Our new study, Sirens or Silence: Tracking Emergency Response Delays, examines which states have the slowest emergency response times and how these delays contribute to preventable fatalities. Using state-by-state data on EMS notifications, on-scene arrivals, and hospital transports, we mapped where delays are most severe—and how they’re putting lives at risk.
When it comes to emergency medical response, every minute matters. Yet our findings reveal that in many states, crash victims are left waiting far too long for critical care. In 2023 alone, there were 40,901 motor vehicle fatalities nationwide, according to the National Highway Traffic Safety Administration (NHTSA).
With car accident rates surging in the summer months, improving emergency response is not just a logistical goal—it’s a public health necessity.
The Gold Standard for Emergency Response
Industry standards call for EMS to arrive within eight minutes for at least 90% of life-threatening emergencies, such as cardiac arrests or severe trauma. However, our analysis of statistics from JAMA Network and the National Library of Medicine shows that many areas are falling short.
- Median EMS response time nationwide: Approximately 9 minutes
- Mortality risk with slower response: In areas where EMS takes 12 minutes or more to arrive, crash mortality rates are 46% higher than where arrival is within seven minutes.
These figures highlight the life-or-death stakes behind every minute in the emergency response timeline.
Evening Rush Hour: The Most Dangerous Time on the Road
Our review of national EMS data reveals that the busiest hours for crash-related notifications occur between 5:00 p.m. and 8:59 p.m., with the peak at 7:00–7:59 p.m., when 1,139 EMS notifications were recorded. This spike closely aligns with evening commute patterns.
However, high call volume is only part of the problem. We found consistent gaps between the number of notifications, the number of EMS units arriving on scene, and the number of patients ultimately transported to the hospital.
Example patterns during peak hours:
- 8:00 p.m.: 1,137 notifications vs. 1,067 arrivals (–70 gap)
- 5:00 p.m.: 1,074 scene arrivals vs. only 501 hospital arrivals (–573 gap)
These drop-offs may result from dispatch delays, patient refusals, prolonged on-scene care, or limited transport capacity. Regardless of cause, the bottleneck puts patients at greater risk during the very hours when serious crashes are most likely to occur.
State-Level Gaps: Where Are the Missing Patients?
We analyzed the top 10 states with the highest EMS notification volumes. In all cases, the number of hospital arrivals was significantly lower than the number of scene responses.
- California: 4,061 EMS responses vs. 2,769 hospital arrivals (gap of 1,292 patients)
- Georgia: 1,615 EMS responses vs. 160 hospital arrivals (gap of 1,455 patients)
- Ohio: 1,204 fewer hospital arrivals than scene responses
- Illinois: 958 fewer hospital arrivals
- North Carolina: 948 fewer hospital arrivals
While some of these differences may be explained by on-scene treatment or refusals, the scale and consistency of the shortfalls point to systemic inefficiencies, from ambulance shortages to triage protocols that may leave certain patients without hospital care.
The Long Road from Scene to Hospital
Our analysis of publicly reported emergency response data reveals that several states have average scene-to-hospital transport times approaching or exceeding half an hour.
States with the longest average EMS transport times:
- Massachusetts: 29.8 minutes
- Rhode Island: 29.6 minutes
- Hawaii: 29.4 minutes
- Kentucky: 29.4 minutes
- Delaware and Ohio: Nearing 30 minutes
Such prolonged transport times are especially concerning in cases of internal bleeding, traumatic brain injury, or other conditions where rapid hospital intervention is critical.
Potential contributing factors:
- Urban congestion and overloaded systems in densely populated states like Massachusetts and Rhode Island
- Geographic distance and limited resources in rural areas, such as Idaho or Utah
- Hospital overcrowding that forces EMS crews to travel farther to find available emergency beds
These delays show that location alone can determine survival odds. Faster, better-equipped EMS systems—supported by policy change and funding—are critical to saving lives.
Why the Delays Matter
Research consistently shows that survival rates drop as response and transport times increase. Our analysis of National Library of Medicine data reinforces this: the jump from an eight-minute to a 12-minute response correlates with a 46% higher crash mortality rate.
When a patient’s condition involves heavy bleeding, brain trauma, or compromised airways, delays at any stage—from notification to hospital arrival—compound the risk of death or permanent disability.
Methodology Overview
Our study examined emergency medical response to motor vehicle crashes using three core metrics:
- EMS notifications — 911 calls requesting emergency medical assistance
- EMS arrivals on scene — when a crew reaches the crash site
- Hospital arrivals — when the patient reaches a medical facility
We calculated two delay metrics:
- Notification–to–scene gap: The difference between EMS notifications and scene arrivals
- Scene–to-hospital gap: The difference between scene arrivals and hospital arrivals
Negative values in the second metric indicate a significant drop in hospital transports compared to scene responses, pointing to potential bottlenecks. Hourly and state-level data were analyzed to identify patterns, high-risk time windows, and geographic disparities.
Key Findings at a Glance
- National median EMS response time: ~9 minutes
- Mortality impact: 46% higher crash death rate with response times ≥12 minutes
- Industry benchmark: ≤8 minutes for 90% of life-threatening emergencies
- Peak danger hours: 5:00–8:59 p.m., with highest notifications (1,139) at 7:00–7:59 p.m.
- State transport gaps: Georgia (–1,455 patients), California (–1,292), Ohio (–1,204), Illinois (–958), North Carolina (–948)
- Longest transport times: Massachusetts (29.8 minutes), Rhode Island (29.6), Hawaii (29.4), Kentucky (29.4)
These numbers reveal how even small delays can have deadly consequences. Targeted investment, improved coordination, and data-driven policies are essential to closing the gap and saving more lives.
The Public Health Imperative
With over 40,000 motor vehicle deaths in 2023, the stakes for improving EMS systems are urgent. The combination of high-risk evening hours, long transport durations, and significant patient drop-offs between scene and hospital demands targeted reforms.
Potential improvement strategies include:
- Increasing ambulance availability during peak crash hours
- Optimizing dispatch systems to reduce delays from notification to arrival
- Improving hospital coordination to reduce diversion and wait times
- Investing in rural EMS infrastructure to address distance challenges
Every stage of the emergency response chain must be strengthened to prevent avoidable deaths and disabilities.
Every Minute Saved Is a Life Saved
Our research makes one thing clear—slow emergency response is not just an operational flaw, it’s a life-threatening crisis. The data shows that thousands of patients never make it from crash scenes to hospitals, and those who do often face transport times well beyond recommended standards.
The summer driving season brings higher crash rates, and without targeted action, fatalities will rise. States must invest in faster dispatch systems, more available EMS units, and stronger coordination with hospitals. These changes are not optional—they are essential to save lives.
As North Carolina car accident lawyers, we have seen how delays in care can change the outcome of a crash victim’s life. Our work reinforces the urgent need for systemic improvements that protect drivers, passengers, and pedestrians alike.
