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      Exploring optimal air ambulance base locations in Norway using advanced mathematical modelling

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          Abstract

          Background

          Helicopter emergency medical services are an important part of many healthcare systems. Norway has a nationwide physician staffed air ambulance service with 12 bases servicing a country with large geographical variations in population density. The aim of the study was to estimate optimal air ambulance base locations.

          Methods

          We used high resolution population data for Norway from 2015, dividing Norway into >300 000 1 km×1 km cells. Inhabited cells had a median (5–95 percentile) of 13 (1–391) inhabitants. Optimal helicopter base locations were estimated using the maximal covering location problem facility location optimisation model, exploring the number of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, both in green field scenarios and conditioning on the current base structure. We reanalysed on municipality level data to explore the potential information loss using coarser population data.

          Results

          For a 45 min threshold, 90% of the population could be covered using four bases, and 100% using nine bases. Given the existing bases, the calculations imply the need for two more bases to achieve full coverage. Decreasing the threshold to 30 min approximately doubles the number of bases needed. Results using municipality level data were remarkably similar to those using fine grid information.

          Conclusions

          The whole population could be reached in 45 min or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases. Municipality level data appears sufficient for proper analysis.

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          Most cited references16

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          Association between helicopter vs ground emergency medical services and survival for adults with major trauma.

          David T Efron, J. Koenig, Michael Millin … (2012)
          Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Retrospective cohort study involving 223,475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank. Transport by helicopter or ground emergency services to level I or level II trauma centers. Survival to hospital discharge and discharge disposition. A total of 61,909 patients were transported by helicopter and 161,566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17,775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score-matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14-1.17; P < .001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13-1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers by helicopter were discharged to rehabilitation compared with 12.7% transported by ground services (P < .001), and 9.3% transported by helicopter were discharged to intermediate facilities compared with 6.5% by ground services (P < .001). Fewer patients transported by helicopter left level II trauma centers against medical advice (0.5% vs 1.0%, P < .001). Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders.
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            Locating AED Enabled Medical Drones to Enhance Cardiac Arrest Response Times.

            Aaron Pulver, Ran Wei, N Mann (2024)
            Out-of-hospital cardiac arrest (OOHCA) is prevalent in the United States. Each year between 180,000 and 400,000 people die due to cardiac arrest. The automated external defibrillator (AED) has greatly enhanced survival rates for OOHCA. However, one of the important components of successful cardiac arrest treatment is emergency medical services (EMS) response time (i.e., the time from EMS "wheels rolling" until arrival at the OOHCA scene). Unmanned Aerial Vehicles (UAV) have regularly been used for remote sensing and aerial imagery collection, but there are new opportunities to use drones for medical emergencies.
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              Prehospital advanced life support provided by specially trained physicians: is there a benefit in terms of life years gained?

              Janne Søreide, S Hapnes, O Eielsen … (2002)
              The benefit of prehospital advanced life support (ALS) is disputed, as is the prehospital use of specially trained, hospital-based physicians. The purpose of the study was to assess the health benefit from an anesthesiologist-manned prehospital emergency medical service (EMS), and to separate the benefit of the anesthesiologist from that of rapid transport. The anesthesiologist-manned helicopter and rapid response car service at Rogaland Central Hospital assisted 1106 patients at the scene during the 18-month study period. Two expert panels assessed patients with a potential health benefit for life years gained (LYG) using a modified Delphi technique. The probability of survival as a result of the studied EMS was multiplied by the life expectancy of each patient. The benefit was attributed either to the anesthesiologist, the rapid transport or a combination of both. The expert panels estimated a benefit of 504 LYG in 74 patients (7% of the total study population), with a median age of 54 years (range 0-88). The cause of the emergency was cardiac diseases (including cardiac arrest) in 61% of the 74 patients, trauma in 19%, and cardio-respiratory failure as a result of other conditions in 20%. The LYG were equally divided between air and ground missions, and the majority (88%) were attributed solely to ALS by the anesthesiologist. The expert panels found LYG in every 14th patient assisted by this anesthesiologist-manned prehospital EMS. There was no difference in LYG between the helicopter and the rapid response car missions. The role of the anesthesiologist was crucial for health benefits.
              Article 0 comments Cited 37 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Inj Prev
                Journal ID (iso-abbrev): Inj. Prev
                Journal ID (hwp): injuryprev
                Journal ID (publisher-id): ip
                Title: Injury Prevention
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 1353-8047
                ISSN (Electronic): 1475-5785
                Publication date (Print): February 2017
                Publication date (Electronic): 20 June 2016
                Volume: 23
                Issue: 1
                Pages: 10-15
                Affiliations
                [1 ]Department of Health Studies, University of Stavanger , Stavanger, Norway
                [2 ]Department of Research, Norwegian Air Ambulance Foundation , Drøbak, Norway
                [3 ]Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo , Oslo, Norway
                [4 ]Delft Institute of Applied Mathematics, Delft University of Technology , Delft, The Netherlands
                [5 ]SAFER (Stavanger Acute Medicine Foundation for Education and Research) and Stavanger University Hospital , Stavanger, Norway
                [6 ]Department of Global Public Health and Primary Care, University of Bergen , Bergen, Norway
                [7 ]Centrum Wiskunde & Information , Amsterdam, The Netherlands
                Author notes
                [Correspondence to ] Dr Jo Røislien, Institutt for Helsefag, Universitetet i Stavanger, Postboks 8600 Forus, Stavanger 4036, Norway; jo.roislien@ 123456norskluftambulanse.no
                Article
                Publisher ID: injuryprev-2016-041973
                DOI: 10.1136/injuryprev-2016-041973
                PMC ID: 5293838
                PubMed ID: 27325670
                SO-VID: 47a3c785-22f2-4f67-9b0e-8de1fcca73ee
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 27 January 2016
                Date revision received : 11 May 2016
                Date accepted : 24 May 2016
                Categories
                Subject: 1506
                Subject: Original Article
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                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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