A groundbreaking new study published in JAMA Network Open has revealed stark disparities in emergency medical services (EMS) accessibility that trace their roots back nearly a century to redlining—a discriminatory housing practice institutionalized in the 1930s. The research uncovers how the legacy of structural racism continues to shape critical healthcare trajectories in the United States, particularly by limiting rapid EMS response times in historically marginalized neighborhoods. This delay in life-saving care amplifies risks for patients suffering from acute, time-sensitive medical crises such as severe trauma, stroke, cardiac arrest, and septic shock.
The investigation, conducted across 236 U.S. cities, utilized Home Owners’ Loan Corporation (HOLC) maps from the 1930s to categorize neighborhoods based on their historical risk grading. Areas marked as “hazardous” or Grade D—typically inhabited by racial minorities and economically disadvantaged populations—faced significantly reduced probabilities of prompt EMS access relative to Grade A or “most desirable” neighborhoods. Applying rigorous geospatial analysis with 2020 Census data and traffic modeling, investigators demonstrated a measurable and persistent inequity in prehospital care infrastructure that undermines health equity provisions.
One of the study’s central findings highlights that approximately 2.2 million residents—representing 5.4% of the combined population across sampled cities—do not benefit from rapid EMS intervention within recommended response windows. Notably, within Grade D districts, the proportion of individuals without timely EMS access rose to 7%, markedly higher than the 4.4% observed in Grade A zones. This inequity correlates with demographic patterns: Grade D areas had lower percentages of non-Hispanic White residents (39.4%) while comprising more non-Hispanic Black residents (28%), intensifying concerns about systemic racial disparities.
Methodologically, the research employed advanced ArcGIS StreetMap network analysis integrated with historical traffic data to compute EMS travel times, delivering precise accessibility metrics. This layered approach enabled the quantification of EMS reach and allowed for robust comparison across different urban landscapes. The study found that residents in historically redlined neighborhoods were more than 1.5 times as likely to experience EMS delays, underscoring the enduring consequences of racially biased urban planning decisions.
Beyond mapping disparities, the study delved into socioeconomic variables that intersect with EMS accessibility. Neighborhoods graded as D exhibited lower median household incomes and higher population densities, factors known to strain public health resources and infrastructure. Such characteristics exacerbate challenges in swift EMS response, contributing to cumulative disadvantages in health outcomes among oppressed communities.
The clinical implications are profound. Delays in EMS response are strongly linked to increased mortality rates, especially in emergencies where every minute dictates survival odds. The National Fire Protection Association recommends EMS arrivals within nine minutes for general emergencies and a more urgent five minutes for critical cases. Falling short of these benchmarks systematically disadvantages individuals located in former redlined areas, emphasizing the role of historic discriminatory policies as a structural determinant of health.
Experts affiliated with trauma and surgical critical care emphasize that these findings reveal a clandestine health crisis, one concealed beneath the surface of contemporary emergency medicine. Rapid EMS availability is not merely a logistical challenge; it is a matter of life and death, shaped by sociopolitical histories of segregation and disinvestment. The authors argue that failure to address these disparities perpetuates cycles of poor health and inequity.
To confront these systemic gaps, the researchers advocate a comprehensive, data-driven strategy. They propose transparent tracking of EMS equity metrics to promote accountability and inform targeted interventions at all jurisdictional levels. Moreover, planning and resource allocation must incorporate an equity lens, ensuring historically marginalized communities receive prioritized attention in EMS infrastructure development and deployment.
Technological innovations also play a critical role. By harnessing geospatial information systems (GIS) and geostatistical modeling, EMS units can be redistributed intelligently to optimize response times in resource-poor neighborhoods. This reallocation would involve redesigning EMS deployment protocols to recognize and respond more effectively to areas with heightened risk profiles, reducing preventable mortality linked to delayed care.
Community engagement is another pillar of the proposed remedy. The study underscores the necessity of incorporating voices from affected neighborhoods into EMS planning and policy formulation. Such participatory approaches foster trust, align services with localized needs, and enhance the cultural competence of emergency responses, promoting equitable health outcomes.
This pioneering research, supported by the National Institute on Minority Health and Health Disparities, unites epidemiological expertise from esteemed institutions including Columbia University, Rutgers Health, New York University, University of Utah, and University of California campuses. Their collaborative effort opens avenues for systemic reform by empirically linking historic racialized policies to present-day health inequities, catalyzing urgent policy discourse.
As Dr. Dustin Duncan from Columbia University Mailman School of Public Health succinctly concludes, the findings demand pragmatic, equity-centered policy intervention informed by robust data analytics to safeguard equitable access to lifesaving prehospital care. Addressing EMS disparities is indispensable to dismantling health inequalities ingrained by decades of structural racism.
This study not only elevates awareness about EMS accessibility inequities but also epitomizes how historical urban planning legacies echo in modern healthcare systems. Ultimately, ensuring rapid EMS response for all communities, regardless of their historical grading, is pivotal to building a just and responsive public health infrastructure for future generations.
Subject of Research: Impact of historical redlining on equitable access to rapid emergency medical services in U.S. cities.
Article Title: Rapid Access to Emergency Medical Services Within Historically Redlined Areas
News Publication Date: August 12, 2025
Web References:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837256
http://dx.doi.org/10.1001/jamanetworkopen.2025.25681
References: National Institute on Minority Health and Health Disparities grant 5R01MD018177
Keywords: Health and medicine
