Helicopter Emergency Medical Services as a Tool for Prehospital Emergency Rescue in Northern Italy

OBJECTIVE: Stroke is a time-sensitive condition in which timely intervention is crucial for optimal outcomes. Advances in stroke management, including extended time windows for thrombolysis and mechanical thrombectomy, highlight the need for efficient patient centralization. This study explores the newly adopted stroke algorithm for patient centralization in Lombardy, Italy, and evaluates the potential for helicopter emergency medical services (HEMS) to improve access to timely care. METHODS: Data regarding stroke rescue missions were retrieved from SAS-AREU database. Geospatial maps were created using QGIS (Open Source Geospatial Foundation (OSGeo), Chicago, IL) 3.30, with travel times calculated using Google Maps data. Population density was retrieved from Geoportal Lombardia. Area with road travel time to a Hub hospital >60 minutes were identified as potential HEMS priority settings. RESULTS: In 2024, 11,822 patients rescued by the Regional Agency for Emergency and Urgency were given the "stroke code." HEMS was used in 214 cases, covering a median distance of 49.3 km with a median rescue time of 77 minutes. The study identified areas with road travel times exceeding 60 minutes, highlighting northern Lombardy's mountainous regions and areas with low population density as high priority areas for HEMS intervention. The analysis also revealed an unexpected advantage for air transport in some plain areas, despite viable road access. CONCLUSION: Geospatial mapping is a valuable tool for identifying areas where HEMS can reduce response times. The integration of HEMS into stroke care algorithms enhances timely interventions, ensuring that patients are centralized within recommended time windows, improving outcomes, and addressing geographic and infrastructural challenges.