Barriers to Helicopter Emergency Medical Service Operations in Nepal: A Retrospective Study of Mission Cancellations

Background Helicopter Emergency Medical Services (HEMS) play an important role in geographically challenging regions such as Nepal, where mountainous terrain, limited road infrastructure, and remote settlements can delay access to advanced medical care. However, mission cancellations remain a significant operational challenge and may reduce system efficiency and timely patient transfer. Objective The study aimed to analyse the reasons for HEMS mission cancellations at a tertiary care centre in Nepal and identify the financial, operational, environmental, and patient-related factors influencing HEMS utilisation. Methods A retrospective observational study was conducted using HEMS coordination data from Mediciti Hospital, Kathmandu, Nepal, between February 2023 and July 2024. All cancelled HEMS missions during the study period were included. Cancellation reasons were categorised using data from the hospital's call register book and analysed descriptively using frequencies and percentages. Results During the 18-month study period, 407 HEMS calls were recorded. Of these, 249 missions (61.1%) were completed, and 158 missions (38.8%) were cancelled. Financial constraints were the most common reason for cancellation (54 missions, 34.18%), followed by miscellaneous operational causes (18 missions, 11.39%), helicopter unavailability (17 missions, 10.76%), and visual flight rules (VFR) limitations (16 missions, 10.13%). Weather-related factors accounted for 12 cancellations (7.59%), while night operation limitations contributed to 13 cancellations (8.23%). Patient-related factors, including preference for another medical centre, non-transferable clinical status, and self-transport, accounted for a smaller proportion of cancellations overall. Conclusion Financial and operational limitations were the leading causes of HEMS mission cancellations in this single-centre Nepalese study. Improving financial protection mechanisms, increasing helicopter availability, and expanding night-flight and all-weather operational capability may improve the efficiency and reliability of HEMS delivery in resource-limited mountainous settings. Further multicentre prospective studies are required to better inform sustainable HEMS development in Nepal.