Björn Gunnarsson^1,2
Kristrún María Björnsdóttir³
Sveinbjörn Dúason

¹Department of Health Sciences, University of Akureyri, ²Department of Anaesthesia and Emergency, The Hospital of Akureyri, ³Department of Health Sciences, University of Iceland, Reykjavík.

Correspondence: Björn Gunnarsson, bjorngun@unak.is

Key words: Air ambulance services, Dispatch time, Transport time, Emergency medical sevices, Iceland.

 

INTRODUCTION: This study investigated the use of fixed-wing air ambulance in Iceland between 2012 and 2020.

MATERIAL: Medical records were filled out during each flight and information afterwards entered into an electronic database.

METHODS: The annual number of patient transports nationwide; triage scale category; reason for transportation, age and gender; and departure and arrival airports were analyzed. Response time and total transport time were compared between years and locations. Poisson regression analysis was used to compare the yearly number of transports. One-way ANOVA was used to compare response time and total transport time by year and departure site.

RESULTS: In total, 6011 patients were transported in fixed-wing air ambulances during the study period. Majority were male (54.3%). Median age was 64 years (range 0-99 years). Most patients were transported due to medical conditions; 15.8% due to trauma. Thirty percent of women aged 20 to 44 years were transported due to pregnancy or childbirth. Two-thirds of patients were transported to Reykjavik (n=3937), and one-fifth to Akureyri (n=1139).

Median response time for acute transports was 84 minutes (range 0-2870 minutes). Median total transport time was 150 minutes (range 50-2930 minutes).

Differences were found in total transport time from departure locations (F=32.19; DF 9, 2678; p<0.001). Egilsstaðir, Norðfjörður, Höfn, and, partly, Ísafjörður had the longest total transport times.

CONCLUSION: Icelandic air ambulance flights are often long, likely affecting outcomes for patients with time-sensitive medical conditions. Access to specialized healthcare is unequal among places of residence, and it is important to address this.

Table I. Number of missions with the same individual during the study time.

Table II. Total transport time from airports with the greatest number of departures: number of departures, mean in minutes, standard deviation and p value according to post-hoc Tukey's test.

				Tukey’s test
Airport	n	Mean	SD	BIU	IFJ	SAK	AEY	HZK	VPN	EGS	NOR	HFN	VEY
Bíldudalur	126	168	145	-	0.101	0.895	0.276	0.958	1.000	< 0.001	< 0.001	0.010	0.921
Ísafjörður	244	201	236	0.101	-	0.002	< 0.001	0.035	< 0.001	0.415	0.052	0.999	< 0.001
Sauðárkrókur	74	143	35	0.895	0.002	-	1.000	1.000	0.967	< 0.001	< 0.001	< 0.001	1.000
Akureyri	656	157	127	0.276	< 0.001	1.000	-	1.000	0.698	< 0.001	< 0.001	< 0.001	0.860
Húsavík	42	144	49	0.958	0.035	1.000	1.000	-	0.985	< 0.001	< 0.001	< 0.001	1.000
Vopnafjörður	77	155	45	1.000	0.224	0.967	0.698	0.985	-	< 0.001	< 0.001	0.049	0.991
Egilsstaðir	571	190	85	< 0.001	0.415	< 0.001	< 0.001	< 0.001	< 0.001	-	0.852	0.916	< 0.001
Norðfjörður	182	198	69	< 0.001	0.052	< 0.001	< 0.001	< 0.001	< 0.001	0.852	-	0.254	< 0.001
Höfn	287	186	105	0.010	0.999	< 0.001	< 0.001	< 0.001	0.049	0.916	0.254	-	< 0.001
Vestmannaeyjar	429	159	129	0.921	< 0.001	1.000	0.860	1.000	0.991	< 0.001	< 0.001	< 0.001	-

Figure 1. Annual number of patients and triage scale classification.

Figure 2. Age and sex distribution 2012-2020.

Figure 3. Age and triage scale classification.

Figure 4. Medical conditions leading to transport.

Figure 5. Number of patients according to departure airport.

Figure 6. Number of patients according to destination airport.

Figure 7. Total transport time in triage scale F-1 and F-2 missions. The thick horisontal line represents the median. The boundaries of the box indicate the 25th and the 75th percentile and the whiskers extend 1.5 box-length from the boundaries. Points are outliers.

Figure 8. Box plot showing total transport time from airports with the greatest number of departures. BIU: Bíldudalur, IFJ: Ísafjörður, SAK: Sauðárkrókur, AEY: Akureyri, AEY: HZK: Húsavík, VPN: Vopnafjörður, EGS: Egilsstaðir, NOR: Norðfjörður: HFN: Höfn í Hornafirði: VEY: Vestmannaeyjar