Medical Evacuations by Search and Rescue Helicopters in the Barents Sea

Medical Evacuations by Search and Rescue Helicopters in the Barents Sea | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Medical Evacuations by Search and Rescue Helicopters in the Barents Sea Silje Aune, Torben Wisborg, Hanne Rikstad Iversen, Lasse Raatiniemi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6750756/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Dec, 2025 Read the published version in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine → Version 1 posted 10 You are reading this latest preprint version Abstract Background The Barents Sea, characterized by remote locations, vast distances, harsh weather conditions and seasonal polar night, presents significant challenges for search and rescue (SAR) operations. In emergencies involving illness, injury, or other rescue needs, helicopters are often the only feasible response resource. Rescue helicopters are critical for both SAR operations and medical evacuations (medevacs) to meet the region’s urgent demands. The aim of this study was to describe the characteristics of SAR helicopter medevacs in the Barents Sea, with a focus on patient presentations, medical interventions, mission profiles, and operational challenges encountered over a 22-year period. Methods A retrospective cohort study reviewed all requests for medevacs involving the SAR helicopter at Banak, operated by the 330 Squadron between 1 January 2000 and 31 December 2022. Results A total of 418 requests for medevacs were received, resulting in 283 completed missions. Among the patients 96.5% were male with a median age of 41 years. Most (84%) had a National Advisory Committee for Aeronautics (NACA) score of 3 or 4 on a severity scale from 0 to 7. Wounds and fractures of the upper extremities were the most common injuries, whereas gastrointestinal and cardiovascular conditions were the most frequently reported medical emergencies. Among the trauma cases, 81% were related to the fishing industry. Blunt injuries, including crushing, compression, and pressure-related trauma, were the most common mechanisms. Twenty-five patients (18%) sustained injuries affecting more than one body region. Conclusion This study highlights the year-round importance of SAR helicopters in evacuating ill and injured patients from the Barents Sea. Many presented with serious but not immediately life-threatening conditions that could deteriorate without timely intervention. These findings reinforce the need for regular and comprehensive training of the entire SAR crew to maintain readiness for patient evacuations in demanding maritime environments. SAR missions medical evacuation medevacs maritime evacuation Barents Sea NACA score. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background The Barents Sea is bordered by mainland Norway to the south, Svalbard to the north, the Norwegian Sea to the west, and Russia to the east. The region is rich in marine life and hosts a significant fishing industry involving multiple nations ( 1 ). In recent years, there has been a marked increase in oil and gas exploration, as well as a rise in cruise tourism, leading to a substantial number of people residing in or travelling through the area at any given time. In cases of illness, injury, or other emergencies requiring evacuation, helicopters are often the only practical means of response. Rescue operations in this Arctic environment are challenged by remote locations, long distances, extreme weather conditions, and seasonal darkness. Missions are conducted primarily by helicopters stationed at Banak, Tromsø and Longyearbyen. Limited research has been published on medevacs performed in the Barents Sea. A study using data from ambulance and SAR missions conducted by the 330 Squadron between 1994 and 1999 was published in 2004 and provided an overview of these operations, concluding that they were carried out with high regularity and were in most cases medically justified relative to the operational risk ( 2 ). Given the substantial changes in regional activity and the passage of time, it is essential to reassess mission characteristics and outcomes in a more recent period. Understanding the nature of these missions, including common diagnoses, operational challenges and interventions is crucial for operational planning and resource allocation. Despite a well-established national system for SAR and medevac operations in Norway, little has been published on their medical aspects. Approximately 50 physicians work in these services, providing advanced prehospital care across a wide range of missions. More comprehensive data could support quality improvement and strengthen the future training of medical personnel. The aim of this study is to investigate medevacs conducted in the Barents Sea from 2000 to 2022. Specifically, we aim to describe the characteristics of the missions, including medical conditions, treatments administered, time intervals, and hoisting methods used. Methods Study setting The Royal Norwegian Air Force (RNoAF) 330 Squadron operates six Search and Rescue (SAR) helicopter bases across Norway, with the Banak base, located at 70°N, being the northernmost. In February 2022, the squadron transitioned to AW101 all-weather rescue helicopters, replacing the previous Sea King helicopters. Each SAR helicopter crew consists of six members: two pilots, a hoist operator, a systems operator/navigator, a rescue swimmer (RS), and a consultant physician specialized in anaesthesiology and critical care medicine ( 3 ). Approximately 25–30% of the squadron's missions involve sea rescue operations ( 4 ). The Air Force’s SAR service has search and rescue as its primary mission but also serves as a secondary resource within the national air ambulance service ( 5 ). All missions are coordinated through the Joint Rescue Coordination Centres (JRCC). Emergency medical calls in the Barents Sea region are coordinated by JRCC Northern Norway ( 6 ). Contact may be initiated through the Emergency Medical Communication Centres (EMCC) or directly with the JRCC. Additionally, Radio Medico, operated by the Norwegian Centre for Maritime Medicine and Diving, provides 24/7 medical consultation services to ships and offshore installations ( 7 ). The helicopter physician plays an active role in assessing the need for medevac and participates in the decision-making process. Study design We conducted a retrospective observational study to analyse the characteristics of medevacs performed in the Barents Sea. Data source The study included all requests for medevacs involving the SAR helicopter stationed at Banak from 1 January 2000 to 31 December 2022. Only missions over maritime areas were included. Search and rescue missions were operationally defined as missions involving hoisting. Only missions in which the primary indication was medevac were included. Initiated missions which were aborted before or during flight were also included in the review. Data were retrieved from the digital air ambulance record system, LABAS (Labas 7, Norman IT, Norway), which is maintained at the helicopter base. All requests for assistance are recorded systematically in this electronic database by the physician on call. Data extraction The data extracted included patient demographics, diagnosis classified using the International Classification of Diseases (ICD), severity of condition assessed using the National Advisory Committee for Aeronautics (NACA) scale ( 8 ), interventions performed and medications administered both on-scene and during transport. The operational variables included the year and month of the mission, mission irregularities, mission time intervals, pickup positions, rescue techniques, and receiving hospitals. In cases where pick-up positions were incomplete or missing in the LABAS documentation, coordinates were obtained from the JRCC based on the ship’s reported position at the time of the rescue request. Definitions A rejected mission is defined as one not initiated due to a lack of medical necessity, technical issues before take-off or unfavourable weather conditions. Aborted missions are those cancelled after take-off. Data analysis The data were exported to Microsoft Excel 2019 MSO (version 1808, MS365) for descriptive statistical analysis. Ethics and permissions The Regional Committee for Medical and Health Research Ethics (REK) concluded that the project was not subject to mandatory ethical review (15 June 2023). The study was registered as a research and quality improvement project with the Data Protection Officer at Finnmark Hospital Trust who approved the project and handled the personal data (25 Oct 2023). An exemption from the duty of confidentiality was granted by the Norwegian Directorate of Health permitting access to relevant LABAS records for the specified study period (8 Sept 2023). Results Mission outcomes During the study period, 473 requests for medevacs by the SAR helicopter stationed at Banak were received for patients located on vessels or offshore installations within the Barents Sea. A total of 283 missions were completed (Fig. 1). The reasons for rejected or aborted missions are presented in Table 1. In some cases, patients had already received advanced medical treatment onboard prior to evacuation, highlighting the capability of certain vessels such as large cruise ships to provide a high level of care. Table 1 Reasons for rejected or aborted missions Rejected Aborted No need 111 6 Coordination 37 0 Weather 7 5 Mortem 4 3 Other 3 2 Technical 2 3 Duty time 2 0 Concurrency conflict 1 3 Not specified 0 1 Total 167 23 Patient characteristics The majority of patients were male (n=273, 96.5%), while 10 (3.5%) were female. The average age was 41 years, with a range from 17 to 85 years. A total of 169 (60%) were admitted for medical conditions, while 114 (40%) were admitted due to traumatic causes. A NACA score of 3 was recorded for 55% of the patients, and 29% were assigned a NACA score of 4 (Fig. 2). Five were declared deceased onboard before evacuation. One patient was hoisted during cardiac arrest while receiving cardiopulmonary resuscitation (CPR). No patients died during helicopter transport. The patients represented 21 different nationalities, with the majority being foreign nationals (53%), of whom the largest group were from Russia, comprising 82 patients (29%). A total of 132 (47%) were Norwegian. Mission characteristics Among trauma-related cases, fishing was the most common activity at the time of injury (n = 82, 81%). Crush and compression injuries were the leading mechanisms (Table 2). Upper extremity injuries were most common, typically involving wounds or fractures. For medical emergencies, gastrointestinal and cardiovascular conditions were most frequent. (Table 3). Medical interventions The most commonly administered treatments were infusions (n = 155), analgesics (n = 144), and oxygen therapy (n = 116) (Table 4). A total of eight patients underwent endotracheal intubation. In cases of cardiac arrest, endotracheal intubation was performed in four cases. Three of these patients were intubated onboard the boat but were not evacuated due to unsuccessful resuscitation efforts. One patient was hoisted during ongoing CPR and intubated upon arrival in the helicopter. Among the drug-assisted intubations, two was performed on board vessels prior to evacuation, one in-flight and one at the airport before transfer to a fixed-wing aircraft. Table 2 Overview of activity at the time of injury, mechanism of injury, affected anatomical regions, and type of injury for 114 traumatic cases Activity n % Fishing 92 81 Work offshore 11 10 Military service 4 4 Tourism/Leisure 1 1 Not specified 6 5 Mechanism Crushed, Compressed, or Pressed 32 30 Blow, Impact, or Collision 22 21 Fall Accidents 17 16 Transport Accident at Sea 12 11 Stabbed, Pinched by Tools, Weapons, or Explosion 11 10 Other 13 12 Anatomic region primar diagnosis Shoulder/arm/hand 40 35 Lower Extremities 27 24 Head 18 16 Abdomen/back/pelvis 12 11 Eye 7 6 Thorax/ Chest 7 6 Other 3 3 Consequence Multiple Injuries 25 18 Unspecified 22 16 Wound Injury 19 14 Fracture 17 12 Crush Injury 16 12 Amputation 12 9 Commotio 10 7 Organ Damage 9 7 Other 9 7 Table 3 Main medical diagnoses among evacuated patients with non-traumatic conditions Medical diagnosis n % Gastrointestinal 64 38 Cardiovascular 46 27 Neurological 22 13 Diabetes/ Embolism/Other 10 6 Urinary tract 9 5 Airways 8 5 Infectious 5 3 Musculoskeletal 5 3 Table 4 Medical interventions performed during missions Treatment given to diseased or injured patients n Infusion 155 Analgesics 144 Oxygen Therapy 116 Antibiotics 42 Vasoactive Agents 20 Splinting/Traction Devices 14 Endotracheal Intubation 8 Wound Care/Dressings 7 Cardiopulmonary Resuscitation (CPR) 5 Operational conditions The monthly and annual distributions of missions are presented in Fig. 3 and 4, respectively. A seasonal pattern was observed, with the highest number of missions occurring in June and the lowest number occurring in December. The number of missions decreased over time, from 26 missions in 2000 to 12 missions in 2022. The pick-up locations are shown in Fig. 5, covering an area from 69.3°N to 74.5°N latitude and from 10.0°E to 42.18°E longitude. The median total mission duration was 332 minutes (range: 78–1880 minutes). The total mission time encompasses the entire operation, from scramble to mission completion, including the time required to prepare the helicopter and equipment for subsequent missions. The median response time, defined as the interval from alarm activation to arrival at the patient's location, was 153 minutes (range: 46–1335 minutes). The median transport time was 85 minutes (range: 10–335 minutes), while the median patient care time was 98 minutes (range: 10–480 minutes). Patient care time includes the duration spent attending to the patient, encompassing care at the scene, during transport, and at the destination, until the patient is handed over to the next care provider. Rescue techniques Vertical sling hoisting was the most common method of patient evacuation from vessels (n = 139, 49%), followed by horizontal stretcher hoisting (n = 102, 36%). In five missions, the helicopter landed directly on the vessel's deck. In five additional missions, a rendezvous was conducted at Bjørnøya. In one mission, the physician was delivered to the vessel and accompanied the boat to land. Five were declared deceased before helicopter transport and were not transported by helicopter. Hospital admissions Most patients (70%) were admitted to local hospitals. 28% was transported directly to the University Hospital of North Norway. Three patients (1%) were transferred to fixed-wing aircraft for onward transport to specialised centres in southern Norway. Discussion Medevacs in the Barents Sea 2000–2022 predominantly involved men of working age. Many patients presented with serious, although not immediately life-threatening conditions that could have escalated without timely evacuation. Missions often lasted several hours, requiring extended patient care during transport. This demonstrates the critical need for highly trained medical personnel and well-equipped helicopters capable of managing complex conditions and potential complications en route. The ability to provide advanced care in such challenging environments underscores the importance of ongoing training and maintaining a high standard of preparedness among medical and flight crews. Given the relatively infrequent nature of maritime missions, regular training is essential to maintain operational readiness. Forty percent of the evacuations involved traumatic injuries, while sixty percent involved medical conditions, which is consistent with previous findings ( 2 , 9 ). Traumatic crush injuries to the extremities were the most common type of trauma with 81% of trauma patients engaging in fishing-related activities. This finding underlines the key role of SAR services in supporting maritime occupational safety. Given the fishing industry’s importance to Norway, safeguarding this workforce is both a humanitarian and economic priority [10]. Among medevacs, gastrointestinal conditions were most common, followed by cardiovascular events. This contrasts with more accessible areas, such as mainland Norway, where cardiovascular conditions typically dominate ( 1 , 11 , 12 , 13 ). As reported in Haagensen’s study ( 2 ), gastrointestinal conditions were the most frequent cause of evacuation in the Barents Sea. The severe conditions and long distances in the Barents Sea mean that helicopter transport is often required even when the patient is not critically ill. This highlights the importance of SAR operations in supporting emergency care in this remote environment. Treatment patterns were similar to earlier findings ( 14 , 15 ), with infusions, analgesics, and oxygen as the most common interventions. Hoisting of intubated patients occurred only twice in 22 years, a finding that aligns with previous studies ( 14 , 16 , 17 ). Despite a noticeable decline in the total number of missions and a low number of hoist operations per crew member over two decades the need for regular training remains critical. 33% of all patients had a NACA score of 4–6, indicating potentially serious conditions. Even though the annual volume was modest, many required rapid evacuation to prevent deterioration. The fact that all evacuated patients were admitted to hospital supports the medical justification for the missions. Most evacuations resulted in admission to local hospitals, mainly Hammerfest Hospital, enhancing logistical efficiency and reducing the burden on tertiary centers. Earlier involvement of helicopter physicians in mission planning could help reduce unnecessary evacuations and optimize resource use. 77 missions were rejected, primarily due to lack of medical necessity. Early medical consultation might improve resource use and coordination of alternatives. Limitations This study is based on retrospective data manually recorded in the LABAS system by helicopter physicians after the missions. This carries a risk of missing or incomplete entries. An electronic patient record system capable of capturing data automatically during missions could have mitigated this potential bias. Coordinates from JRCC were used to supplement missing pick-up positions. These data often reflect the ship’s location at the time of distress call, not necessarily the exact evacuation site. We lacked follow-up data after hospital admission which could have helped the analysis by confirming diagnoses, assessing intervention outcomes, and evaluating the appropriateness of evacuations. Conclusion This study highlights the year-round necessity of SAR helicopters for medical evacuation of patients from the Barents Sea. The findings provide valuable insights into injury patterns, operational challenges, and medical interventions associated with medevacs. To maintain readiness for complex maritime evacuations, ongoing and comprehensive training of SAR crews is essential. Future research and operational adjustments are important for improving safety and effectiveness in this Arctic region. Abbreviations CPR Cardiopulmonary Resuscitation EMCC Emergency Medical Communication Centres ICD International Classification of Diseases JRCC Joint Rescue Coordination Centres LABAS Digital Air Ambulance Record System NACA National Advisory Committee for Aeronautics RNoAF The Royal Norwegian Air Force SAR Search And Rescue Declarations Ethics approval The Regional Committee for Medical and Health Research Ethics (REK) concluded that the project was not subject to mandatory ethical review (REK nord, reference 638876, 15 Jun 2023). The study was registered as a research and quality improvement project with the Data Protection Officer at Finnmark Hospital Trust, who approved the project (reference 2023/5031, 25 Oct 2023). An exemption from the duty of confidentiality was granted by the Norwegian Directorate of Health (Helsedirektoratet), permitting access to relevant LABAS records for the specified study period (reference 2023/5031, 8 Sep 2023). The study was approved and conducted according to the guidelines of the Regional Committee for Medical and Health Research Ethics (REK). Clinical trial number Not applicable. Human Ethics and Consent to Participate declarations Not applicable. Consent for publication Not applicable. Availability of data and materials The data used during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding Silje Aune has received research funding from Finnmark Hospital Trust for the conduct of this study. Author contributions SA conducted the study, analysed the data and wrote the main manuscript. TW and LR supervised the work. TW, HRI and LR contributed to the preparation of the manuscript through review. All authors critically revised the article and approved the final manuscript. Acknowledgements The authors would like to thank Linda Maria Saariniemi Hansen at Joint Rescue Coordination Centres (JRCC) of North Norway for her assistance in providing data on pick-up positions. We would also like to thank Olaf Normann from Normann IT for his support in identifying relevant tasks in LABAS. Authors` information Emergency Medicine Department, Finnmark Hospital, Hammerfest, Norway: Silje Aune, Torben Wisborg, Hanne Rikstad Iversen, Lasse Raatiniemi Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway: Torben Wisborg Norwegian Centre for Traumatology, Oslo University Hospital, Oslo, Norway: Torben Wisborg Department of anesthesiologists and department of airambulance, University hospital of North Norway, Tromsø, Norway: Lasse Raatiniemi Corresponding author Correspondence to Silje Aune ( [email protected] ). References Norum J, Elsbak TM. Air ambulance services in the Arctic 1999–2009: a Norwegian study. Int J Emerg Med. 2011;4(1):1–8. Haagensen R, Sjøborg KÅ, Rossing A, Ingilæ H, Markengbakken L, Steen PA. Long-range rescue helicopter missions in the Arctic. Prehosp Disaster Med. 2004;19(2):158–63. The National Norwegian Air Ambulance Service. Nasjonale standarder for luftambulanseleger (helikopter), flysykepleiere og redningsmenn [Internet]. [cited 2024 Dec 28]. Available from: http://www.luftambulanse.no/nasjonale-standarder-luftambulanseleger-helikopterflysykepleiere-og-redningsmenn Glomseth R, Gulbrandsen FI, Fredriksen K. Ambulance helicopter contribution to search and rescue in North Norway. Scand J Trauma Resusc Emerg Med. 2016;24:1–6. Justis- og beredskapsdepartementet. Organisasjonsplan for redningstjenesten [Internet]. [cited 2024 Dec 28]. Available from: https://lovdata.no/dokument/LTI/forskrift/2019-12-16-1740 The Joint Rescue Coordination Centres. Norwegian search and rescue [Internet]. [cited 2024 Dec 28]. Available from: https://www.hovedredningssentralen.no/english/ Radio Medico –. legevakten til sjøs [Internet]. [cited 2024 Dec 28]. Available from: https://www.helse-bergen.no/avdelinger/yrkesmedisinsk-avdeling/norsk-senter-for-maritim-medisin-og-dykkemedisin/radio-medico-legevakten-til-sjos/#les-mer-om-radio-medico Raatiniemi L, Mikkelsen K, Fredriksen K, Wisborg T. Do pre-hospital anaesthesiologists reliably predict mortality using the NACA severity score? A retrospective cohort study. Acta Anaesthesiol Scand. 2013;57(10):1253–9. Collins D, Crickmer M, Brolly K, Abrams D, Ritchie A, Milsom W. Epidemiology of emergency medical search and rescue in the North Shore Mountains of Vancouver, Canada, from 1995 to 2020. Wilderness Environ Med. 2023;34(1):55–62. SINTEF. Personulykker i den norske fiskeflåten: Analyser av ulykkeshendelser og årsaksforhold [Internet]. [cited 2024 Dec 28]. Available from: https://sintef.brage.unit.no/sintef-xmlui/handle/11250/3110350 Rzońca P, Świeżewski SP, Jalali R, Gotlib J, Gałązkowski R. Helicopter emergency medical service (HEMS) response in rural areas in Poland: retrospective study. Int J Environ Res Public Health. 2019;16(9):1532. Zakariassen E, Burman RA, Hunskaar S. The epidemiology of medical emergency contacts outside hospitals in Norway: a prospective population-based study. Scand J Trauma Resusc Emerg Med. 2010;18(1):9. Krüger AJ, Lossius HM, Mikkelsen S, Kurola J, Castrén M, Skogvoll E. Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia: a prospective population-based study. Acta Anaesthesiol Scand. 2013;57(9):1175–85. Samdal M, Eiding H, Markengbakken L, Røislien J, Rehn M, Sandberg M. Time course of hoist operations by the search and rescue helicopter service in Southeast Norway. Wilderness Environ Med. 2019;30(4):351–61. Park-Ross JF, Howard I, Hodkinson P. Rescue activity of a civilian helicopter emergency medical service in the Western Cape, South Africa: a 5-year retrospective review. Wilderness Environ Med. 2022;33(4):437–45. Pietsch U, Knapp J, Kreuzer O, Ney L, Strapazzon G, Lischke V, et al. Advanced airway management in hoist and longline operations in mountain HEMS–considerations in austere environments: a narrative review. Scand J Trauma Resusc Emerg Med. 2018;26:1–9. Skaiaa SC, Roslin A, Heggland T, Heian S, Elden T, Åreskjold Ø, et al. Characteristics of helicopter hoist operations with intubated patients: a retrospective analysis of a Norwegian physician-staffed SAR helicopter service. Scand J Trauma Resusc Emerg Med. 2024;32(1):118. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Dec, 2025 Read the published version in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine → Version 1 posted Editorial decision: Revision requested 14 Aug, 2025 Reviews received at journal 31 Jul, 2025 Reviewers agreed at journal 18 Jun, 2025 Reviewers agreed at journal 04 Jun, 2025 Reviews received at journal 03 Jun, 2025 Reviewers agreed at journal 03 Jun, 2025 Reviewers invited by journal 02 Jun, 2025 Editor assigned by journal 28 May, 2025 Submission checks completed at journal 28 May, 2025 First submitted to journal 26 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6750756","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466018175,"identity":"e3f8c7ba-ccc8-4f68-9c02-b61491b24df7","order_by":0,"name":"Silje Aune","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYDACZuYGAxDNLwHmSsgQoYURokVyBgNjA1ALDxHWgBQCgcENCIuwFvl2xoaCDzWH84xvNx9/dKPGgoeB/fDRDfi0GBxmbDCccexwsdmdY4nNOceADuNJS7uBVwvQL8Y8bIcTt93IMWzOYQNqkeAxw6tFvhmo5c+/w4mbZ4C0/CNCCwPQYcaMbYcTN0gAteS2EaEF7JfevvTEGTfSEmfn9knwsBHyi3z/4WMGP75ZJ/bPSD7wOedbnRw/++Fj+B3GwMBmgMoloBwEmB8QoWgUjIJRMApGMgAADrlI6HDxecwAAAAASUVORK5CYII=","orcid":"","institution":"Finnmark Hospital","correspondingAuthor":true,"prefix":"","firstName":"Silje","middleName":"","lastName":"Aune","suffix":""},{"id":466018176,"identity":"d5c91d85-a70a-48d7-ba6c-2e931ae4a960","order_by":1,"name":"Torben Wisborg","email":"","orcid":"","institution":"Finnmark Hospital","correspondingAuthor":false,"prefix":"","firstName":"Torben","middleName":"","lastName":"Wisborg","suffix":""},{"id":466018181,"identity":"039df77d-4779-47b5-8189-d4da20f03144","order_by":2,"name":"Hanne Rikstad Iversen","email":"","orcid":"","institution":"Finnmark Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hanne","middleName":"Rikstad","lastName":"Iversen","suffix":""},{"id":466018185,"identity":"671e80d8-401a-4c69-8d30-190964602228","order_by":3,"name":"Lasse Raatiniemi","email":"","orcid":"","institution":"University hospital of North Norway","correspondingAuthor":false,"prefix":"","firstName":"Lasse","middleName":"","lastName":"Raatiniemi","suffix":""}],"badges":[],"createdAt":"2025-05-26 12:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6750756/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6750756/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13049-025-01529-6","type":"published","date":"2025-12-17T15:57:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84186610,"identity":"022f9107-7936-4f1d-8a6d-78a0fb396386","added_by":"auto","created_at":"2025-06-09 05:39:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19975,"visible":true,"origin":"","legend":"\u003cp\u003eStudy diagram showing total requests and completed missions from 2000-2022\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6750756/v1/f42118d79c299f654a99acc9.png"},{"id":84186609,"identity":"07cec123-ba8d-4a52-a447-4eb3e0c81f48","added_by":"auto","created_at":"2025-06-09 05:39:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8324,"visible":true,"origin":"","legend":"\u003cp\u003eSeverity scoring of injury or illness according to the National Advisory Committee for Aeronautics (NACA) for 283 medevacs in the Barents Sea during the period 2000–2022\u003c/p\u003e\n\u003cp\u003eNACA 0: no injury or disease\u003c/p\u003e\n\u003cp\u003eNACA 1:injuries/diseases without any need for acute physician care\u003c/p\u003e\n\u003cp\u003eNACA 2: injuries/diseases requiring examination and therapy by a physician, but hospital admission is not indicated\u003c/p\u003e\n\u003cp\u003eNACA 3: injuries/diseases without acute threat to life but requiring hospital admission\u003c/p\u003e\n\u003cp\u003eNACA 4: injuries/diseases that can possibly lead to deterioration of vital signs\u003c/p\u003e\n\u003cp\u003eNACA 5: injuries/diseases with acute threat to life\u003c/p\u003e\n\u003cp\u003eNACA 6: injuries/diseases transported after successful resuscitation of vital signs\u003c/p\u003e\n\u003cp\u003eNACA 7: lethal injuries or diseases (with or without resuscitation attempts)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6750756/v1/81e737536e3ff58009f3e229.png"},{"id":84186588,"identity":"1f54b4b8-2f51-444a-b78b-a096014bc050","added_by":"auto","created_at":"2025-06-09 05:39:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15746,"visible":true,"origin":"","legend":"\u003cp\u003eMonthly distribution of missions\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6750756/v1/601fe48093fe659b2146fcae.png"},{"id":84186594,"identity":"ba16c975-c020-487a-a1a2-e76cf84c16c1","added_by":"auto","created_at":"2025-06-09 05:39:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":25651,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual number of requested and completed medevacs in the Barents Sea (2000-2022)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6750756/v1/f798d75e1b154e07c801e727.png"},{"id":84186591,"identity":"d6e52adb-e2c5-471a-ac57-3422f89ad505","added_by":"auto","created_at":"2025-06-09 05:39:02","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":135860,"visible":true,"origin":"","legend":"\u003cp\u003ePick-up locations of medevacs in the Barents Sea. The range rings illustrate distances from the helicopter base at intervals of 100 nautical miles (185 km), 200 nautical miles (370 km), and 300 nautical miles (555 km). Each dot represents the position of å medevac\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6750756/v1/9324228ba58899ffa0e5d7d8.png"},{"id":98813824,"identity":"c2ddc060-441e-49a0-bb58-d2e774cc5a90","added_by":"auto","created_at":"2025-12-22 16:02:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1087240,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6750756/v1/e9a2b75b-5fca-4b70-84d0-132d8c54db5d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Medical Evacuations by Search and Rescue Helicopters in the Barents Sea","fulltext":[{"header":"Background","content":"\u003cp\u003eThe Barents Sea is bordered by mainland Norway to the south, Svalbard to the north, the Norwegian Sea to the west, and Russia to the east. The region is rich in marine life and hosts a significant fishing industry involving multiple nations (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In recent years, there has been a marked increase in oil and gas exploration, as well as a rise in cruise tourism, leading to a substantial number of people residing in or travelling through the area at any given time.\u003c/p\u003e \u003cp\u003eIn cases of illness, injury, or other emergencies requiring evacuation, helicopters are often the only practical means of response. Rescue operations in this Arctic environment are challenged by remote locations, long distances, extreme weather conditions, and seasonal darkness. Missions are conducted primarily by helicopters stationed at Banak, Troms\u0026oslash; and Longyearbyen.\u003c/p\u003e \u003cp\u003eLimited research has been published on medevacs performed in the Barents Sea. A study using data from ambulance and SAR missions conducted by the 330 Squadron between 1994 and 1999 was published in 2004 and provided an overview of these operations, concluding that they were carried out with high regularity and were in most cases medically justified relative to the operational risk (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Given the substantial changes in regional activity and the passage of time, it is essential to reassess mission characteristics and outcomes in a more recent period. Understanding the nature of these missions, including common diagnoses, operational challenges and interventions is crucial for operational planning and resource allocation. Despite a well-established national system for SAR and medevac operations in Norway, little has been published on their medical aspects. Approximately 50 physicians work in these services, providing advanced prehospital care across a wide range of missions. More comprehensive data could support quality improvement and strengthen the future training of medical personnel.\u003c/p\u003e \u003cp\u003eThe aim of this study is to investigate medevacs conducted in the Barents Sea from 2000 to 2022. Specifically, we aim to describe the characteristics of the missions, including medical conditions, treatments administered, time intervals, and hoisting methods used.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eThe Royal Norwegian Air Force (RNoAF) 330 Squadron operates six Search and Rescue (SAR) helicopter bases across Norway, with the Banak base, located at 70\u0026deg;N, being the northernmost. In February 2022, the squadron transitioned to AW101 all-weather rescue helicopters, replacing the previous Sea King helicopters. Each SAR helicopter crew consists of six members: two pilots, a hoist operator, a systems operator/navigator, a rescue swimmer (RS), and a consultant physician specialized in anaesthesiology and critical care medicine (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Approximately 25\u0026ndash;30% of the squadron's missions involve sea rescue operations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Air Force\u0026rsquo;s SAR service has search and rescue as its primary mission but also serves as a secondary resource within the national air ambulance service (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). All missions are coordinated through the Joint Rescue Coordination Centres (JRCC).\u003c/p\u003e \u003cp\u003eEmergency medical calls in the Barents Sea region are coordinated by JRCC Northern Norway (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Contact may be initiated through the Emergency Medical Communication Centres (EMCC) or directly with the JRCC. Additionally, Radio Medico, operated by the Norwegian Centre for Maritime Medicine and Diving, provides 24/7 medical consultation services to ships and offshore installations (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The helicopter physician plays an active role in assessing the need for medevac and participates in the decision-making process.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eWe conducted a retrospective observational study to analyse the characteristics of medevacs performed in the Barents Sea.\u003c/p\u003e\n\u003ch3\u003eData source\u003c/h3\u003e\n\u003cp\u003eThe study included all requests for medevacs involving the SAR helicopter stationed at Banak from 1 January 2000 to 31 December 2022. Only missions over maritime areas were included.\u003c/p\u003e \u003cp\u003eSearch and rescue missions were operationally defined as missions involving hoisting. Only missions in which the primary indication was medevac were included. Initiated missions which were aborted before or during flight were also included in the review.\u003c/p\u003e \u003cp\u003eData were retrieved from the digital air ambulance record system, LABAS (Labas 7, Norman IT, Norway), which is maintained at the helicopter base. All requests for assistance are recorded systematically in this electronic database by the physician on call.\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\n\u003cp\u003eThe data extracted included patient demographics, diagnosis classified using the International Classification of Diseases (ICD), severity of condition assessed using the National Advisory Committee for Aeronautics (NACA) scale (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), interventions performed and medications administered both on-scene and during transport.\u003c/p\u003e \u003cp\u003eThe operational variables included the year and month of the mission, mission irregularities, mission time intervals, pickup positions, rescue techniques, and receiving hospitals.\u003c/p\u003e \u003cp\u003eIn cases where pick-up positions were incomplete or missing in the LABAS documentation, coordinates were obtained from the JRCC based on the ship\u0026rsquo;s reported position at the time of the rescue request.\u003c/p\u003e\n\u003ch3\u003eDefinitions\u003c/h3\u003e\n\u003cp\u003eA rejected mission is defined as one not initiated due to a lack of medical necessity, technical issues before take-off or unfavourable weather conditions. Aborted missions are those cancelled after take-off.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe data were exported to Microsoft Excel 2019 MSO (version 1808, MS365) for descriptive statistical analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthics and permissions\u003c/h3\u003e\n\u003cp\u003e The Regional Committee for Medical and Health Research Ethics (REK) concluded that the project was not subject to mandatory ethical review (15 June 2023). The study was registered as a research and quality improvement project with the Data Protection Officer at Finnmark Hospital Trust who approved the project and handled the personal data (25 Oct 2023). An exemption from the duty of confidentiality was granted by the Norwegian Directorate of Health permitting access to relevant LABAS records for the specified study period (8 Sept 2023).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eMission outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study period, 473 requests for medevacs by the SAR helicopter stationed at Banak were received for patients located on vessels or offshore installations within the Barents Sea. A total of 283 missions were completed (Fig. 1). The reasons for rejected or aborted missions are presented in Table 1.\u003c/p\u003e\n\u003cp\u003eIn some cases, patients had already received advanced medical treatment onboard prior to evacuation, highlighting the capability of certain vessels such as large cruise ships to provide a high level of care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eReasons for rejected or aborted missions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"340\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRejected\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAborted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo need\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoordination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeather\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTechnical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuty time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConcurrency conflict\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot specified\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of patients were male (n=273, 96.5%), while 10 (3.5%) were female. The average age was 41 years, with a range from 17 to 85 years. A total of 169 (60%) were admitted for medical conditions, while 114 (40%) were admitted due to traumatic causes. A NACA score of 3 was recorded for 55% of the patients, and 29% were assigned a NACA score of 4 (Fig. 2). Five were declared deceased onboard before evacuation. One patient was hoisted during cardiac arrest while receiving cardiopulmonary resuscitation (CPR). No patients died during helicopter transport.\u003c/p\u003e\n\u003cp\u003eThe patients represented 21 different nationalities, with the majority being foreign nationals (53%), of whom the largest group were from Russia, comprising 82 patients (29%). A total of 132 (47%) were Norwegian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMission characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong trauma-related cases, fishing was the most common activity at the time of injury (n = 82, 81%). \u0026nbsp;Crush and compression injuries were the leading mechanisms (Table 2). Upper extremity injuries were most common, typically involving wounds or fractures. For medical emergencies, gastrointestinal and cardiovascular conditions were most frequent. (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedical interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most commonly administered treatments were infusions (n = 155), analgesics (n = 144), and oxygen therapy (n = 116) (Table 4). A total of eight patients underwent endotracheal intubation. In cases of cardiac arrest, endotracheal intubation was performed in four cases. Three of these patients were intubated onboard the boat but were not evacuated due to unsuccessful resuscitation efforts. One patient was hoisted during ongoing CPR and intubated upon arrival in the helicopter. Among the drug-assisted intubations, two was performed on board vessels prior to evacuation, one in-flight and one at the airport before transfer to a fixed-wing aircraft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e Overview of activity at the time of injury, mechanism of injury, affected anatomical regions, and type of injury for 114 traumatic cases\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActivity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003en \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eFishing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eWork offshore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eMilitary service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eTourism/Leisure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eNot specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMechanism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eCrushed, Compressed, or Pressed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eBlow, Impact, or Collision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eFall Accidents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eTransport Accident at Sea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eStabbed, Pinched by Tools, Weapons, or Explosion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnatomic region primar diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eShoulder/arm/hand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eLower Extremities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eHead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eAbdomen/back/pelvis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eEye\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eThorax/ Chest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsequence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eMultiple Injuries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eUnspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eWound Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eFracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eCrush Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eAmputation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eCommotio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eOrgan Damage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e Main medical diagnoses among evacuated patients with non-traumatic conditions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"387\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGastrointestinal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiovascular\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeurological\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes/ Embolism/Other\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrinary tract\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAirways\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfectious\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMusculoskeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e Medical interventions performed during missions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"383\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment given to diseased or injured patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnalgesics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOxygen Therapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVasoactive Agents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSplinting/Traction Devices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndotracheal Intubation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWound Care/Dressings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiopulmonary Resuscitation (CPR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eOperational conditions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe monthly and annual distributions of missions are presented in Fig. 3 and 4, respectively. A seasonal pattern was observed, with the highest number of missions occurring in June and the lowest number occurring in December. The number of missions decreased over time, from 26 missions in 2000 to 12 missions in 2022.\u003c/p\u003e\n\u003cp\u003eThe pick-up locations are shown in Fig. 5, covering an area from 69.3\u0026deg;N to 74.5\u0026deg;N latitude and from 10.0\u0026deg;E to 42.18\u0026deg;E longitude. The median total mission duration was 332 minutes (range: 78\u0026ndash;1880 minutes). The total mission time encompasses the entire operation, from scramble to mission completion, including the time required to prepare the helicopter and equipment for subsequent missions. The median response time, defined as the interval from alarm activation to arrival at the patient\u0026apos;s location, was 153 minutes (range: 46\u0026ndash;1335 minutes). The median transport time was 85 minutes (range: 10\u0026ndash;335 minutes), while the median patient care time was 98 minutes (range: 10\u0026ndash;480 minutes). Patient care time includes the duration spent attending to the patient, encompassing care at the scene, during transport, and at the destination, until the patient is handed over to the next care provider.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRescue techniques\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVertical sling hoisting was the most common method of patient evacuation from vessels (n = 139, 49%), followed by horizontal stretcher hoisting (n = 102, 36%). In five missions, the helicopter landed directly on the vessel\u0026apos;s deck. In five additional missions, a rendezvous was conducted at Bj\u0026oslash;rn\u0026oslash;ya. In one mission, the physician was delivered to the vessel and accompanied the boat to land. Five were declared deceased before helicopter transport and were not transported by helicopter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHospital admissions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost patients (70%) were admitted to local hospitals. 28% was transported directly to the University Hospital of North Norway. Three patients (1%) were transferred to fixed-wing aircraft for onward transport to specialised centres in southern Norway.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMedevacs in the Barents Sea 2000\u0026ndash;2022 predominantly involved men of working age. Many patients presented with serious, although not immediately life-threatening conditions that could have escalated without timely evacuation. Missions often lasted several hours, requiring extended patient care during transport. This demonstrates the critical need for highly trained medical personnel and well-equipped helicopters capable of managing complex conditions and potential complications en route. The ability to provide advanced care in such challenging environments underscores the importance of ongoing training and maintaining a high standard of preparedness among medical and flight crews. Given the relatively infrequent nature of maritime missions, regular training is essential to maintain operational readiness.\u003c/p\u003e \u003cp\u003eForty percent of the evacuations involved traumatic injuries, while sixty percent involved medical conditions, which is consistent with previous findings (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Traumatic crush injuries to the extremities were the most common type of trauma with 81% of trauma patients engaging in fishing-related activities. This finding underlines the key role of SAR services in supporting maritime occupational safety. Given the fishing industry\u0026rsquo;s importance to Norway, safeguarding this workforce is both a humanitarian and economic priority [10]. Among medevacs, gastrointestinal conditions were most common, followed by cardiovascular events. This contrasts with more accessible areas, such as mainland Norway, where cardiovascular conditions typically dominate (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). As reported in Haagensen\u0026rsquo;s study (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), gastrointestinal conditions were the most frequent cause of evacuation in the Barents Sea. The severe conditions and long distances in the Barents Sea mean that helicopter transport is often required even when the patient is not critically ill. This highlights the importance of SAR operations in supporting emergency care in this remote environment.\u003c/p\u003e \u003cp\u003eTreatment patterns were similar to earlier findings (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), with infusions, analgesics, and oxygen as the most common interventions. Hoisting of intubated patients occurred only twice in 22 years, a finding that aligns with previous studies (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Despite a noticeable decline in the total number of missions and a low number of hoist operations per crew member over two decades the need for regular training remains critical. 33% of all patients had a NACA score of 4\u0026ndash;6, indicating potentially serious conditions. Even though the annual volume was modest, many required rapid evacuation to prevent deterioration. The fact that all evacuated patients were admitted to hospital supports the medical justification for the missions. Most evacuations resulted in admission to local hospitals, mainly Hammerfest Hospital, enhancing logistical efficiency and reducing the burden on tertiary centers.\u003c/p\u003e \u003cp\u003eEarlier involvement of helicopter physicians in mission planning could help reduce unnecessary evacuations and optimize resource use. 77 missions were rejected, primarily due to lack of medical necessity. Early medical consultation might improve resource use and coordination of alternatives.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study is based on retrospective data manually recorded in the LABAS system by helicopter physicians after the missions. This carries a risk of missing or incomplete entries.\u003c/p\u003e \u003cp\u003eAn electronic patient record system capable of capturing data automatically during missions could have mitigated this potential bias.\u003c/p\u003e \u003cp\u003eCoordinates from JRCC were used to supplement missing pick-up positions. These data often reflect the ship\u0026rsquo;s location at the time of distress call, not necessarily the exact evacuation site.\u003c/p\u003e \u003cp\u003eWe lacked follow-up data after hospital admission which could have helped the analysis by confirming diagnoses, assessing intervention outcomes, and evaluating the appropriateness of evacuations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the year-round necessity of SAR helicopters for medical evacuation of patients from the Barents Sea. The findings provide valuable insights into injury patterns, operational challenges, and medical interventions associated with medevacs. To maintain readiness for complex maritime evacuations, ongoing and comprehensive training of SAR crews is essential. Future research and operational adjustments are important for improving safety and effectiveness in this Arctic region.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiopulmonary Resuscitation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency Medical Communication Centres\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Classification of Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJRCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJoint Rescue Coordination Centres\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLABAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDigital Air Ambulance Record System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNACA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Advisory Committee for Aeronautics\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRNoAF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Royal Norwegian Air Force\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSearch And Rescue\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval\u003c/h3\u003e\n\u003cp\u003eThe Regional Committee for Medical and Health Research Ethics (REK) concluded that the project was not subject to mandatory ethical review (REK nord, reference 638876, 15 Jun 2023). The study was registered as a research and quality improvement project with the Data Protection Officer at Finnmark Hospital Trust, who approved the project (reference 2023/5031, 25 Oct 2023). An exemption from the duty of confidentiality was granted by the Norwegian Directorate of Health (Helsedirektoratet), permitting access to relevant LABAS records for the specified study period (reference 2023/5031, 8 Sep 2023). The study was approved and conducted according to the guidelines of the Regional Committee for Medical and Health Research Ethics (REK).\u003c/p\u003e\n\u003ch3\u003eClinical trial number\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch3\u003eHuman Ethics and Consent to Participate declarations\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe data used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eSilje Aune has received research funding from Finnmark Hospital Trust for the conduct of this study.\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eSA conducted the study, analysed the data and wrote the main manuscript. TW and LR supervised the work. TW, HRI and LR contributed to the preparation of the manuscript through review. All authors critically revised the article and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Linda Maria Saariniemi Hansen at Joint Rescue Coordination Centres (JRCC) of North Norway for her assistance in providing data on pick-up positions. We would also like to thank Olaf Normann from Normann IT for his support in identifying relevant tasks in LABAS.\u003c/p\u003e\n\u003cp\u003eAuthors` information\u003c/p\u003e\n\u003cp\u003eEmergency Medicine Department, Finnmark Hospital, Hammerfest, Norway: Silje Aune, Torben Wisborg, Hanne Rikstad Iversen, Lasse Raatiniemi\u003c/p\u003e\n\u003cp\u003eAnaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of \u0026nbsp;Troms\u0026oslash;, Troms\u0026oslash;, Norway: Torben Wisborg\u003c/p\u003e\n\u003cp\u003eNorwegian Centre for Traumatology, Oslo University Hospital, Oslo, Norway: Torben Wisborg\u003c/p\u003e\n\u003cp\u003eDepartment of anesthesiologists and department of airambulance, University hospital of \u0026nbsp; North Norway, Troms\u0026oslash;, Norway: Lasse Raatiniemi\u003c/p\u003e\n\u003cp\u003eCorresponding author\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCorrespondence to Silje Aune ([email protected]).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNorum J, Elsbak TM. Air ambulance services in the Arctic 1999\u0026ndash;2009: a Norwegian study. Int J Emerg Med. 2011;4(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaagensen R, Sj\u0026oslash;borg K\u0026Aring;, Rossing A, Ingil\u0026aelig; H, Markengbakken L, Steen PA. Long-range rescue helicopter missions in the Arctic. Prehosp Disaster Med. 2004;19(2):158\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe National Norwegian Air Ambulance Service. Nasjonale standarder for luftambulanseleger (helikopter), flysykepleiere og redningsmenn [Internet]. [cited 2024 Dec 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.luftambulanse.no/nasjonale-standarder-luftambulanseleger-helikopterflysykepleiere-og-redningsmenn\u003c/span\u003e\u003cspan address=\"http://www.luftambulanse.no/nasjonale-standarder-luftambulanseleger-helikopterflysykepleiere-og-redningsmenn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlomseth R, Gulbrandsen FI, Fredriksen K. Ambulance helicopter contribution to search and rescue in North Norway. Scand J Trauma Resusc Emerg Med. 2016;24:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJustis- og beredskapsdepartementet. Organisasjonsplan for redningstjenesten [Internet]. [cited 2024 Dec 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://lovdata.no/dokument/LTI/forskrift/2019-12-16-1740\u003c/span\u003e\u003cspan address=\"https://lovdata.no/dokument/LTI/forskrift/2019-12-16-1740\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Joint Rescue Coordination Centres. Norwegian search and rescue [Internet]. [cited 2024 Dec 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hovedredningssentralen.no/english/\u003c/span\u003e\u003cspan address=\"https://www.hovedredningssentralen.no/english/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRadio Medico \u0026ndash;. legevakten til sj\u0026oslash;s [Internet]. [cited 2024 Dec 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.helse-bergen.no/avdelinger/yrkesmedisinsk-avdeling/norsk-senter-for-maritim-medisin-og-dykkemedisin/radio-medico-legevakten-til-sjos/#les-mer-om-radio-medico\u003c/span\u003e\u003cspan address=\"https://www.helse-bergen.no/avdelinger/yrkesmedisinsk-avdeling/norsk-senter-for-maritim-medisin-og-dykkemedisin/radio-medico-legevakten-til-sjos/#les-mer-om-radio-medico\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaatiniemi L, Mikkelsen K, Fredriksen K, Wisborg T. Do pre-hospital anaesthesiologists reliably predict mortality using the NACA severity score? A retrospective cohort study. Acta Anaesthesiol Scand. 2013;57(10):1253\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollins D, Crickmer M, Brolly K, Abrams D, Ritchie A, Milsom W. Epidemiology of emergency medical search and rescue in the North Shore Mountains of Vancouver, Canada, from 1995 to 2020. Wilderness Environ Med. 2023;34(1):55\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSINTEF. Personulykker i den norske fiskefl\u0026aring;ten: Analyser av ulykkeshendelser og \u0026aring;rsaksforhold [Internet]. [cited 2024 Dec 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://sintef.brage.unit.no/sintef-xmlui/handle/11250/3110350\u003c/span\u003e\u003cspan address=\"https://sintef.brage.unit.no/sintef-xmlui/handle/11250/3110350\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRzońca P, Świeżewski SP, Jalali R, Gotlib J, Gałązkowski R. Helicopter emergency medical service (HEMS) response in rural areas in Poland: retrospective study. Int J Environ Res Public Health. 2019;16(9):1532.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZakariassen E, Burman RA, Hunskaar S. The epidemiology of medical emergency contacts outside hospitals in Norway: a prospective population-based study. Scand J Trauma Resusc Emerg Med. 2010;18(1):9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKr\u0026uuml;ger AJ, Lossius HM, Mikkelsen S, Kurola J, Castr\u0026eacute;n M, Skogvoll E. Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia: a prospective population-based study. Acta Anaesthesiol Scand. 2013;57(9):1175\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamdal M, Eiding H, Markengbakken L, R\u0026oslash;islien J, Rehn M, Sandberg M. Time course of hoist operations by the search and rescue helicopter service in Southeast Norway. Wilderness Environ Med. 2019;30(4):351\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark-Ross JF, Howard I, Hodkinson P. Rescue activity of a civilian helicopter emergency medical service in the Western Cape, South Africa: a 5-year retrospective review. Wilderness Environ Med. 2022;33(4):437\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePietsch U, Knapp J, Kreuzer O, Ney L, Strapazzon G, Lischke V, et al. Advanced airway management in hoist and longline operations in mountain HEMS\u0026ndash;considerations in austere environments: a narrative review. Scand J Trauma Resusc Emerg Med. 2018;26:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkaiaa SC, Roslin A, Heggland T, Heian S, Elden T, \u0026Aring;reskjold \u0026Oslash;, et al. Characteristics of helicopter hoist operations with intubated patients: a retrospective analysis of a Norwegian physician-staffed SAR helicopter service. Scand J Trauma Resusc Emerg Med. 2024;32(1):118.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"stre","sideBox":"Learn more about [Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine](http://sjtrem.biomedcentral.com)","snPcode":"13049","submissionUrl":"https://submission.nature.com/new-submission/13049/3","title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","twitterHandle":"@SJTREM","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"SAR missions, medical evacuation, medevacs, maritime evacuation, Barents Sea, NACA score.","lastPublishedDoi":"10.21203/rs.3.rs-6750756/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6750756/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Barents Sea, characterized by remote locations, vast distances, harsh weather conditions and seasonal polar night, presents significant challenges for search and rescue (SAR) operations. In emergencies involving illness, injury, or other rescue needs, helicopters are often the only feasible response resource. Rescue helicopters are critical for both SAR operations and medical evacuations (medevacs) to meet the region\u0026rsquo;s urgent demands. The aim of this study was to describe the characteristics of SAR helicopter medevacs in the Barents Sea, with a focus on patient presentations, medical interventions, mission profiles, and operational challenges encountered over a 22-year period.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort study reviewed all requests for medevacs involving the SAR helicopter at Banak, operated by the 330 Squadron between 1 January 2000 and 31 December 2022.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 418 requests for medevacs were received, resulting in 283 completed missions. Among the patients 96.5% were male with a median age of 41 years. Most (84%) had a National Advisory Committee for Aeronautics (NACA) score of 3 or 4 on a severity scale from 0 to 7. Wounds and fractures of the upper extremities were the most common injuries, whereas gastrointestinal and cardiovascular conditions were the most frequently reported medical emergencies. Among the trauma cases, 81% were related to the fishing industry. Blunt injuries, including crushing, compression, and pressure-related trauma, were the most common mechanisms. Twenty-five patients (18%) sustained injuries affecting more than one body region.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the year-round importance of SAR helicopters in evacuating ill and injured patients from the Barents Sea. Many presented with serious but not immediately life-threatening conditions that could deteriorate without timely intervention. These findings reinforce the need for regular and comprehensive training of the entire SAR crew to maintain readiness for patient evacuations in demanding maritime environments.\u003c/p\u003e","manuscriptTitle":"Medical Evacuations by Search and Rescue Helicopters in the Barents Sea","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 05:38:33","doi":"10.21203/rs.3.rs-6750756/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-14T13:39:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-31T08:46:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135723900360556965037233963486385658412","date":"2025-06-18T07:32:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162583777903361379304465261488919848193","date":"2025-06-04T16:03:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-03T17:40:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183083297342152269729795804585990672352","date":"2025-06-03T16:38:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-02T15:26:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-28T11:14:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-28T11:11:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","date":"2025-05-26T12:15:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"stre","sideBox":"Learn more about [Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine](http://sjtrem.biomedcentral.com)","snPcode":"13049","submissionUrl":"https://submission.nature.com/new-submission/13049/3","title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","twitterHandle":"@SJTREM","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"70a9c181-b011-4e12-aba6-76e7d2076093","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T15:59:05+00:00","versionOfRecord":{"articleIdentity":"rs-6750756","link":"https://doi.org/10.1186/s13049-025-01529-6","journal":{"identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isVorOnly":false,"title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine"},"publishedOn":"2025-12-17 15:57:01","publishedOnDateReadable":"December 17th, 2025"},"versionCreatedAt":"2025-06-09 05:38:33","video":"","vorDoi":"10.1186/s13049-025-01529-6","vorDoiUrl":"https://doi.org/10.1186/s13049-025-01529-6","workflowStages":[]},"version":"v1","identity":"rs-6750756","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6750756","identity":"rs-6750756","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}