Geospatial structural isolation analysis of emergency services in New York State

Access to emergency health care is a fundamental component of public health, yet rural regions, particularly in New York State, face persistent disparities. With 3.5 million residents living in rural areas spanning more than 41,000 mi², distance, travel infrastructure, and limited transportation create barriers to care. This study evaluates structural isolation of hospitals providing emergency services by quantifying inter-facility spacing, travel-time catchments, and resulting coverage responsibilities, with attention to border contexts.

The study employs geospatial analysis to evaluate hospital structural isolation, focusing on emergency services, and identifies facilities with extensive coverage responsibilities or limited inter-facility connectivity. Research integrates US and Canadian datasets, applying various measures to determine the isolation of health care facilities and assess catchment areas.

Large gaps in emergency access persist in rural and border regions of NYS. The most isolated facilities exhibited up to 60- to 70-mile diameters between coverage edges and catchments exceeding 3000 mi². After reassignment of >60-min areas, several regions remained beyond timely ground access, indicating heightened vulnerability despite low resident density and challenging terrain/road networks.

Structural isolation concentrates service burden on a small set of rural hospitals. Integrating cross-border facilities, drive-time isochrones, and reassignment of uncovered areas yields a more realistic depiction of emergency coverage than distance alone. By adopting a multifaceted approach that includes community needs and regional collaboration, New York State can improve emergency health care access and foster a more equitable health care system.