Ambulance Deserts

August 2, 2023

Access to timely ambulance service is an essential part of the emergency medical system. Yet ambulance access varies widely with significant gaps across the country. New research from the Maine Rural Health Research Center identifies places and people that are more than 25 minutes from an ambulance station, known as an ambulance desert.  Without ambulance services nearby, these are dangerous areas to have an accident.

  • Nationally, about 4.5 million residents live more than 25 minutes from an ambulance station. About 2.3 million of those are rural; 2.2 million are urban.    
  • Another way of understanding the rural disparity is that while about 14% of Americans live in a rural area, they make up more than half of the population that lives in an ambulance desert. Urban Americans constitute about 86% of the U.S. population but make up less than half of the population that lives in an ambulance desert.
  • States in the South (e.g., Texas, North Carolina, Alabama, Kentucky, Arkansas, and Tennessee) the Midwest (Missouri) and the West (Montana) had the highest number of rural people living in ADs (over 100,000 people)


According to the lead researcher, the cause of ambulance deserts boils down to money. Medicare, Medicaid and commercial insurance reimburse ambulance service, but only if a patient is transported. The study found that reimbursement is often not sufficient to cover the operating costs of the service, particularly in rural areas where low call volume and longer drives combine to create higher fixed operating costs.  Hospitals and health care systems are not going after ambulance services because they are not a lucrative service line. That leaves most ambulance services being run by volunteers and funded through community goodwill. 

In medical emergencies, getting swift transportation to a hospital is imperative. For rural counties in Missouri, ambulance deserts can mean the difference between life and death.

Read more about the study here.