Built environment and emergency medical services response time in a high-density megacity: multilevel evidence from urban–suburban

Introduction Emergency medical services (EMS) response time is a key indicator for evaluating the performance of public health system and is closely associated with patient survival rates. However, empirical evidence on the potential relationship between the built environment and EMS response time remains limited, restricting the development of spatially informed strategies for improving EMS system operations. Methods This study employed 2024 ambulance dispatch data from the Beijing Emergency Center Office Management System, combined with multi-source data on the built environment, to construct a multilevel regression model examining the influence of subdistrict (township)-level built environment factors on EMS response time and investigating the heterogeneity between urban areas and suburbs. Results The results indicate that, at the citywide level, lower residential facility density and denser arterial and local road networks significantly reduced EMS response time. Specifically, while in central urban areas, high densities of residential facilities were associated with longer response time, in suburban areas, higher densities of local roads enhanced EMS efficiency. Discussion These findings provide valuable evidence to guide built environment interventions aimed at shortening EMS response time and improving service efficiency across different areas.