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Ambulance Deserts & the Struggle For Timely Cardiac Arrest Intervention 


People who live more than 25 minutes away from the nearest ambulance service live in what are called ambulance deserts. Just like the term food desert describes places where it’s difficult for people to access grocery stores or healthy food, an ambulance desert refers to an area where communities lack access to quick emergency medical services. This becomes especially problematic in the context of emergencies that require immediate medical intervention to ensure the best chances of survival, like Sudden Cardiac Arrest

ambulance desert

The need for AEDs in rural communities and throughout ambulance deserts is quite large since the window for responding to a cardiac emergency is narrow. While public access AEDs exist, today’s AEDs are not really a part of a system of response- and there’s no way to know where and when one is needed quickly. 

What is an Ambulance Desert?

Pickens County, Alabama is an example of an ambulance desert. There is one ambulance station in Carrollton, AL that has just two ambulance vehicles dedicated to serve 20,000 residents who are spread across 900 square miles. This means that when there are three emergency situations happening at the same time, only two ambulances are available to respond. A study that analyzed ambulance services across rural, suburban and urban areas, found that the time it took EMS to respond to rural calls was double the average response time in urban areas. 

The residents of Pickens are part of the nearly 4.5 million Americans who live in ambulance deserts and experience disparities in access to timely medical care. Research has shown that rural communities are more likely to have ambulance deserts, however urban areas are not without gaps in coverage. Ambulance deserts are determined by the average length of time it takes for EMS to respond to a call for help, not just the mileage from the nearest ambulance service, so ambulance deserts can exist in more populous, urban areas, too. 

The Rural Health Research Center (RHRC) found that the mountainous ranges of Maine, Vermont, Oregon and Washington were among places with the highest number of people living in ambulance deserts as well as states like Kentucky, West Virginia, and others in the Appalachian region in the south. Other states with notably high percentages of people impacted by ambulance deserts were Nevada, Utah and New Mexico. 

How Do Ambulance Services Work? 

Unlike EMS agencies like fire and police departments, ambulance services are primarily funded by insurance reimbursements, not local or state allocated resources. This means that it can be particularly difficult to finance ambulances in rural areas where the call volume is lower and the distance between caller, hospital and ambulance is more spread out. 

Ambulances across the country are staffed by both paid and volunteer responders, however, rural ambulance services rely more heavily on volunteer medical responders to render care in these less populated communities. A study from 2020 found that while only 13% of all EMS professionals are volunteers, the overwhelming majority, 74%, of these volunteers are working in rural communities. 

Why Do Ambulance Deserts Exist?

Ambulance deserts exist due to the combination of several factors: 

  • Budgetary constraints 
  • Low call volumes 
  • Hospital closures 
  • Staffing challenges 
  • Lack of healthcare infrastructure 

Ambulances services are funded by insurance, and medical reimbursement often isn’t enough to cover the full operating costs of running an ambulance service, especially in rural areas.

When hospitals close, this puts even more strain on ambulance services because they have to travel even further distances to transport patients to the closest emergency room. Staffing challenges in more remote areas, compounded by low pay, lead to a shortage of qualified personnel to run ambulances. 

Impact of Ambulance Deserts During Cardiac Emergencies 

When there aren’t enough service vehicles or they take too long to reach someone in cardiac arrest, that person’s chances of survival and recovery are much lower.  For every minute that someone in cardiac arrest does not receive high-quality CPR or a shock from an AED, their chances of survival drop by about 10%. So, if the first shock from a defibrillator is the one that’s delivered by an ambulance, the person in SCA likely will not survive in an ambulance desert. 

The delay of early defibrillation unfortunately leads to death in many cardiac arrest cases. Medically underserved communities suffer disproportionately from cardiac arrest, and the residents in ambulance deserts face heightened risks without quick access to public AEDs. 

What to Do While Waiting for EMS to Arrive 

Bystanders who witness a cardiac arrest play the most crucial role in supporting a person in SCA until the ambulance arrives. Calling 911, performing CPR and using an AED before EMS arrives can significantly increase chances of survival and give patients the best chance of survival. High-quality CPR will keep oxygenated blood flowing throughout the body and a shock(s) from an AED can restart the heart so that it’s able to regain its normal rhythm. 

11% of cardiac arrest patients in 2022 had a bystander apply an AED before EMS arrived on scene, which means that most of the time, the first AED available is the one that the ambulance service delivers. Because more than 70% of cardiac arrest incidents happen in the home, it’s important to expand AED technology into the home for family and neighborhood use to ensure a swift response. This would make a huge difference in communities where ambulance deserts exist since waiting more than 25 minutes for EMS to deliver an AED does not bode well for patient outcomes. 

Melissa-Jo Nason, Doctoral Candidate at Baylor University and registered nurse specializing in rural health, shared how she believes communities in ambulance deserts can best address the issues of out-of-hospital cardiac arrest in the absence of quick EMS access, “…by increasing access to strategically placed AEDs and providing widespread training on CPR and AED use. Evidence from multiple studies reflects that consistent training not only elevates the skills of individuals but also boosts their confidence and willingness to utilize AEDs when the need arises.”

Addressing Ambulance Deserts with the Avive Connect AED™

The Avive Connect AED was conceptualized and designed by outdoor enthusiasts with many of these rural healthcare challenges in mind. We saw a real need for a more accessible, portable, and affordably priced AED that could expand the possibilities of lifesaving care in off-the-grid areas before EMS arrival. This is particularly valuable in ambulance deserts where emergency response times are 25 minutes or longer.

The Avive Connect AED’s connectivity features enhance communication and coordination between the arrest patient, 911, and medical professionals, allowing for more informed emergency and treatment responses. Its next generation features work to integrate AEDs into the prehospital system of response by enabling in-rescue communication with 911, geolocation services, and rapid incident data transfer. The device’s modern subscription model makes it easy for individuals to afford, allowing lifesaving technology to be brought into neighborhoods and homes, where over 70% of cardiac arrest incidents occur. 

Avive’s 4 Minute City™ Solution 

Avive’s 4 Minute City Programs present a unique solution to the problem of out-of-hospital cardiac arrest (OHCA) by strategically placing Avive Connect AEDs with individuals in select communities throughout the country to help increase bystander intervention and provide rapid response to someone in cardiac arrest. As a 4 Minute City, the Avive Connect AED is integrated with the community’s 911 Telecommunication center so that the devices will alert their owners when and where they need to be immediately used, with the goal of rendering professional help with an AED before EMS arrives. 

Avive Connect AEDs bridge the gap by offering an affordable, portable, and user-friendly solution, significantly improving the chances of survival for individuals experiencing cardiac arrest in remote areas. 

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