Helicopter emergency medical services response times in Norway: Do they matter?
Peer reviewed, Journal article
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Objective. The main objective of the Norwegian air ambulance service is to provide advanced emergency medicine to critically ill or severely injured patients. The government has defined a time frame of 45 minutes as the goal within which 90% of the population should be reached. The aims of this study were to document accurate flying times for rotor wing units to the scene and to determine the rates of acute primary missions in Norway. Methods. We analyzed operational data from every acute primary mission from all air ambulance bases in Norway in 2011, focusing on the flying time taken to reach scene, the municipality requesting the flight, and the severity score data. Results. A total of 5,805 acute primary missions were completed in Norway in 2011. The median flying time was 19 minutes (25%-75% percentiles: 13-28). The mean mission rate for the 17 bases was 7.5 (95% confidence interval, 7.4-7.8 per 10,000 inhabitants). The overall mean (standard deviation) National Committee on Aeronautics score for all missions was 4.07 (1.30). Conclusion. The government's expectation of serving the entire population via HEMS within 45 minutes appears to be achieved on a national level. However, vast differences remain in the flying times and rates between bases. Helicopter emergency medical services (HEMS) are an integral part in many health care systems in the developed world. The effect of HEMS is still subject to debate although they have several theoretical advantages, such as bringing advanced medical care and medical competence to the scene, shortening the transport time, providing access to remote areas, and reducing the time elapsed until definitive care is available. Several outcome studies have found positive associations with increased survival under the care of HEMS, whereas the opposite effects have also been well documented. However, many of these studies have been subject to methodological limitations, selection bias, and noncomparable study settings or designs. A position paper by several American air medical societies initiated the process of establishing national guidelines to facilitate the beneficial effects of HEMS implementation. The paper stated that clinical benefit could be provided by minimizing the time to definitive care in time-sensitive medical conditions, providing necessary competence and equipment on the scene, and accessing patients who are otherwise inaccessible by other modes of transport.4 These objectives are consistent with national guidelines in other countries. Based on international experiences, a Norwegian national air ambulance (AA) service was established in 1988. A paramount principle in Norwegian health legislation is that all citizens should have equal access to publicly funded health care regardless of their residential pattern. In that sense, well-developed air emergency services have a compensatory effect that adjusts for geographic dispersion and potential unequal access to advanced emergency medical care. A time frame of 45 minutes, including up to a 15-minute reaction time from alarm to takeoff, has been defined as the national goal to reach 90% of the population. In 2002, Heggestad and Børsheim published results on the accessibility and distribution of the Norwegian national air emergency service. In their study, the mean reaction time was 8 minutes in acute missions (from alarm until takeoff), and the mean total response time from alarm until scene arrival was 26 minutes. Nearly 98% of the population was reached within 60 minutes. Within the last decade, the population has increased, enhanced medical capabilities have been developed, and additional helicopter bases have been implemented. Hence, the aims of this study were to document the accurate flying times of rotor wing units to the scene as well as the rates of acute primary missions in Norway.