Across Europe, demand for ground ambulance services is rising, while capacity, workforce availability, regulatory limits and inflationary cost pressures intensify. We look at the evolving landscape, highlight major market stress points, and assess how stakeholders are responding. We also have anassessment of the latest regulations in different jurisdictions that are hindering insurance development and growth. We cover the most important regulatory frictions across major and emerging jurisdictions, explain how they impede growth, and propose actionable mitigations for industry stakeholders.