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. This chartbook analyzes 41 states in 2021-2022 and identifies places and people that are more than 25 minutes from an ambulance station, also called an ambulance desert.

Key Findings:

• 4.5 million people lived in an ambulance desert (AD); 2.3 million (52%) of them in rural counties.
• Four out of five counties (82%) had at least one AD.
• Rural counties were more likely to have ADs (84%) than urban counties (77%).
• Areas with the highest share and number of people living in ADs include the Appalachian region in the South; Western states with difficult mountainous terrain; coastal areas across the U.S.; and the rural mountainous areas of Maine, Vermont, Oregon, and Washington.
• Eight states had fewer than three ambulances covering every 1,000 square miles of land area (the Western states of Nevada, Wyoming, Montana, Utah, New Mexico, and Idaho; and the Midwestern states of North Dakota and South Dakota).

This report presents data on ADs by state and county. Included are maps of AD locations and health care facility locations for every state with available data. Nine states lack data on ambulance locations so the results in this report are likely an undercount of the people and places that are more than 25 minutes from an ambulance station.