title: An investigation into the cost, coverage and activities of Helicopter Emergency Medical Services in the state of New South Wales, Australia.
abstract: BACKGROUND
  Helicopter Emergency Medical Services (HEMS) have been incorporated into modern health systems for their speed and coverage. In the state of New South Wales (NSW), nine HEMS operate from various locations around the state and currently there is no clear picture of their resource implications. The aim of this study was to assess the cost of HEMS in NSW and investigate the factors linked with the variation in the costs, coverage and activities of HEMS.
  
  
  METHODS
  We undertook a survey of HEMS costs, structures and operations in NSW for the 2008/2009 financial year. Costs were estimated from annual reports and contractual agreements. Data related to the structure and operation of services was obtained by face-to-face interviews, from operational data extracted from individual HEMS, from the NSW Ambulance Computer Aided Despatch system and from the Aeromedical Operations Centre database. In order to estimate population coverage for each HEMS, we used GIS mapping techniques with Australian Bureau of Statistics census information.
  
  
  RESULTS
  Across HEMS, cost per mission estimates ranged between $9300 and $19,000 and cost per engine hour estimates ranged between $5343 and $15,743. Regarding structural aspects, six HEMS were run by charities or not-for-profit companies (with partial government funding) and three HEMS were run (and fully funded) by the state government through NSW Ambulance. Two HEMS operated as 'hub' services in conjunction with three associated 'satellite' services and in contrast, four services operated independently. Variation also existed between the HEMS in the type of helicopter used, the clinical staffing and the hours of operation. The majority of services undertook both primary scene responses and secondary inter-facility transfers, although the proportion of each type of transport contributing to total operations varied across the services.
  
  
  CONCLUSIONS
  This investigation highlighted the cost of HEMS operations in NSW which in total equated to over $50 million per annum. Across services, we found large variation in the cost estimates which was underscored by variation in the structure and operations of HEMS.
authors: The George Institute for Global Health, Camperdown, NSW, 2050, Australia. ctaylor@georgeinsitute.org.au
authors: Colman B
authors: CB
authors: Taylor
authors: Mark
authors: M
authors: Stevenson
authors: Stephen
authors: S
authors: Jan
authors: Bette
authors: B
authors: Liu
authors: Gary
authors: G
authors: Tall
authors: Paul M
authors: PM
authors: Middleton
authors: Michael
authors: M
authors: Fitzharris
authors: John
authors: J
authors: Myburgh
mesh_terms: D017732:Air Ambulances / Q000191:economics / Q000706:statistics & numerical data*; D002391:Catchment Area, Health; D003362:Cost-Benefit Analysis; D003625:Data Collection; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D009517:New South Wales; D012041:Regional Medical Programs / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000191:economics