As in many other countries, HEMS (helicopter emergency medical service) helicopters are essential for providing these services in remote areas. The main tasks of the HEMS helicopters are to offer advanced emergency medical treatment outside hospitals; and to bring patients directly to the correct level of treatment in the health service. The medical benefits of HEMS are primarily related to emergency medical competence and the time factor.
Emergency medical expertise ensured by having doctors and nurses with a specialisation; in emergency medicine as crew members. The time factor covers; both how long it takes from when the emergency medical condition occurs until adequate emergency care is given; and the time taken from when the condition occurs until the patient reaches hospital for treatment.
The introduction of common European regulations for working; and resting periods may lead to a reduction in down-time due to better crew availability; but it will also involve increased costs due to investment in more crews and helicopters. Based on this, investigate whether the cost of investing in increased staffing of the state HEMS helicopters; to avoid missions not carried out due to limitations in crew availability, can be justified by the benefits associated with carrying out these missions.
Helicopter emergency medical service
The Norwegian HEMS organised into 12 HEMS bases; and 13 helicopters on standby 24 h a day, all year round. A regulation from the Ministry of Transport and Communications Norway, i.e. the ‘BSL D 2-4’, governs the staffing arrangements of the HEMS helicopters, including allowing 24 h of continuous emergency readiness service for Norwegian HEMS crews. Furthermore, according to the ‘BSL D 2-4’ regulations, emergency readiness on land (on a base) shall; as a minimum count as 50% of the active working hours.
In order to ensure a sufficient buffer for unforeseen circumstances; within the annual limit of 2000 h of working time, the number of crews calculated based on a normal man-year of 1750–1900 h; which gives a normal shift pattern of approximately 104 shift days plus days for the completion of necessary operational training. The minimum staffing requirement is four crews per HEMS helicopter. The tactical disposition of working hours while the employee is actually; at work regulated according to the individual operator’s operating manual.
The benefits of changing the working and resting regulations; will be related to fewer cancelled missions. When introducing new regulations, it assumed that no missions will cancel due to improve crew availability due to the increased staffing. While this is unrealistic; as there almost certainly will be cancellations.
Number of completed missions
Registered activity data shows variations between the different HEMS; bases with regard to share of missions that not completed due to crew availability. At the Lørenskog base, there is a high number of completed missions; and the proportion of missions ‘not completed due to crew availability’ is low. Statistics for the HEMS helicopter in Tromsø are close to the average; in terms of both requested mission and completed missions, while the share of registered missions ‘not completed due to crew availability’ is higher than average.
Available activity data is used to calculate i) the average number of requested missions; ii) the average number of completed missions and iii) the average number of not completed missions. Such averages do not necessarily represent any of the actual HEMS helicopters bases in terms of their activity profile. For some of the HEMS helicopter bases the activity level is much higher than average; and for some the activity level is lower.
HEMS helicopters mainly used for missions in rural areas; where their use gives benefits in terms of time and emergency medical competence, meaning that the assumption of an average of 6.95 life years gained can be representative. To provide a better basis for decision-making, the cost-benefit analysis could have included a thorough calculation in monetary values of all the positive and negative effects that the implementation of a new European framework for working and resting periods would entail.