Objective <p>Swedish emergency medical services (EMS) faces challenges due to increased demand and limited resources. In Sweden, EMS have experienced a general increase in workload, with longer response times, and limited access to and capacity of receiving facilities. The geographical distribution of EMS events remains unknown. The study aims to investigate the occurrence of EMS missions and assessment of patients' conditions by mapping and comparing the geographical distribution between a Swedish suburban and a rural setting.&#xa0;</p> Methods <p>A descriptive observational study assessed patient conditions and geographical distributions of EMS events in a medium-sized region in Sweden in 2018. Data was retrieved from ambulance medical records.</p> Results <p>EMS assessed 24,672 patients, of whom two-thirds had non-urgent conditions. Almost half of the patients were females, and the median age of all patients was 72&#xa0;years. Suburban areas had a slightly higher proportion of urgent dispatch priority than rural areas, while patient contact times were considerably longer in rural areas. There were no notable differences in suburban versus rural areas regarding which conditions were most common. Overall, 29% of patients were left on-scene after EMS assessment. Rural units more often left patients on-scene compared with suburban units.</p> Conclusions <p>Overall, the EMS events were broadly equal between suburban and rural areas. Despite longer transport and patient contact times in rural areas, response times were still similar. However, patients in rural areas are assessed and left on-site to a greater extent compared to patients in suburban areas, who are instead transported to hospitals for discharge.</p> Trial registration <p>Not applicable.</p>