Alpine Helicopter Rescue: Only 10% of Rescues Are Truly Critical

Today's challenge is distinguishing what is urgent from what is not.

Every summer, millions of people climb above 2,500 meters in the Alps to experience the thrill of the mountains. But when something goes wrong, who should pay the bill? And more importantly: is it worth risking the lives of rescuers for those who have consciously chosen to face the mountain?

A recent study published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine has analyzed over 3,500 helicopter rescue missions in Switzerland, revealing surprising data that reignites the debate on one of the most controversial topics in modern emergency medicine.

The research shows that approximately 40 million tourists annually visit altitudes above 2,500 meters in the Alps. Of these, a growing percentage ends up requiring helicopter rescue intervention. But here's the thought-provoking data: only 1 in 10 people rescued is actually in life-threatening danger.

The NACA Scale: Measuring Severity in the Mountains

To understand the scope of the phenomenon, it's necessary to familiarize ourselves with the NACA scale (National Advisory Committee for Aeronautics), a universally used system for classifying patient severity in pre-hospital rescue. The scale ranges from 0 (uninjured person) to 7 (deceased during intervention), where scores 4-6 identify patients in serious life-threatening danger requiring immediate advanced medical interventions.

The Anatomy of Alpine Rescue: Surprising Numbers

The analysis of 3,564 missions conducted by Swiss Air Ambulance between 2011 and 2021 reveals an unexpected epidemiological landscape. 66.8% of rescues involve adult men, predominantly engaged in summer activities. But it's the distribution of severity that's surprising: 88.1% of patients present minor injuries or are completely uninjured (NACA 0-3), while only 9.4% are in critical conditions (NACA 4-6).

The most significant data concerns winch missions: 35.3% of the total, with uninjured patients representing almost 20% of these complex interventions. This pattern highlights how many operations have a preventive rather than life-saving character.

The study identifies three factors that significantly influence operational times: patient severity (NACA scale), winch use, and, surprisingly, trauma seasonality. Trauma patients in summer require significantly longer scene times (from 38.2 to 46 minutes), probably due to the greater complexity of interventions possible in conditions of better accessibility.

The Paradox of Preventive Medicine

The authors define many of these missions as having "preventive character": they prevent deterioration due to environmental exposure, hypothermia, exhaustion, or secondary accidents. But this approach raises profound questions.

The risk of accidents for HEMS crews is documented to be higher compared to ground services [2], an element that must be considered every time a helicopter intervention is decided. This creates an ethical paradox: is it acceptable to expose rescuers to risks to evacuate people who have voluntarily chosen high-risk activities?

The temporal evolution shows a concerning trend: a significant increase in missions for patients with minor injuries, reflecting what some researchers define as the shift from "life-saving medicine" to "comfort medicine". This trend can lead to greater dissatisfaction and boredom (boreout) among HEMS personnel and raises questions about system sustainability.

Toward a New Balance: Shared Responsibility

The challenge is not to eliminate mountain rescue - universally recognized as a fundamental right - but to optimize operational protocols. The authors propose innovative strategies: expanding the role of non-medical rescue services, introducing intermediate response levels, refining triage protocols considering not only clinical severity but also environmental risk.

The 9% of severely injured patients fully justifies the existence of specialized HEMS services. The question is how to preserve these critical resources for those who truly need them, while developing safe alternatives for less critical situations.

Beyond Controversy: Toward a Safer and More Responsible Mountain Environment

The Swiss research doesn't provide definitive answers but offers data for a more mature debate. The mountains will continue to attract millions of people, and the right to rescue remains inviolable. However, the numbers suggest the need for a new pact between mountain users, rescuers, and society.

Perhaps the real challenge is not deciding whether to rescue, but how to do it more intelligently: investing in prevention, education, and technologies that reduce the need for risky interventions, preserving the most precious resources - specialized crews and equipment - for those who desperately need them.

The mountain teaches that every choice has consequences. It's time this lesson also applies to how we conceive the future of alpine rescue.

A More Efficient Future is Possible!

Today, distinguishing between real emergencies and avoidable situations is one of the most complex challenges in helicopter rescue. AI and tools like EMSy, already used in pre-hospital settings, are created precisely with the objective of supporting healthcare personnel in the most critical moments.

An additional help to make better decisions, where every second counts.

Bibliography

1. Klocker E, et al. High-altitude HEMS missions—a retrospective analysis of 3,564 air rescue missions conducted between 2011 and 2021. Scand J Trauma Resusc Emerg Med. 2025;33:97.

2. Bledsoe BE, Smith MG. Medical helicopter accidents in the United States: a 10-year review. J Trauma. 2004;56(6):1325-8.