 minutes from arrival, the crew will notify the Seminole County Communications Center of “DELAYED OFFLOAD” in accordance with SC Practice Parameter 1.15.
• When 20 minutes have elapsed from time of arrival, the EMS crew will notify the charge RN that they have waited 20 minutes of the 30 minute maximum wait time and the EMS crew will be required to leave at or before 30 minutes.
• If the wait for offload continues to 30 minutes, the EMS unit may leave the patient in the department and return to service. The EMS crew member will notify the charge RN that they are leaving and returning to service. It is recommended that the ED charge RN should immediately make arrangements to provide staff and a stretcher prior to the EMS staff leaving the department. If a stretcher or location is not provided, the EMS crew will create an offload option which may include triage chair, triage stretcher, vacant stretcher, wheel chair or foldable cot.

IN CONDITION RED ALL OFFLOADS WILL BE IMMEDIATE.