Finnish Helicopter Emergency Medical Service

Finland is a Nordic country with a population of 5.5 million and an area of 338,424 km², thus making it the most sparsely populated country in the European Union. Healthcare is governed regionally by 21 hospital districts, each braced by one of the five university hospitals for tertiary care.
EMS in Finland are locally organized by the hospital districts. The system is publicly funded, including the dispatch centers and HEMS. Since 2012 HEMS is administered by a national administrative unit FinnHEMS Ltd., owned and governed by the five university hospitals during the study period. A few central hospitals have also organized physician staffed rapid response cars to support the local EMS.
Emergency calls are all made to a national emergency number 112 (healthcare, fire, police & social services). The calls are processed by Emergency Response Centre Operators (ERCO) in one of the six regional dispatch centers using a nationally unified, tiered dispatch structure assisting in the dispatch of units, with slight local variations. ERCOs are specially educated for the task but they are not healthcare providers. In addition to being alarmed by the dispatch centers, the HEMS units can also be requested by the EMS crews. A list of dispatch codes and those leading to HEMS activation can be seen in Additional File 1.
HEMS units are alerted to patients who are thought to benefit from early prehospital intensive care. Typical alarm criteria are Out-of-Hospital Cardiac Arrest (OHCA), major trauma and unconsciousness with an unknown origin. In the Finnish EMS system, HEMS units are not normally dispatched to conscious stroke patients, patients suffering from respiratory failure, and cardiovascular accidents, with the exception of the unit based in Lapland, due to the extremely sparse population and long distances in the area.
Five HEMS units are based at the university hospitals and one in Lapland, and their actual service areas encompassing 95% of the operations cover nearly the whole population of Finland (Fig. 1) [16 (link), 17 ]. The three southernmost units operate with Airbus H135 and the three other units with Airbus H145 helicopters. The primary task of the HEMS units is prehospital care, with rare interhospital transfers and search-and-rescues being decided upon in a case-by-case fashion.
Fig. 1

The population density of Finland, location of HEMS bases and their actual service areas with 95% of the missions in 2017 [16 (link), 17 ]. The population density is shown as density (population per km²) per postal area. H = HEMS base, FH = FinnHEMS unit

The HEMS units operating out of the university hospitals are staffed by a physician, a HEMS Crew Member (HCM; either a paramedic or a firefighter according to local regulations) and a pilot, while the unit in Lapland has two advanced level flight paramedics and two pilots. Physicians in the HEMS units are mainly anesthesiologists with sub specialization in prehospital critical care whereas HCMs are specially trained in prehospital critical care as well as in aviation. The HEMS pilots have significant previous experience in either civilian or military helicopter operations.
The wide array of equipment and medications used in the HEMS units is not nationally standardized but locally governed by the hospital districts. All units are on-call 24/7/365 and are capable of flying under instrument flight rules and night-time flight operations using night vision goggles. Rapid response vehicles are available for the HEMS crews in every base for short-range missions or for when weather conditions don’t meet the HEMS minima for airborne operations.