Ambulance Deserts: Unveiling the High Stakes of Timely Medical Care

Author: Emily Singh

For every American, the phone number 911 signals a promise: a direct line to critical, often life-saving care. In the most populous cities, emergency response time can be as short as 9 minutes and 23 seconds (source). For rural Americans, emergency dispatch often takes upwards of 30 minutes. When every second counts, access to timely emergency care is critical. Ambulance deserts leave Americans vulnerable and without adequate access to care.   


What is an Ambulance Desert?  

An ambulance desert is a residential area located more than a 25-minute drive from the nearest stationed ambulance. A staggering 4.5 million Americans live in these so-called ambulance deserts. While ambulance deserts can occur in both urban and rural communities, over half of the ambulance deserts in the United States are in rural communities.   

Ambulance deserts are typically defined by county and are determined by said county having at least one community living in an ambulance desert. Texas has one of the highest total populations living in ambulance deserts, even reaching top of the list for number of rural residents living in ambulance deserts. Texas has experienced many factors, including workforce shortages, that have left Texans facing difficulty getting access to care. This has ultimately resulted in roughly 95% of Texas counties containing at least one community in an ambulance desert (source).  


Causes and Consequences of Ambulance Deserts 

There is a complex web of factors that lead to the development of ambulance deserts. Socioeconomic disparities can exacerbate the issue, with underfunded communities struggling to maintain adequate services. Funding and reimbursement are some of the largest obstacles for EMS providers, particularly in rural communities. Oftentimes, reimbursement rates for ambulance services are up to 70% less than the cost of providing.  State level supplemental payment programs can be daunting to navigate, but companies like PCG can help assess your agency to optimize supplemental payment opportunities available.  

Further distances between the location of the call and the hospital require EMS providers to provide critical care for longer periods of time. This requires additional and more thorough training to provide a higher level of care. Although there is a great need for staff with additional training, ambulance deserts are often faced with difficulty recruiting and retaining staff with any amount of training. The consequences are severe, including increased mortality rate and compromised public health. Addressing this problem requires targeted investment, improved infrastructure, and innovative solutions to ensure equitable access to life-saving medical care. 


Regional Differences in Ambulance Deserts 

Though every region of the United States struggles with ambulance deserts, there are many variations between them. For example, Western and Midwestern states struggle with ambulance deserts due to vast, sparsely populated rural areas. Because the geographic distance is so great between residential communities, ambulance coverage is challenging. Though these regions have a relatively high number of ambulance stations per capita, the long travel distances between communities perpetuates the prevalence of ambulance deserts.  

Conversely, Southern states tend to have ambulance deserts in areas with high population density but low numbers of ambulance stations. The exceptions are Kentucky, Oklahoma, Arkansas, and Texas, which each have significant ambulance desert populations in rural counties. Addressing these disparities in ambulance services is essential for ensuring equitable access to emergency healthcare.


How PCG Can Help 

Public Consulting Group (PCG) has over 16 years of experience working with EMS providers to develop supplemental payment cost reports that help recuperate much needed funding for ambulance services. If your organization needs help alleviating the administrative burden throughout the design, development, and implementation of a supplemental payment program, let the PCG team work for you! Download PCG’s supplemental payment services data sheet for more information.  

Please visit the University of Southern Maine’s Rural Health Research Center for detailed research notes and additional information about ambulance deserts in the United States.  



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