HEMS and the challenges of an aging population: a nationwide study of interventions

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Purpose: We aimed to characterize HEMS missions in Poland in 2015-2024 among patients aged ≥65 years and to describe unadjusted associations between age strata and escalation of advanced interventions as well as on-scene mortality after HEMS arrival. Materials and methods: We performed a retrospective analysis of the national HEMS registry in 2015-2024, including patients aged ≥65 years. Diagnoses were grouped into five clinical domains. The primary endpoint was on-scene mortality after HEMS arrival (death on scene recorded as mission outcome left on scene - death); dispatches coded as dead on arrival (DOA) were excluded. Secondary endpoints were use of advanced airway management, Prehospital Emergency Anaesthesia (PHEA), and mission outcome. We used univariable logistic regression to estimate unadjusted odds ratios (OR) with 95% confidence intervals (95% CI) for each exposure - outcome association. Results: Among 30,075 missions, neurological (42.8%) and cardiovascular (31.0%) conditions predominated. Most missions occurred in daytime (92.5%) and in rural areas (57.1%). Compared with the 65-74 group, patients aged ≥75 years less often required escalation to advanced interventions, including intubation (OR 0.71; 95% CI 0.66-0.76), PHEA-consistent sedation (0.76; 0.71-0.80), and neuromuscular blockade (0.66; 0.61-0.72). They also had lower on-scene mortality (0.75; 0.69-0.83). The highest on-scene mortality risk occurred in the cardiovascular domain (OR 6.20; 4.93-7.80). Conclusion: In Poland, HEMS provides critical access to rapid, advanced prehospital care for older adults, especially in rural regions. The observed associations highlight age-stratified differences in intervention intensity and on-scene mortality; however, results are unadjusted and may be influenced by differences in case-mix, illness severity, and treatment limitation decisions. Frailty was not measured in the registry; therefore, any interpretation in terms of frailty should be considered hypothesis-generating and requires prospective studies incorporating standardized frailty instruments (e.g., CFS).

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