Education: When Ambulances Disappear

Pitt Public Health students map the growing problem of ambulance deserts

By Clare Collins

Emergency medical services (EMS) are a critical yet often overlooked part of the public health system. When ambulance services close or scale back, communities can lose a vital link to lifesaving care.

Across the United States, many communities are experiencing growing gaps in emergency response coverage. These “ambulance deserts” are areas where it can take more than 25 minutes for emergency responders to arrive. In health crises like cardiac arrest, trauma or stroke, those delays can have profound consequences.

“Ground ambulance services are a critical part of the health care safety net,” said Samantha Hilker, vice president of programs and services at the American Ambulance Association. “In some communities, they may be the only point of access into the health care system.”

Hilker, who began her career as a paramedic, sees the challenges facing emergency medical services firsthand. “When someone calls 911, they’re trusting us to show up and help them at one of the most vulnerable moments in their lives,” she said.

Concerns about unequal emergency response have surfaced in American culture before. In 1990, the hip-hop group Public Enemy released the song “911 Is a Joke,” criticizing slow emergency response in Black communities—a critique of inequities that researchers say still shape emergency care today. Workforce shortages, rising costs and reimbursement policies now make it difficult for ambulance services to remain financially viable in many parts of the country.

While ambulance providers across the country are grappling with many of the same issues, these challenges are particularly acute in rural communities. Ambulance services are typically paid only when a patient is transported to a hospital. In areas with fewer calls and long travel distances, providers can often struggle to remain financially stable.

To better understand the scope of ambulance-service closures and their impact on communities, Hilker partnered with students at the University of Pittsburgh School of Public Health.

Five students in the school’s Bachelor of Science in Public Health (BSPH) program set out to track ambulance service closures nationwide between 2019 and 2024. Because no centralized database exists, the team built its own dataset by combing through news reports, public records and other sources to identify services that had closed, merged or consolidated.

The work was part of Pitt Public Health’s BSPH capstone program, which connects graduating seniors with organizations tackling true public health problems. Working in small teams, students meet with a client organization, conduct research and produce deliverables the partner can use to inform its own work. >>2026 Capstone Symposium

The American Ambulance Association provided three project opportunities for student teams. One group examined ambulance-service closures and ambulance deserts. A second group explored the role of EMS in responding to opioid overdoses. A third assessed the impact of EMS-led public-access automated external defibrillator programs.

The research quickly revealed another challenge: reliable national data on ambulance closures is difficult to find. The students contacted officials in all 50 states to verify closures or gather additional information, but only one state provided detailed data.

Using the information they collected, the team created maps comparing ambulance closures with existing ambulance desert data. Many closures took place in areas that already faced limited EMS access.

The current class of BSPH seniors is building on this dataset, expanding the effort to track additional ambulance-service closures and better understand how gaps in emergency response coverage are evolving nationwide. These kinds of projects are central to the capstone experience at Pitt Public Health.

“Students are essentially acting as consultants,” said Mara Leff Koperwas, director of undergraduate curriculum. “They’re working with real organizations, asking questions, collecting data and producing something that is very useful to their community clients.”

The collaboration has also been valuable for Hilker and the American Ambulance Association. “It’s been really exciting to see the project take shape through their perspective,” she said.

For Naomi Jesionowski (BSPH ’26), the experience reinforced how critical emergency-response systems can be for underserved communities. “If help can’t reach people when they need it most, the consequences can be life-changing,” she said.

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