Loss of life years due to unavailable helicopter emergency medical service: a single base study from a rural area of Norway

Abstract

Background: Despite the potential benefits of physician-staffed Helicopter Emergency Medical Service (HEMS), many dispatches to primary HEMS missions in Norway are cancelled before patient encounter. Information is sparse regarding the health consequences when medically indicated HEMS missions are cancelled and the patients are treated by a GP and ambulance staff only. We aimed to estimate the potential loss of life years for patients in these situations.

Method: We included all HEMS requests in the period 2010–2013 from Sogn and Fjordane County that were medically indicated but subsequently cancelled. This provided a selection of patients, with the purpose of studying cancellations independently of the patient’s medical status A multidisciplinary expert panel retrospectively assessed each patient’s potential loss of life years due to the lack of helicopter transport and intervention by a HEMS physician.

Results: The study included 184 patients from 176 missions. Because of unavailable HEMS, seven patients (4%) were anticipated to have lost a total of 18 life years. Three patients suffered from myocardial infarction, three from stroke and one from abdominal haemorrhage. The main contribution from HEMS care in these seven cases might have been rapid transport to definitive care. The probability of a patient losing life years when in need of HEMS evacuation was found to be 0.2%.

Conclusion: During the four years period seven patients lost 18 life years. Lack of rapid transport seems to be the primary cause of lost life years in this specific geographical area.

Key Points

• Knowledge about to what extent HEMS contributes to an increased survival and a better outcome for patients is limited.

• Compared to similar studies on life years gained the estimated loss of life years was minor when HEMS evacuation was unavailable in this rural area.

• The findings indicates that lack of rapid HEMS transport was the primary cause of the estimated loss of life years.

Keywords:

• Emergency medicine system
• Primary health care
• Air ambulance
• rural area

Ethics approval

The study was approved by the Regional Committee for Medical and Health Research Ethics (2013/373 REC West, Norway). All patient data were anonymized before assessment by the expert panel.

Consent for publication

The Regional Committee for Medical and Health Research Ethics found that the legal requirements were fulfilled in the project and approve that patient information could be collected, anonymized and published without the consent from the patients.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Partial grant was provided by the Regional Health Trust West [NOK 400 000]. National Centre for Emergency Primary Health Care was responsible for administration and additional founding of the study.