This project builds on our recent work identifying areas across the country lacking adequate access to ambulance services (i.e., ambulance deserts). Because these areas are newly identified, little is known of the populations living in ambulance deserts or of the market characteristics associated with ambulance deserts. Factors contributing to ambulance deserts include:

• Declining number of rural hospitals and ambulance services
• Lack of integration of ambulance services into the rural healthcare system
• Gaps in the provision of rural ambulance services, increasing the geographic coverage areas for existing ambulance services.

To assist state and regional policymakers in formulating strategic plans to address these gaps, we will use our existing ambulance and ambulance desert location data and data from the U.S. Census to identify vulnerable populations living within ambulance deserts and the implications associated with traveling to the nearest health care facility capable of serving the emergent healthcare needs of these vulnerable populations.

We propose to explore the following questions:

1. What are the demographic and socioeconomic profiles of rural and urban populations living in ambulance deserts; what are the healthcare and market characteristics associated with ambulance deserts?
2. How far do ambulance desert populations travel to get to the closest emergency department, hospital, or trauma center; how do these distances vary by rural-urban location, and across counties, states, and regions?
3. For those living in ambulance deserts, how have hospital closures experienced during 2016-2020 impacted the travel distances to the nearest health care facilities?
4. What risk factors are associated with long (over 25 minute) travel distances to the nearest health care facility for ambulance desert populations and do they vary geographically?