About Emergency Department/Trauma
California’s emergency departments (EDs) are filled to the brim (some 15 million people visit EDs every year) — often so packed that patients are forced to wait hours to be treated and ambulances are delayed in transferring patients to hospitals. Several things are behind this crisis:
- A lack of primary care clinicians that accept Medi-Cal
- A lack of post-hospital care sites (nursing homes, rehab facilities, mental health and addiction facilities, etc.) for patients and challenges with commercial insurance companies approving post-hospital care
- Workforce shortages
- Massive increases in the need for mental health and substance use disorder treatment
- Growing hospital financial distress, in part due to government payer shortfalls
- A dearth of alternative community care sites, like clinics or home settings
Without change, EDs — which accept all patients 24/7 year-round — will struggle to provide critical care to those experiencing trauma, injury, or acute medical conditions. Addressing this problem will take commitment and innovation from insurance companies, state policymakers, providers, and others to deliver better access to primary and specialty services, improved funding for ED care, and more.
Chapter 6 and AB 40 Regulations Now Final
What’s happening: The Office of Administrative Law has approved two regulations related to emergency departments:
Implementation of Assembly Bill 40 (ambulance patient offload times) – in effect as of July 23, 2026
Chapter 6 Specialty Designation and Regulations (trauma, STEMI/stroke, emergency medical services care for children) – effective Oct. 1
EMSA Pausing Audit Tool Compliance Activities Through August
What’s happening: The Emergency Medical Services Agency (EMSA) is pausing some activities associated with Assembly Bill 40 compliance and the ambulance patient offload time (APOT) Audit Tool. All APOT audits, compliance evaluations, and ongoing biweekly calls with participating facilities exceeding their APOT standard will be paused through August 2026.
CHA Advocacy Strengthens APOT Audit Tool Responsibilities in Final Regulations
What’s happening: Last week, the state Emergency Medical Services (EMS) Commission met and approved regulations focused on Assembly Bill 40 (2023) and Chapter 6 Specialty Care Designation and discuss the statewide ambulance patient offload time (APOT) report.
2026 Behavioral Health Care Symposium
This year’s symposium will tackle the most pressing challenges facing behavioral health care professionals and offer insights into complying with California’s shifting policies. Explore the issues keeping behavioral health care professionals up at night and learn innovative ways to connect patients to community-based care. Sessions will cover nursing ratios, perinatal mental health, EmPATH, co-responder models, […]
Reminder: Hospital APOT Reduction Protocols Due June 30
What’s happening: As a reminder, all hospitals must submit an ambulance patient offload time (APOT) reduction protocol — required under Assembly Bill (AB) 40 (2023) — to the Emergency Medical Services Authority (EMSA) annually on or before June 30. CHA recommends hospitals submit their protocols as soon as possible.
2026 Disaster Planning Conference
Disaster planning in health care means being ready for anything and ensuring the safety of our communities while maintaining continuity of care when it matters most. The challenges are real, and the expectations are high.
EMSA Re-Releases AB 40 Regulations; Comments Due May 18
What’s happening: The Emergency Medical Services Authority has opened a new comment period for additional modifications to the Chapter 1.2 Ambulance Patient Offload Time regulations, which implement provisions of Assembly Bill 40 (2023).
In Comments on Proposed APOT Regulations, CHA Urges Stronger Collaboration and Accurate Data Publication
What’s happening: Last week, CHA submitted comments to the Emergency Medical Services Authority (EMSA) on the proposed Chapter 1.2 Ambulance Patient Offload Time (APOT) regulations, which implement provisions of Assembly Bill (AB) 40 (2023).
EMSA Re-Releases Chapter 6 and AB 40 Regulations for Comments
What’s happening: Last week, the Emergency Medical Services Authority re-released two regulatory packages: Chapter 6 Specialty Designation Regulations (trauma, STEMI/stroke, emergency medical services care for children) and Assembly Bill (AB) AB 40 Regulations (ambulance patient offload times).
Hospital APOT Reduction Protocols Due June 30
What’s happening: As a reminder, all hospitals must submit an ambulance patient offload time (APOT) reduction protocol — required under Assembly Bill (AB) 40 (2023) — to the Emergency Medical Services Authority (EMSA) annually on or before June 30. CHA recommends hospitals submit their protocols as soon as possible.