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Background  The Helicopter Emergency Medical Service ( HEMS ) in Norway is operated day and night, despite challenging geography and weather. In Western Norway, three ambulance helicopters, with a rapid response car as an alternative, cover close to 1 million inhabitants in an area of 45,000 km 2 . Our objective was to assess patterns of emergency medical problems and treatments in  HEMS  in a geographically large, but sparsely populated region.    Methods  Data from all  HEMS  dispatches during 2004–2013 were assessed retrospectively. Information was analyzed with respect to patient treatment and characteristics, in addition to variations in services use during the day, week, and seasons.    Results  A total of 42,456 dispatches were analyzed. One third of the patients encountered were severely ill or injured, and two thirds of these received advanced treatment. Median activation time and on‐scene time in primary helicopter missions were 5 and 11 min, respectively. Most patients (95%) were reached within 45 min by helicopter or rapid response car. Patterns of use did not change. More than one third of all dispatches were declined or aborted, mostly due to no longer medical indication, bad weather conditions, or competing missions.    Conclusion  One third of the patients encountered were severely ill or injured, and more than two thirds of these received advanced treatment.  HEMS  use did not change over the 10‐year period, however  HEMS  use peaked during daytime, weekends, and the summer. More than one third of all dispatches were declined or aborted.

Helicopter‐based emergency medical services for a sparsely populated region: A study of 42,500 dispatches