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Emerg Med J. 2018 Dec;35(12):720-725. doi: 10.1136/emermed-2018-207553. Epub 2018 Oct 23.

Evaluation of the provision of helicopter emergency medical services in Europe.

Author information

Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Departments of Emergency and Retrieval Medicine, Ninewells Hospital, Dundee, UK.
Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.



Helicopter emergency medical services (HEMS) are a useful means of reducing inequity of access to specialist emergency care. The aim of this study was to evaluate the variations in HEMS provision across Europe, in order to inform the further development of emergency care systems.


This is a survey of primary HEMS in the 32 countries of the European Economic Area and Switzerland. Information was gathered through internet searches (May to September 2016), and by emailing service providers, requesting verification and completion of data (September 2016 to July 2017). HEMS provision was calculated as helicopters per million population and per 1000 km2 land area, by day and by night, and per US$10 billion of gross domestic product (GDP), for each country.


In 2016, the smallest and least prosperous countries had no dedicated HEMS provision. Luxembourg had the highest number of helicopters by area and population, day and night. Alpine countries had high daytime HEMS coverage and Scandinavia had good night-time coverage. Most helicopters carried a doctor. Funding of services varied from public to charitable and private. Most services performed both primary (from the scene) and secondary (interfacility) missions.


Within Europe, there is a large variation in the number of helicopters available for emergency care, regardless of whether assessed with reference to population, land area or GDP. Funding of services varied, and did not seem to be clearly related to the availability of HEMS.


emergency care systems; global health; prehospital care, doctors in PHC; prehospital care, helicopter retrieval; trauma, majot trauma management

Conflict of interest statement

Competing interests: None declared.

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