Response times for emergency medical services in rural areas can take nearly 20 minutes longer than the national average — and patients in these regions are more likely to experience severe medical emergencies, according to a new analysis of national EMS data by the American College of Surgeons.
Researchers presented their findings in early October at the American College of Surgeons (ACS) Clinical Congress 2025 in Chicago. The study analyzed data from the National Emergency Medical Services Information System (NEMSIS) covering more than 69 million EMS calls between January 2023 and January 2025.
Longer call times and higher patient acuity
“EMS response times in rural areas are considerably longer than what you would see in an urban or suburban setting,” said Isabella Turcinovic, lead study author and a third-year medical student at Baylor College of Medicine. “In an emergency, this can be the difference between life or death for many patients.”
The researchers found that the average EMS call time — which includes response, on-scene and transport phases — was 92.8 minutes in rural communities, compared with 74.1 minutes nationally.
For patients with high-acuity conditions — those experiencing life-threatening injuries or severe medical issues — rural response and transport times were even longer, averaging 97.1 minutes compared with 69 minutes nationally. When transported to specialized trauma centers, the average total call time stretched to 155 minutes, about 40 minutes longer than the national average of 114 minutes.
Rural patients face barriers to specialized care
Nearly 40% of rural EMS calls involved patients with high-acuity injuries, compared with 26.4% nationally. The study also found rural patients were four times more likely to be transported to lower-level trauma centers and five times more likely to go to critical access hospitals — small rural hospitals that provide essential care but are not equipped for complex trauma cases.
“These data demonstrate a disparity in access to care,” said Dr. Chad T. Wilson, the study’s senior author and associate professor of surgery at Baylor.
Turcinovic emphasized the essential role of rural hospitals as first points of treatment. “Rural patients present to critical access hospitals at far higher proportions than urban counterparts, highlighting the importance of these rural hospitals, especially at a time when their funding can be constrained,” she said. “The findings also illustrate why rural hospitals may need support for the management of high-acuity patients.”
Why rural patients often have more severe injuries
Several factors contribute to the higher rate of severe injuries seen in rural settings, Turcinovic said. Limited access to primary and preventive care can cause medical conditions to worsen before patients seek help. Rural communities also see higher injury rates due to work-related accidents, longer commutes, and higher driving speeds.
“I think of it as both an acute and chronic concern,” Turcinovic said. “The combination of limited access to care and greater exposure to injury risk makes it more likely that rural patients will need emergency services — and that those emergencies will be serious.”
Looking ahead
The research team, which included Dr. Lubna Khan, a surgical resident at Baylor, plans to continue studying ways to improve EMS resource allocation and trauma care access in rural areas.
Turcinovic said policymakers and planners can use this data to “justify the continued need for rural hospitals and better EMS deployment strategies.”
