Who Lives in Ambulance Deserts? Demographic and Geographic Differences in Accessing Ambulance Services

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07/2026

Building upon the original May 2023 Ambulance Deserts Chartbook, this study characterizes who lives in ambulance deserts (AD), defined as populated areas that are more than 25 minutes from an ambulance station. Using ambulance location data obtained from 41 states (2021-2022) and the 2016-2020 American Community Survey (ACS) five year estimates, this study identifies systemic gaps in access to ambulance services by analyzing differences in the following characteristics of AD and non-AD populations: age, sex, race/ethnicity, education, household income, poverty levels, employment, health insurance status, and rural-urban county location.

Key Findings:

• Disproportionate Impact on Older Adults: AD populations have a significantly higher concentration of adults aged 65 and older (21.3%) compared to non-AD areas (16.1%), placing a medically vulnerable age group at higher risk for adverse health outcomes.
• Rurality as a Primary Driver: Residents in ADs were more likely to live in rural counties compared to non-AD populations. Rurality rates reach as high as 86.5-87.5% in Iowa and Wyoming, and peak at over 96% in states like New Hampshire and Nebraska.
• Racial Differences in Access: Nationally, 80% of AD residents were non-Hispanic White. However, in specific regions, racial and ethnic subpopulations were disproportionately represented. Notably, American Indian/Alaska Native (AI/AN) populations were more concentrated in ADs than non-ADs in nearly every state analyzed, with concentrations reaching 25.4% in New Mexico and 34.0% in South Dakota.
• Socioeconomic Barriers: AD residents generally face greater economic instability, characterized by higher rates of poverty, unemployment, and lower educational attainment (high school diploma or less) than their non-AD counterparts.
• Regional Insurance Gaps: While insurance rates vary by region, AD populations in the Midwest and West face significantly higher uninsured rates than non-AD populations, with uninsured figures peaking at 17.6% in South Dakota.

Maine Rural Health Research Center

Yvonne Jonk, Heidi O'Connor, Brianna Holston, Celia Jewell, Tyler DeAngelis

Aging, Emergency medical services (EMS) and trauma, Healthcare access, Poverty, Private health insurance, Rural statistics and demographics, Social determinants of health