Improving the coordination mechanism of air medical services within the emergency medical care system

Medical air services constitute one of the key components of emergency medical care, enabling the transport of patients, medical teams, specialist physicians, donor organs, medical equipment, and biological materials in situations where ground transportation cannot provide timely access to specialized care. This topic is of particular importance for the Republic of Kazakhstan due to the country’s vast territory, the remoteness of many settlements from multidisciplinary and highly specialized medical centers, regional disparities in transport infrastructure, and the need for interhospital transfer of patients with critical conditions.

The aim of this review is to synthesize evidence from the scientific literature and official sources on coordination mechanisms for medical air services within emergency medical care systems and to identify opportunities for their improvement in the context of the Republic of Kazakhstan. The review includes publications addressing medical air services, helicopter emergency medical services (HEMS), fixed-wing aeromedical evacuation, interhospital transport, clinical prioritization, dispatch systems, telemedicine, digital clinical decision-support tools, training of aeromedical teams, quality assessment, mission cancellations, overutilization of air transport, and emergency and disaster management.

The current literature demonstrates that the effectiveness of medical air services depends not only on the availability of aircraft but also on the quality of coordination among healthcare organizations, regional coordination centers, aviation operators, receiving hospitals, and the national coordination authority. International evidence indicates that, in the absence of standardized activation criteria, digital resource management, and systematic auditing of dispatch decisions, medical air services may be either overutilized or activated too late for patients who genuinely require urgent specialized care.

For Kazakhstan, the most appropriate approach is a three-tier centralized digital dispatch model, in which the National Coordination Center for Emergency Medicine serves as the national coordination hub, regional coordination centers ensure the operational coordination of requests and available resources, and healthcare organizations submit standardized clinical information. Further development of the system should include standardized activation criteria for medical air services, a digital referral and dispatch pathway, telemedicinebased assessment of indications, real-time monitoring of aircraft and crew availability, confirmation of receiving hospital readiness, interregional coordination when local resources are insufficient, and routine auditing of completed, cancelled, and declined missions.

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