Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway

Jo Røislien,Hans Johan Breidablik,Dag Ståle Nystøyl,Øyvind Østerås,Erik Zakariassen,Steinar Hunskaar

doi:10.1186/s12873-020-00377-0

Abstract

BackgroundOrganizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district.MethodsAll primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable.ResultsWe included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001).ConclusionAfter relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.

Highlights

Organizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services
A total of 8751 helicopter emergency medical services (HEMS) dispatches were identified during the 10-year period
Fitting a quasipoisson regression model adjusted for seasonality (Fig. 2b), we found no significant change in HEMS dispatches after the policy change (p = 0.251)

Summary

Introduction

Organizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. In Norway, HEMS is an integrated part of the public prehospital emergency medical services, together with ground ambulances and primary care out-of-hours (OOH) services [4]. Ambulances and OOH services, with on-call general practitioners (GPs), are the backbone of prehospital services [4, 5], and the majority of medical emergencies are handled by the ground ambulance staff, often in cooperation with the GPs. The organization of prehospital services in Norway has changed over the last few decades in order to meet the requirements of new treatment algorithms and to fulfill the demands of health regulations. Use of HEMS was stable during the same period [6], though differences between HEMS bases have been reported [7]

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Discussion

Conclusion