Document Type

Policy Brief

Publication Date



MRHRC, EMS, Emergency Medical Services, rural, ambulance, cost, policy


This brief serves to fill the information void on the costs of running ambulance services for three population-based service tiers and establishes a minimum access standard for ambulances servicing a 25-minute travel time radius from the ambulance station. The model enables policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services. Key Highlights: An expert panel established that ambulances could reasonably serve a maximum 25-minute travel time from the ambulance station that accounts for road conditions. A minimum access standard was defined as a single resource consisting of one full-time staffed ambulance, with a second unit “on-call”, supported by a chief. Based on this minimum access standard, the population density within an ambulance service area, and the expected run volume, the expert panel established three population-based service tiers and estimated corresponding start-up and annual service costs. Total annual budgets scale up from approximately $964,200 in 2020 dollars ($1.04 million in 2023 dollars) in low volume service areas (with as few as 25 responses per year) to $2.09 million in 2020 dollars ($2.25 million in 2023 dollars) in high volume service areas (with 1,500 - 2,200 responses per year). Breakeven analyses suggest that low volume agencies experience operating costs of approximately $41,500 (in 2023 dollars) per response, while high volume agencies experience operating costs of roughly $1,020 per response.

For more information on this study, please contact Yvonne Jonk,


This project was funded by the Federal Office of Rural Health Policy within the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreements U1CRH24742 and U1CRH03716. The information or content and conclusions are those of the author(s) and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

Related study:

Jonk Y, Milkowski C, Croll Z, Pearson K. Ambulance deserts: Geographic disparities in the provision of ambulance services. University of Southern Maine, Muskie School, Maine Rural Health Research Center;2023 May.

Funding Organization

HRSA-Federal Office of Rural Health Policy

Grant Number

U1CRH24742; U1CRH03716



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