Equitable access to emergency medical services (EMS) is a core principle of health system performance. However, in territorially heterogeneous countries, resource allocation often fails to reflect interacting demographic and spatial determinants. In Poland, systematic nationwide evidence integrating demographic, spatial, and operational determinants of EMS utilisation remains limited. This study examines whether EMS allocation aligns with actual demand patterns and identifies structural imbalances across regions. A nationwide cross-sectional analysis was conducted using official EMS dispatch data covering all 16 voivodeships over a 31-day period (16 February–18 March 2025). Indicators were calculated per 100,000 inhabitants and per km² using national demographic statistics. Associations between population size, density, territorial extent, EMS team allocation and workload were assessed using correlation and regression analyses. Daily call volume averaged 13,106 nationwide, with 71.5% resulting in ambulance dispatch. Population size strongly predicted absolute demand (r = 0.96, p < 0.001), explaining most regional variance (R² = 0.964). However, population-standardized and area-adjusted indicators revealed substantial structural discrepancies. Population density was positively associated with spatial call intensity (r = 0.88, p < 0.001) but negatively associated with per-capita rates (r = − 0.62, p = 0.008). Workload per EMS team varied significantly across regions (p < 0.001), indicating that resource allocation does not fully correspond to operational burden. EMS demand in Poland is not solely a function of population size. Territorial accessibility and density shape operational pressure in distinct ways, exposing structural allocation imbalances. Sustainable EMS planning requires integrated, multidimensional allocation models that simultaneously account for demographic scale, spatial dispersion and workload intensity.
Żuratyński et al. (Sat,) studied this question.