Does a physician's base specialty influence on‑scene efficiency? A four‑year analysis of 11,315 missions from five Austrian physician‑staffed HEMS bases.
BMC emergency medicine · 2026-02-20 · Observational study
Abstract
BACKGROUND: Physician-staffed helicopter emergency medical services (HEMS) in Austria operate under a uniform, high-accreditation framework: all physicians complete the same advanced prehospital curriculum, and dispatch decisions do not consider individual board certification. Nevertheless, it remains unclear whether a physician’s original specialty (anaesthesiology, surgery, orthopaedics, internal medicine or paediatrics) affects on-scene efficiency or procedural choices. We therefore investigated whether board specialty independently predicts prehospital treatment times and intervention patterns in Austrian HEMS missions. METHODS: We retrospectively analyzed 11 315 missions from five alpine HEMS bases (January 2021 to April 2025). On-scene time (OST) was the primary endpoint. Predictors included physician specialty (10 boards, merged where appropriate) and NACA severity. Two-way ANOVA tested main and interaction effects, with sensitivity analyses for intubated trauma and logistic regression for intubation odds. RESULTS: Severity dominated OST (F = 204, p < 0.001; η² ≈ 0.20), whereas specialty explained < 1% of the variance (F = 3.6, p = 0.003; η² = 0.006). A minor surgical advantage (≈ 5 min) was restricted to NACA 3 (p < 0.01) and clinically negligible. Specialty effects disappeared in sensitivity analyses. Specialty-specific practice patterns (e.g. surgeons’ higher ketamine/TXA use, anesthesiologist’ opioid preference) did not affect OST. CONCLUSION: In this standardized Austrian HEMS system, patient severity and mission complexity (not physician specialty) were the main determinants of on-scene time. Physician specialty showed no clinically relevant influence on pre-hospital time metrics. As this study assessed time-related parameters only, no conclusions can be drawn regarding system efficiency or overall quality of care. On-scene time should therefore be interpreted as one performance dimension among multiple quality indicators in HEMS systems.
Tags
Endotracheal intubation · Prehospital physicians · Time intervals