America’s Medical Deserts: What Happens When Disaster Strikes and There’s No Hospital?

Imagine a Category 4 hurricane making landfall in a rural town, leaving destruction in its wake. Homes are flooded, power lines are down, and a father of three suffers a heart attack. He calls 911-only to learn that the nearest emergency room is over 50 miles away, and the local ambulance service is overwhelmed.

This is not a hypothetical scenario. It is the reality for many Americans living in medical deserts-regions where hospitals have closed, emergency services are scarce, and access to basic healthcare is severely limited. When disasters strike, these communities face an alarming reality: no hospitals, no doctors, and no immediate medical assistance.

Rural Hospital Closures: A Growing Crisis

In the past two decades, over 190 rural hospitals have closed across the U.S., leaving large portions of the country without access to emergency care. Since 2010, an average of over 10 rural hospitals per year have shut their doors. Hundreds more are at risk of shutting down due to financial strain, staffing shortages, and policy decisions that hinder the sustainability of small hospitals. These closures disproportionately impact older adults, low-income families, and individuals with chronic conditions who rely on nearby medical facilities for routine and urgent care.

According to the Center for Healthcare Quality and Payment Reform, over 600 rural hospitals-nearly 30% of all rural hospitals in the U.S.-are at immediate risk of closure due to financial instability. Many of these facilities operate on razor-thin margins, often serving uninsured or underinsured populations that struggle to pay for care. Medicare reimbursement rates and declining patient volumes further exacerbate the crisis.

For millions of Americans, this means that a routine emergency-such as a heart attack, stroke, or car accident-can become fatal due to the absence of a nearby emergency room. Without swift medical intervention, even treatable conditions can become life-threatening. During a disaster, when time is of the essence, the consequences are even more severe.

The absence of hospitals in rural communities also means a lack of specialty care, including obstetrics, cardiology, and trauma services. Pregnant women are particularly vulnerable, as maternity wards continue to shut down in rural areas, forcing expectant mothers to travel long distances for prenatal and emergency care. Between 2011 and 2021, over 400 obstetric units in rural hospitals closed, making it even harder for women to access maternity care in emergencies.

The Emergency Medical Services Gap

In many medical deserts, emergency medical services (EMS) are stretched dangerously thin. Some counties rely on volunteer EMTs, and ambulances often must cover vast geographic areas. In some cases, a single ambulance may serve an entire county, leading to dangerously long wait times for emergency transport.

• In rural Texas, some residents wait up to an hour for an ambulance.

• In parts of Mississippi and Alabama, hospital maternity wards have closed, forcing pregnant women to drive hours to access care.

• In California, wildfires have overwhelmed local EMS, leaving residents without immediate medical assistance.

During a disaster, when roads are impassable and hospitals are distant, some individuals do not receive care in time to survive. The strain on EMS services increases exponentially in crisis situations, when demand surges beyond capacity. Hurricane evacuations, wildfire-induced displacements, and tornado-related injuries place enormous pressure on already fragile emergency response systems.

Air medical transport, often the only viable option for critically ill patients in remote areas, is prohibitively expensive and not always available. Even when air transport is an option, weather conditions during disasters can render it unsafe or impossible.

Natural Disasters Are Intensifying the Crisis

Hurricanes, wildfires, floods, and tornadoes do not just destroy infrastructure-they expose critical vulnerabilities in the nation’s healthcare system. Some of the hardest-hit areas in recent disasters include:

• The Gulf Coast – Coastal hospitals have closed, leaving hurricane-prone areas with dwindling medical options. When hurricanes make landfall, flooding can render the few remaining hospitals inaccessible.

• The Midwest – Tornado-prone states like Kansas and Missouri have seen a wave of rural hospital closures, increasing risk for affected communities. With tornadoes often striking suddenly, the ability to access emergency care in the immediate aftermath is critical.

• The West – Wildfire evacuations often mean losing access to medical care entirely. In some instances, hospitals themselves have been destroyed, leaving residents with no medical infrastructure to return to once the fires subside.

The impact of medical deserts is exacerbated by climate change, which has increased the frequency and intensity of natural disasters. Rising temperatures and prolonged droughts have made wildfires more devastating, while stronger storms and hurricanes lead to widespread destruction and displacement. Without access to healthcare, disaster survivors face prolonged suffering, untreated injuries, and increased mortality rates.

Addressing the Crisis: Potential Solutions

Despite the severity of the issue, there are actionable steps that can help mitigate the impact of medical deserts and improve disaster resilience:

1. Expand Mobile Clinics – Deploying fully equipped mobile health units can bring emergency care to underserved regions, particularly after disasters. These units can provide first aid, prescription medications, and basic diagnostic services to communities cut off from healthcare access.

2. Invest in Telemedicine – Virtual urgent care services can help bridge gaps when in-person care is unavailable. Advancements in telehealth technology enable remote consultations with doctors, reducing the need for long-distance travel for non-emergency medical concerns.

3. Strengthen Rural EMS – Increasing funding for ambulances, paramedics, and air transport services can significantly improve emergency response times. Federal and state investments in rural EMS infrastructure can help ensure that residents in medical deserts receive timely care.

4. Support Rural Hospitals – State and federal initiatives to sustain and reopen small hospitals can prevent further closures and restore access to emergency care. Providing financial incentives, loan forgiveness programs for rural healthcare workers, and policy reforms to sustain critical access hospitals are essential to reversing the trend of closures.

5. Enhance Disaster Preparedness in Healthcare – Emergency planning must incorporate proactive strategies to ensure continued medical access before the next crisis occurs. Hospitals and local governments should develop emergency response plans that include backup medical facilities, rapid deployment of mobile clinics, and pre-positioning of medical supplies in high-risk areas.

6. Increase Public Awareness and Advocacy – Raising awareness about medical deserts can help drive policy changes and funding initiatives. Community-driven advocacy efforts, combined with legislative action, are necessary to ensure that rural and underserved populations are not left without critical healthcare services.

The Urgency of Action

The assumption that hospitals will always be available in times of need is no longer a reality for millions of Americans. The closure of healthcare facilities in rural and underserved regions has created a significant public health crisis, one that becomes even more dire during disasters. Without nearby hospitals, the survival of residents in medical deserts is increasingly dependent on alternative solutions, many of which remain underfunded or nonexistent.

Addressing America’s medical deserts is not just a matter of improving healthcare-it is an essential component of disaster preparedness and emergency response. Without decisive action, preventable deaths will continue to occur, and vulnerable communities will remain at heightened risk. The cost of inaction is measured in lives lost. The time to act is now.