Planning for emergency medical services (EMS) in a large state with a sparse population like Alaska poses unique challenges that EMS planners in urbanized areas never have to consider. Alaska is the largest state in the USA in land area, covering 586,000 square miles, or an area more than twice the size of the state of Texas. Alaska also has more miles of coastline than the rest of the USA. Despite its large size, Alaska continues to have the smallest year-round population of any state in the nation (400,481–1980 census). Many of Alaska's villages and towns are not accessible by road, including Juneau, the state capital, which can only be accessed by air or water. This means that, with Alaska's often harsh climate, many communities have no available ingress or egress for several hours, or even several days at a time. In these conditions, response times can not be measured in minutes, as they often are in some urbanized areas in other states. For example, Unalaska in the Aleutian Islands, one of Alaska's major fishing ports, is over 900 miles from the nearest hospital in Anchorage.