How we reported on California's ER wait times and shared patient's stories

An AfroLA reporter details how she wrote her story, How do we treat L.A.’s overwhelmed emergency medicine system?

By Eliza Partika


(Illustration by Hal Marie Saga)
What began as a story about long ambulance wait times and diversion — when an ambulance reaches the ER with a patient and gets rerouted to a different hospital — grew into something much bigger: a deeper dive into systemic overcrowding, understaffed and under-resourced hospitals that create delays in care.

Ambulance Patient Offload Time, known as APOT, is the time between a patient’s arrival outside emergency department doors, where they’ll be unloaded, and the time that patient is transferred to the emergency department. Patients may be moved to a gurney, bed, chair or other licensed location. At the hospital, fire paramedics and EMTs relinquish control of patient care by handing over a care report detailing where the patient is coming from, their injury or complaint, demographic information, and the time that they were handed over to the hospital.

For months, I made records requests to city and county fire departments, private ambulance companies and county EMS agencies for data, with little to no response. I was finally able to connect with L.A. County Fire administrators who connected me with data analysts with Falck and McCormick, two of the three private ambulance companies contracted by Los Angeles County.

During the reporting process, we discovered that each ambulance company keeps and records their ambulance offload times differently. Some put emphasis on the fines they accrue from long wait times while others emphasize the number of calls in relation to those wait times. Not only do private, city, county and state EMS agencies keep their records differently, they also seem to rarely communicate with one another about the data they have, even when they have a common goal: to reduce ambulance offload times.

Map pinpointing patient offload times at Los Angeles’s Kaiser hospitals in 2023. Kaiser Downey and West L.A. were worst at around 90 minutes.
These differences made the data analysis and visualization process a seemingly endless string of check-ins, emails, clarifications, fact-checks and rewrites. (But what is writing if not rewriting?) We kept at it, and the final results of painstaking rounds of editing, sheer will and kind collaboration from sources are the beautiful visualizations you see in the story.

Table showing weekly average and annual cost of fines paid by private ambulance company McCormick in 2022 to to Los Angeles County hospitals. Half of the 10 hospitals paid the most in fines are located in South L.A., including Inglewood, Torrance and Lynwood.
I also had generous assistance from data-minded mentors at the USC Center for Health Journalism, who directed me to large state and national datasets. This data was key to forming a narrative around the impact overcrowding, diversion and delays have on EMS staff and the communities they serve. Special thanks to mentors Andrew Tran of the Washington Post, Christian McDonald of University of Texas Austin, and Alvin Chang of The New School were an immense help with cleaning and wrangling massive amounts of data in R Studio and in brainstorming creative ways to visualize that data.

As part of our reporting, we held community listening sessions and manned a table at a community resource fair to share the work we were doing and get feedback from the communities most affected. We opened a survey about residents’ experiences with ambulance transport and worked with community organizations like Black Women for Wellness. Through these efforts, community members shared grievances about closures of local hospitals’ maternal health wards and trauma centers. Having to travel farther for care caused dangerous delays in maternal care and the care of critical conditions in some areas.


They told us about under-resourced local hospitals, where nurses and doctors can’t treat their specialized conditions, about not being able to receive medicine for their diabetes because the pharmacy doesn’t carry their medication, and so much more.

From EMTs, we heard how delays and lack of resources can cause dangerous, and sometimes deadly roadblocks in their ability to care for patients both inside and outside the ambulance. We learned what happens as part of the response to a 911 call, and how, for patients who aren’t in critical condition, having alternatives to ambulance rides could save both the patient and the EMTs valuable time and resources.

Read on AfroLA:

How do we treat L.A.’s overwhelmed emergency medicine system?
Below are some of the things we heard from community members, EMTs and health care workers we spoke to in our reporting process.

Statements have been lightly edited for clarity.

Adrian Galvan
EMT

Galvan told us how fire paramedics use ReddiNet, an app with real time diversion data, to determine the closest hospital for patient transfer, based on trauma level and availability. He and fellow EMT Ryo Miyasaka said experience is key to identifying subtle symptoms in emergency situations, such as gaze or difficulty controlling movements. Some paramedics can pick them up quickly, said Galvan, while others struggle.

Language barriers are common, said Galvan.

“…I speak Spanish, [and] there’s lots of calls where I’m the only one I’ve seen speak Spanish. [If it’s a call about a stroke, for instance, and ] I’m not there, there’s no communication with the person. They might have [had] a previous stroke, they might have deficits from it. And, there’s miscommunication from family freaking out or fire [paramedics] that don’t speak Spanish. So, they don’t know that a new symptom has developed, or something like that.

“If the family can get someone on the phone that does speak English, you can translate…but there’s nothing set up that can help you with interpretation.”

L.A. County hospital worker and patient
(Declined to provide a name to protect medical privacy)

“Palmdale Regional is closest to where I live, but Antelope Valley is much more comprehensive. I had a 6–8 hour wait one time from urgent care to the ER. Another transfer was an overnight wait. I drove myself on my most recent trip to the emergency room in 2023 for aortitis [inflammation of the heart’s aorta], because of the delays. State mandates complicate the ability to discharge patients. It averages six hours to get the routine patient out. Some only take four hours, some take seven days! The state mandated nurse-to-patient ratios also prevent moving patients upstairs. Ambulances refusing to take it’s also delays freeing up a bed.”

Tanya
(Declined to provide her last name to protect medical privacy)

“I was there looking for [my aunt, who had fallen] at 6 o’clock in the morning. I don’t know what time they took her, but they had to go to another hospital. [The fire department had taken her] elsewhere, and I was running around looking for her… She ended up at Kaiser, but I’m just saying that was like a needle in a haystack, running around looking for a 95-year old lady. The next morning, they left no trail. So if an ambulance is sent away, when an ER is closed, there’s no trail. In her case, it wasn’t life-threatening, but if someone has something life-threatening, and they aren’t accepting what are your options? And, I’m sure it only happens in disadvantaged areas.”

Dave
EMT (Declined to provide a last name for fear of job retaliation)

“When I was transporting [patients], we would get people late at night on the weekends who would abuse the 911 system. There would be a party, and they would ask us to go to one hospital near the party, and hop out, and at 2 or 3 in the morning call again to go back to a hospital near their house. If it’s not critical, and that’s where they want to go, that’s where we have to take them.”

Ryo Miyasaka
EMT

“I’ve had patients with alcohol poisoning who will sober up on our gurney, because we are holding the wall so long.”

Adrian Galvan
EMT

“I’ve had patients who overdosed on the scene. We Narcan them, bring them back. We went to the hospital with ALS [critical condition patient], and we ended up holding the wall, and we were waiting so long that they just re-overdosed. The Narcan wears off and they start dropping again. You tell the nurses, and they do their protocols for that patient, and if they come back, they come back.”

Renee Monge
EMT

“Sometimes we pick up patients from a facility that does rehab and we have to take them to the hospital. The case manager has already arranged for the transport to pick up the patient and take them to the hospital, and they already have a bed under their name before they get there. When you call 911, and you’re going from home to hospital, they might not have a bed available for you. Sometimes people have to wait many hours to get a bed.”

This reporting was produced with the support of the USC Annenberg Center for Health Journalism’s 2023 Data Fellowship.

Eliza Partika (she/her) is a multimedia health journalist interested in covering reproductive health issues. Before working with AfroLA, she was a writer for Medscape Medical News and WebMD, where she covered primary care, reproductive health and pediatrics. She earned her master’s from UC Berkeley’s Graduate School of Journalism. As a student, she collaborated with Reveal on a multi-episode series chronicling disinformation campaigns pro-life groups wage against contraception and abortion. Eliza also contributed to the California Reporting Project on police misconduct.