Many rural communities rely on emergency medical services (EMS) and ambulance services to meet the prehospital needs of their residents. However, these services face increasing challenges to their sustainability, including reimbursement concerns, workforce issues, and hospital closures. The purpose of this project is to identify characteristics of and trends in the number of Critical Access Hospitals (CAHs) that owned or operated ambulance services during the period 2017-2022, thereby providing insight into how CAHs may play a role in the sustainability of local EMS.