Aim <p>The COVID-19 pandemic significantly altered healthcare dynamics, including emergency ambulance services. This study investigates the impact of the COVID-19 pandemic on emergency ambulance demand across various counties in the Małopolska region, Poland.</p> Subject and methods <p>We conducted a comprehensive analysis of emergency ambulance calls from January 2020 to December 2023, encompassing the pre-pandemic, pandemic, and post-pandemic phases. Data were aggregated at both daily and monthly levels, with correlation matrices and cluster dendrograms applied to assess spatial and temporal patterns in ambulance demand across different counties.</p> Results <p>A total of 752,987 emergency calls were analyzed. The early stages of the pandemic saw a significant reduction in ambulance calls, correlated with strict lockdown measures, while subsequent phases marked a steady increase in demand, peaking during the vaccination rollout and post-pandemic periods. High correlations were observed between neighboring counties, with the strongest correlations in urban areas like Kraków. Distinct patterns emerged, with heavy tourist counties showing different call trends compared to more industrial regions. The study highlights the evolving nature of emergency medical services demand in response to public health crises and the varying impacts across different types of counties.</p> Conclusion <p>The COVID-19 pandemic had a profound and multifaceted impact on ambulance demand in the Małopolska region, with notable differences between urban, industrial, and tourist areas. These findings underscore the importance of adaptable and region-specific strategies in managing emergency medical services during public health emergencies.</p>