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Time is a sensitive and crucial factor in emergency medical service (EMS). The megacities in low and middle income countries (LMICs) like Karachi are vulnerable to man-made disasters like bomb blasts and ever growing road traffic incidents. The spatial and temporal differences of EMS accessibility are vital for the assessment, provision and utilization of emergency facilities for efficient emergency services dispatch in the urban communities.This was a cross-sectional exploratory study conducted from October-December 2016 to analyze the impact of traffic congestion gridlocks on the temporal and spatial accessibility to EMS in Karachi- the economic and industrial hub of Pakistan. The target study area was Saddar Town- Karachi, the heart of all tertiary and disaster management healthcare services. The analysis was done by using the elevated observation and photographic impressions during peak hours of weekdays, in-depth-interviews with EMS transportation personal and traffic constables and maximum-car-methods.The results revealed : (1) During rush hours, the average and longest time between 12 hospitals and communities are 80% higher than using standard road speed (2) The traffic congestion and gridlocks on EMS accessibility significantly impact areas where the road network are broken, prevalent bottleneck situations and traffic rules are ignored (3) With the increase of time impedance, accessibility was slowed. This trend is more obvious in off-rush hours.The real-time traffic condition should be considered in planning, development and provision of EMS. An integrated approach is needed to optimize EMS scheduling and improved efficiency. Hence this will ensure accessibility to non-affording consumers and victims of disasters (bomb blasts, road traffic incidents) or natural calamity seeking public sector healthcare facilities. Otherwise, limited accessibility and unavailability of EMS services for communities may result in poor health outcomes, compromised quality of care as well as less than optimal utilization of services.