A new report, Sirens or Silence: Tracking Emergency Response Delays, exposes a hidden form of inequality in public safety: the state you crash in may determine whether you survive.
Analyzing national EMS data, researchers found that response times vary dramatically by geography, and that in several states, it routinely takes nearly half an hour to reach a hospital after a crash.
The Slowest States
According to the study, the top five states with the longest EMS transport times are:
- Massachusetts – 29.8 minutes
- Rhode Island – 29.6 minutes
- Hawaii – 29.4 minutes
- Kentucky – 29.4 minutes
- Delaware & Ohio – nearing 30 minutes
In contrast, many western and southern states recorded faster overall transport durations—but not necessarily better outcomes, since EMS often struggles to reach rural or congested areas quickly enough in the first place.
Where Are the Missing Patients?
Every stage of the emergency chain shows strain. States with the highest EMS notifications also reported massive gaps between scene responses and hospital arrivals:
- Georgia: gap of 1,455 patients
- California: gap of 1,292
- Ohio: gap of 1,204
Even after accounting for patient refusals or on-scene treatment, these numbers indicate systemic inefficiencies and potential under-capacity.
Urban Gridlock vs. Rural Distance
- In dense states like Massachusetts and Rhode Island, traffic congestion, hospital crowding, and limited ambulance fleets create long transport times even for short distances.
- In rural areas like Kentucky or Delaware, the nearest trauma center may be 30+ miles away, with fewer EMS resources to cover large regions.
The outcome? Both settings face delays, just for different reasons.
The Deadly Math of Delay
Nationally, EMS takes nine minutes on average to reach crash victims, exceeding the eight-minute benchmark for 90% of life-threatening emergencies. When that window stretches to 12 minutes, mortality risk jumps 46% higher.
These minutes compound: delayed notification, longer travel, and hospital diversions can stretch total prehospital time to 40–50 minutes, even before treatment begins.
“The tragedy isn’t just the crash, it’s what happens after,” said a spokesperson from the firm. “Geography shouldn’t decide who lives or dies after a car accident, but right now, it does.”
Policy Implications
The report calls for:
- Federal funding parity for rural and urban EMS systems
- Data transparency mandates requiring states to publish monthly EMS performance metrics
- Hospital coordination grants to reduce transfer delays
Such reforms could prevent thousands of fatalities each year, particularly in high-risk states identified by the study.
About the Study:
Sirens or Silence: Tracking Emergency Response Delays maps state-by-state performance data on EMS notifications, arrivals, and hospital transports to uncover systemic inefficiencies in U.S. emergency care.
