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Better hope that you aren’t in a rural area if you are seriously hurt and need an ambulance. The wait could be dangerous.

Response times for emergency medical services are more than twice as long in rural areas than urban locations, according to a recent in JAMA Surgery.

Median response times were 13 minutes out in the country compared with six in both city and suburban locations, researchers found after reviewing records of nearly 1.8 million EMS runs across the U.S. in 2015.

That’s not the worst of it. In rural areas, one in 10 EMS units did not reach an emergency scene for nearly half an hour after the 911 call came in, the study reported.

“There are just some things that just can’t wait,” said Dr. Howard Mell, the study’s lead author. “When someone’s heart is not beating … when someone’s not breathing, any delay in care, even a minute — it’s proven to be detrimental.”

The researchers point out in their letter that they looked into the time differences to help inform the debate about improving first aid campaigns. They said their data suggest that bystanders can provide valuable assistance to the sick and injured persons before EMS arrives.

The JAMA letter put it this way: “Recognizing that ‘you are the help until help arrives’ may be lifesaving.”

Mell, whose 25 years in emergency medicine also includes stints as a firefighter and a paramedic, said he cannot recall an instance when a trained bystander at an emergency scene would not have helped before EMS’ arrival. He is the attending emergency physician for CEP-America at Presence Mercy Medical Center in Aurora, Ill., and a spokesperson for the American College of Emergency Physicians.

Caring for the sick and injured is EMS’ workers’ job, but according to Mell’s study, family, friends and bystanders are the first link in the chain of survival. Beneficiaries are not always strangers.

People who get first aid and CPR training will likely use it to save friends and family members one day, Mell said. “It’s extremely rare that you get a patient who is truly alone.”

The researchers’ message is at the center of a public education campaign called “Until Help Arrives,” which is affiliated with the Federal Emergency Management Agency and other government agencies. The campaign provides to teach basic life-saving skills.

An accompanying editorial endorsed the researchers’ viewpoint and said their study “reinforces the importance of bystanders as immediate responders.” It pointed to the need for more emphasis on teaching people how to control bleeding.

Thirty-two states have adopted legislation requiring high school students be trained in CPR and the use of  automatic electric defibrillators before graduation. Students should also learn how to control bleeding, the editorial said.