Introduction:
Mortality due to various causes, despite continuous efforts to improve the quality of medical services, is a serious problem for modern healthcare systems. Ischaemic heart disease and stroke are the cause of over 15 million deaths annually, and are therefore known as the world’s number one killer.

Objective:
The aim of this study is to characterise the missions and the most common reasons for dispatching Helicopter Emergency Medical Service (HEMS) crews, with special emphasis on the differences between urban and rural areas.

Material and methods:
The study was conducted using a retrospective analysis of HEMS missions, including flights to accidents and diseases carried out by HEMS crews in Poland from January 2014 – December 2018. The final analysis included 35,213 cases of HEMS missions.

Results:
The study group consisted mainly of male patients (66.40%), aged 50–64 (22.06%), mean age of the entire analysed group – 47.71 (SD: 25.96). The main reason for HEMS missions were strokes (21.63%). Analysis of patients’ clinical status revealed that the clinical status of patients treated in rural areas was more severe, which was indicated by the Glasgow Coma Scale – GCS (12.03 vs 12.35) and the Revised Trauma Scale – RTS (10.14 vs 10.60) scores. When assessed by the National Advisory Committee for Aeronautics (NACA) score, body injuries and fatal diseases were observed more often in patients in rural areas (NACA 7 6.12% vs 3.46%) (p<0.05).

Conclusions:
Multi-organ injuries, head traumas, sudden cardiac arrest, traumatic brain injuries, collapse and epilepsy, were more frequent reasons for HEMS missions in rural areas than in urban areas.