(Reuters Health) - The availability of helicopter ambulance service varies widely across different European countries, a recent study suggests.

This inconsistency could lead to greater inequity in access to healthcare, the authors write in the Emergency Medicine Journal.

“These services are variable in so many ways in terms of geographic coverage and population coverage,” said senior study author Dr. Jan Jansen of the University of Alabama at Birmingham’s Center for Injury Sciences.

“This isn’t a problem confined to Europe,” he told Reuters Health in a phone interview. “We’re starting to look at the details here in the U.S. to understand the whole story of emergency medical services coverage.”

Jansen, along with colleagues in the UK, surveyed the primary helicopter emergency medical services (HEMS) in the 28 countries of the European Union as well as Iceland, Lichtenstein, Norway and Switzerland. They gathered data on the types of helicopters used by services in each country, the locations of HEMS bases, night flying capacity and medical staffing.

With the data, they calculated HEMS provision in each country by the number of helicopters per 1 million people, per 1,000 square kilometers and by gross domestic product. They also looked at HEMS availability during the day versus night services.

The research team found that the smallest and least prosperous countries had no dedicated HEMS services at all, including Croatia, Estonia, Latvia, Lithuania and Malta. In contrast, Luxembourg had the highest number of helicopters by area and population, both for day and night services.

Overall, 24 countries had HEMS, ranging from one dedicated helicopter in Ireland to 89 in Germany.

Alpine countries tended to have high daytime HEMS coverage, and Scandinavian countries had good nighttime coverage. Most helicopters carried a doctor, although some had only paramedics or nurses, and for nine countries the researchers couldn’t obtain this data.

“In addition, the aircrafts can vary a great deal in terms of how they’re equipped and when they fly,” Jansen said. “Night flying is very common in some countries, but it is also associated with greater risks.”

Importantly, the research team was surprised that the variability didn’t seem be tied to specific factors such as GDP, population, land area or the funding source for the emergency helicopter service. Future studies may be able to tease out these details if more information is provided by HEMS groups, although it can be tough to create consistent definitions of services across the different countries, Jansen noted.

“Uniform reporting would make it easier to compare responses and systems,” said Anne Siri Johnsen of Norsk Luftambulanse, which provides air ambulance services in Norway and Denmark. Johnsen has studied HEMS responses during major disasters to better understand how the resource is used and to improve procedures.

“If there were more uniform reporting, it would be easier to see the advantages and disadvantages of different systems,” said Johnsen, who wasn’t involved in the current study.

For instance, countries with different geographies need different services. Responses and equipment in flat countries such as Denmark differ from those with mountains such as Norway, she said. Using HEMS at night, although riskier, is important in northern European countries where winter daytime hours are short and it’s dark for most of the day.

“Researchers need to see how the entire EMS system is built,” she said in an email. “In Norway, the search and rescue helicopters play a role in patient treatment and need to be accounted for.”

Future research will also focus on HEMS outside of the European Union, Jansen said. In the United States, for example, he and others are interested in looking at variations and disparities in southern states, particularly in rural areas.

“Access isn’t always straightforward, and it often comes down to where the aircraft is based,” he said. “That’s often neglected when looking at area coverage or population coverage, and we need to look into that.”

SOURCE: bit.ly/2PLb2en Emergency Medicine Journal, online October 23, 2018.