California’s AB-40, signed into law as Chapter 367 of the Statutes of 2023, sets a statewide limit on how long ambulance crews can wait at hospital emergency departments to hand off patients. It caps ambulance patient offload time (APOT) at 30 minutes, 90 percent of the time, requires hospitals with emergency departments to file written reduction protocols, and gives the Emergency Medical Services Authority (EMSA) authority to monitor monthly data and force corrective action when hospitals miss the standard.
The Problem AB-40 Targets
APOT is the time between an ambulance arriving at a hospital emergency department and the moment the patient is transferred to a gurney, bed, chair, or other location where the hospital takes responsibility for care.1California Legislative Information. California Health and Safety Code HSC 1797.120 Before AB-40, California had no uniform standard for that handoff. Crews at crowded emergency departments could wait well over an hour, still responsible for their patient and unavailable to answer new 911 calls. The delay is sometimes called “wall time” because paramedics stand along the hallway wall waiting for space.
The 30-Minute Standard
Each local EMS agency (LEMSA) in California must adopt an APOT standard that does not exceed 30 minutes, 90 percent of the time, and must report the adopted standard to EMSA.2California Legislative Information. California Health and Safety Code HSC 1797.120.5 The deadline for adoption was July 1, 2024.
The 30-minute figure is a ceiling. A LEMSA can adopt a tighter standard if local conditions allow, and in developing its standard it may bring in hospital representatives, fire departments, exclusive employee representatives of hospital and fire staff, and EMS providers.2California Legislative Information. California Health and Safety Code HSC 1797.120.5
What Hospitals Have to Do
Every general acute care hospital with an emergency department must develop an APOT reduction protocol describing how it will keep offload times within the LEMSA standard. Hospitals must build these protocols in consultation with their emergency department staff and any exclusive employee representatives, and the protocols must address mechanisms to improve hospital operations and reduce APOT.3California Legislative Information. California Assembly Bill 40 – Emergency Medical Services
Each hospital files its protocol with EMSA and reports any revisions annually. EMSA then monitors monthly APOT data for each hospital.3California Legislative Information. California Assembly Bill 40 – Emergency Medical Services The protocol is the document EMSA can order the hospital to activate when performance slips.
How Offload Time Gets Measured
Accurate APOT depends on two precise timestamps: arrival at the emergency department and actual transfer of care. AB-40 required EMSA to build an electronic signature function into the California Emergency Medical Services Information System (CEMSIS) that captures both.2California Legislative Information. California Health and Safety Code HSC 1797.120.5 The signature is collected when the physical transfer happens and the ambulance crew hands off its report to hospital staff, and it must note the ambulance’s arrival time.3California Legislative Information. California Assembly Bill 40 – Emergency Medical Services EMSA’s deadline for standing up the system was December 31, 2024.
AB-40 also directed EMSA to develop an audit tool, validated by hospitals and LEMSAs, to check the accuracy of transfer-of-care data.2California Legislative Information. California Health and Safety Code HSC 1797.120.5 The implementing regulations describe the audit as a standardized process run through a secure electronic portal where EMSA, hospitals, and LEMSAs verify APOT records together.4California Emergency Medical Services Authority. Title 22 Division 9 Chapter 1.2 – Delivering Equitable and Person-Centered Care – Ambulance Patient Offload Time When discrepancies turn up, the LEMSA convenes the hospital and the EMS provider of record to determine whether the record needs correction.5Emergency Medical Services Authority. Provider APOT Audit Webinar
What Happens When a Hospital Exceeds the Standard
Once the audited data for a month is finalized, any hospital that exceeded its LEMSA’s APOT standard triggers a set of mandatory steps. EMSA reports the exceedance electronically to the relevant LEMSA and to the Commission on Emergency Medical Services, and it directs the LEMSA to alert every EMS provider in the jurisdiction.3California Legislative Information. California Assembly Bill 40 – Emergency Medical Services
The hospital is then directed to activate its APOT reduction protocol no later than five business days after notification. EMSA convenes biweekly coordination calls with hospital administration, emergency department leadership, hospital employees, the LEMSA, and the affected EMS transport providers until the problem is resolved.5Emergency Medical Services Authority. Provider APOT Audit Webinar
Penalties Under AB-40
AB-40 does not attach a specific fine to an APOT exceedance. Enforcement runs through the administrative escalation described above: notification, mandatory protocol activation, biweekly meetings, and Commission-level visibility on hospitals that keep missing the standard.
There is a criminal backstop. AB-40 sits inside California’s Emergency Medical Services System and Prehospital Emergency Medical Care Personnel Act, and violations of that act or regulations adopted under it are punishable as misdemeanors under existing law.6Digital Democracy. AB 40 – Emergency Medical Services Because AB-40 expands the reach of that act, it broadens the conduct that could technically be prosecuted as a misdemeanor. That path is a backstop for serious or willful noncompliance rather than the routine enforcement tool.
Rural Hospitals and Volunteer EMS Providers
AB-40 directs EMSA to provide technical assistance and funding, as needed and subject to appropriation, for small rural hospitals and volunteer EMS providers implementing the law’s requirements.2California Legislative Information. California Health and Safety Code HSC 1797.120.5 Rural facilities may lack the IT infrastructure to integrate with CEMSIS electronic signatures or the staffing to consistently hit a 30-minute target. The “subject to an appropriation” language means the money depends on the state budget funding it.
Implementation Timeline
AB-40’s rollout was staggered:
- July 1, 2024: Every LEMSA must have an adopted APOT standard (30 minutes maximum, 90 percent of the time) and report it to EMSA.
- September 1, 2024: Every general acute care hospital with an emergency department must have its APOT reduction protocol developed.
- December 31, 2024: EMSA must have the electronic signature system, audit tool, and emergency regulations in place, and must begin monthly APOT monitoring.
The statute treats the adoption of the Title 22 regulations as an emergency for purposes of the Administrative Procedure Act, letting EMSA fast-track the rulemaking.2California Legislative Information. California Health and Safety Code HSC 1797.120.5 EMSA re-adopted the emergency regulations in early 2026, and the permanent rulemaking is still in progress.