The development of emergency medical services benefit score: a European Delphi study

Anssi Heino, Lasse Raatiniemi, Timo Iirola, Merja Meriläinen, Janne Liisanantti, Miretta Tommila, Collaboration Group, Andreas Krüger (Member of author group), Fabrice Dami (Member of author group), Didier Moens (Member of author group), Espen Fevang (Member of author group), Heini Harve-Rytsälä (Member of author group), Helena Jäntti (Member of author group), Jouni Nurmi (Member of author group), Kristin Tønsager (Member of author group), Leif Rognås (Member of author group), Marius Rehn (Member of author group), Patrick Schober (Member of author group), Per P. Bredmose (Member of author group), Peter Martin Hansen (Member of author group)Peter Temesvari (Member of author group), Søren Mikkelsen (Member of author group), Thomas W. Lindner (Member of author group), Troels Martin Hansen (Member of author group), Anna Nikula (Member of author group), Anne-Mari Kantanen (Member of author group), Antti E. Lindgren (Member of author group), Heli Salmi (Member of author group), Karri Kirjasuo (Member of author group), Marjut Varpula (Member of author group), Matti Reinikainen (Member of author group), Nanneli Paalasmaa (Member of author group), Outi Peltoniemi (Member of author group), Teemu Luoto (Member of author group), Vesa Lund (Member of author group), Ville Jalkanen (Member of author group)

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The helicopter emergency services (HEMS) Benefit Score (HBS) is a nine-level scoring system developed to evaluate the benefits of HEMS missions. The HBS has been in clinical use for two decades in its original form. Advances in prehospital care, however, have produced demand for a revision of the HBS. Therefore, we developed the emergency medical services (EMS) Benefit Score (EBS) based on the former HBS. As reflected by its name, the aim of the EBS is to measure the benefits produced by the whole EMS systems to patients.

This is a four-round, web-based, international Delphi consensus study with a consensus definition made by experts from seven countries. Participants reviewed items of the revised HBS on a 5-point Likert scale. A content validity index (CVI) was calculated, and agreement was defined as a 70% CVI. Study included experts from seven European countries. Of these, 18 were prehospital expert panellists and 11 were in-hospital commentary board members.

The first Delphi round resulted in 1248 intervention examples divided into ten diagnostic categories. After removing overlapping examples, 413 interventions were included in the second Delphi round, which resulted in 38 examples divided into HBS categories 3–8. In the third Delphi round, these resulted in 37 prehospital interventions, examples of which were given revised version of the score. In the fourth and final Delphi round, the expert panel was given an opportunity to accept or comment on the revised scoring system.

The former HBS was revised by a Delphi methodology and EBS developed to represent its structural purpose better. The EBS includes 37 exemplar prehospital interventions to guide its clinical use.

Trial registration The study permission was requested and granted by Turku University Hospital (decision number TP2/010/18).
Original languageEnglish
Article number151
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Number of pages9
Publication statusPublished - 16. Oct 2021


  • Air Ambulances
  • Aircraft
  • Consensus
  • Delphi Technique
  • Emergency Medical Services
  • Humans
  • Quality control
  • Delphi method
  • Emergency medical services
  • Prehospital


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