ArticleScandinavian journal of trauma, resuscitation and emergency medicine2026
Impact of Helicopter Emergency Medical Services on endovascular thrombectomy delays, clinical outcomes, and societal costs in large vessel occlusion stroke: a retrospective registry based counterfactual simulation study.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is highly time-dependent. This study evaluates the logistical, clinical, and economic utility of physician-staffed Helicopter Emergency Medical Services (HEMS) within a centralized stroke network.
methodsThis retrospective study (2021-2025) of 617 EVT-treated LVO patients used spatial simulations on a 159-patient subset, excluding those with missing data, non-transport delays, and distances ≤ 30 km. Simulation 1 compared 42 realized HEMS missions to simulated ground transports across varying on-scene times (OST). Simulation 2 modeled 117 ground-transported patients (> 30 km) as hypothetical HEMS missions under simultaneous vs. secondary dispatch protocols. Clinical and economic impacts were estimated using ordinal logistic regression, HERMES meta-analysis estimates, and a 2-year societal cost model.
resultsHEMS patients had higher baseline severity (median NIHSS 19 vs. 14, p < 0.001). Multivariable regression confirmed EVT delay independently predicted a 90-day mRS shift. In Simulation 1, a "scene-time paradox" was identified: prolonged on-scene stabilization negated the aerial transit advantage, with the Rapid-Extrication Scenario showing a modest 1.7-minute HEMS saving whereas the Matched-OST Scenario isolating pure transit speed yielded a 19.7-minute advantage. In Simulation 2, simultaneous HEMS dispatch saved a median of 4.8 min for patients located > 30 km away, with over 31% saving > 20 min. Conversely, secondary dispatch caused a median time loss of 3.8 min. Implementing an optimized simultaneous dispatch protocol could prevent 0.76 to 1.98 cases of severe disability over the 5-year period, equating to 2-year societal savings of €39,000 to €107,000 (annualized ~€7,800 to €21,400 per operational year).
conclusionsWhile HEMS provides a transit advantage for LVO stroke, its utility is heavily influenced by on-scene critical care requirements and dispatch timing. Because secondary dispatch negates aerial speed advantages, simultaneous dispatch is essential for maximizing both clinical and economic benefits.
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