An Insight into Iceland’s Emergency Medicine and Pre-Hospital Care Systems
Dr Ross Archibald, ST6 Emergency Medicine, South East Scotland Deanery
The last part of my Fellowship was scheduled to take place in the north of Iceland in Akureyri, the largest town outside the populous south west of the country and only 100km away from the Arctic Circle. From Reykjavík it’s a 400km drive on a stretch of Route 1, the ring road which runs all the way round the island. As always here, there is no shortage of stunning mountainous and coastal scenery to take in on the way!
Once I had arrived, my first stop was the small airport on the edge of town, where the air ambulance service is based. Due to Iceland’s sparse population, long transport distances and numerous small airports, the majority of aeromedical operations in Iceland is accomplished using fixed-wing aircraft. The Icelandic government contracts this service out to the airline Mýflug, based in Akureyri. Named after a local lake, the airline was established in 1985 and conducts air ambulance flights all over Iceland as well as international destinations including Greenland, Scandinavia and the UK. The airline flies around 700-800 air ambulance flights per year, around one third of which require a doctor on board.
I would be spending my week here on-call with Dr Barbara Hess, a Consultant Anaesthetist and Flight Doctor based in Akureyri. She began by showing me around the aircraft and its hangar, as well as the medical kit on board. The aircraft used for the air ambulance flights are two specially configured Beechcraft Kingair 200s, both on constant standby at Akureyri airport. Each aircraft has room for two patient stretchers, monitors and kit bags for medical equipment and medications. Flight times within Iceland are generally in the range of 30-60 minutes.
There is an air ambulance crew on call 24 hours a day, consisting of a captain, co-pilot, paramedic and doctor. When there is an activation, the team will generally respond from home (unless already on a mission), but as Akureyri is a small town and traffic is generally light, travel times to the airport are usually only a few minutes. There are currently seven flight doctors on the rota, with base specialties of EM, anaesthetics and GP. The doctors generally work stretches of 48-72 hours on call and it appeared that this was integrated and supported fairly well alongside their hospital work.
Requests for the air ambulance are usually made by a rural doctor or paramedic via the emergency services dispatch room in Reykjavík, at which point a triage category is allocated. The on call flight doctor and paramedic then receive a notification on their mobile phone that there has been an air ambulance request. After this there they will usually contact the requesting clinician by phone to obtain further information and give advice if required.
It was a busy few days on the air ambulance, with one of the days involving eight flights to all corners of the country. Landing at some of Iceland’s numerous small remote towns where medical facilities are limited, it was easy to see how vital the air ambulance was in connecting patients with the rest of the country’s health service. The patients we dealt with on our activations had a wide age range, from a 21 month old to patients in their eighties. The clinical issues were also varied, including STEMI, fractures, pulmonary oedema, seizures, psychiatric problems and post-operative complications. Most patients were being transferred from remote towns to Reykjavík or Akureyri for further care, but there were also patients being transferred back to their local community hospital for step down care (this was generally arranged opportunistically when the air ambulance was available).
It struck me that the whole process was very smoothly co-ordinated. After activation the aircraft was always waiting on the tarmac in Akureyri by the time the flight team arrived, and the pilots would have us airborne with minimal fuss in just a few minutes. On landing at the destination airport, there would always be an ambulance waiting to take the patient on the last leg of their hospital transfer, as well as an aircraft fuelling truck on standby. The loading and offloading of patients from the aircraft was also efficient and well-practised, with all members of the team involved. I could appreciate the rewards of working in this small close-knit team – not only through enabling unwell patients in remote and rural areas to access timely medical care, but also the regular added bonus of spectacular views of Iceland from the air!
