University of Oulu

Heino, A., Raatiniemi, L., Iirola, T. et al. The development of emergency medical services benefit score: a European Delphi study. Scand J Trauma Resusc Emerg Med 29, 151 (2021).

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

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Author: Heino, Anssi1,2; Raatiniemi, Lasse3; Iirola, Timo2,4;
Organizations: 1Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
2University of Turku, Turku, Finland
3Centre for Prehospital Emergency Care, Oulu University Hospital, Oulu, Finland
4Emergency Medical Services, Turku University Hospital, Turku, Finland
5Medical Research Centre, Oulu University Hospital, Oulu, Finland
6Department of Anaesthesiology, Medical Research Centre and Research Group of Anaesthesia and Intensive Care, University of Oulu, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
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Language: English
Published: Springer Nature, 2021
Publish Date: 2022-03-03


Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Collaboration Group

Andreas Krüger, Fabrice Dami, Didier Moens, Espen Fevang, Heini Harve-Rytsälä, Helena Jäntti, Jouni Nurmi, Kristin Tønsager, Leif Rognås, Marius Rehn, Patrick Schober, Per P. Bredmose, Peter Martin Hansen, Peter Temesvari, Søren Mikkelsen, Thomas W. Lindner, Troels Martin Hansen, Anna Nikula, Anne-Mari Kantanen, Antti E. Lindgren, Heli Salmi, Karri Kirjasuo, Marjut Varpula, Matti Reinikainen, Nanneli Paalasmaa, Outi Peltoniemi, Teemu Luoto, Vesa Lund & Ville Jalkanen

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Series: Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
ISSN-E: 1757-7241
ISSN-L: 1757-7241
Volume: 29
Issue: 1
Article number: 151
DOI: 10.1186/s13049-021-00966-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.