[Emergency helicopters--health services in the grey zone? Description of a one-year activity in Troms]

In 1988 a nation-wide aeromedical emergency service (AES) (12 helicopters and five fixed wing aircraft) was introduced in Norway. An important objective was equity--to offer equal access to treatment for the same need irrespective of age and geographical location. In 1989 cardiovascular disease accounted for 34% of the 282 missions in the county of Troms in Northern Norway, but the use of the helicopters did not reflect the age-related increase in the incidence of this disease. Across the municipalities there was considerable variation in use of helicopters which could not be accounted for by density of doctors, distance to the nearest hospital, population density or coverage by ground ambulances. We believe that the key determinant of the use of helicopters may be varying attitudes among the doctors to the use of AES. The findings indicate that AES does not meet the objective of equity. Stricter medical guidelines for use of AES are called for.