Does a physician’s base specialty influence on‑scene efficiency? A four‑year analysis of 11,315 missions from five Austrian physician‑staffed HEMS bases

Physician-staffed helicopter emergency medical services (HEMS) in Austria operate under a uniform, high-accreditation framework: all physicians complete the same advanced prehospital curriculum, and dispatch decisions do not consider individual board certification. Nevertheless, it remains unclear whether a physician’s original specialty (anaesthesiology, surgery, orthopaedics, internal medicine or paediatrics) affects on-scene efficiency or procedural choices. We therefore investigated whether board specialty independently predicts prehospital treatment times and intervention patterns in Austrian HEMS missions. We retrospectively analyzed 11 315 missions from five alpine HEMS bases (January 2021 to April 2025). On-scene time (OST) was the primary endpoint. Predictors included physician specialty (10 boards, merged where appropriate) and NACA severity. Two-way ANOVA tested main and interaction effects, with sensitivity analyses for intubated trauma and logistic regression for intubation odds. Severity dominated OST (F = 204, p < 0.001; η² ≈ 0.20), whereas specialty explained < 1% of the variance (F = 3.6, p = 0.003; η² = 0.006). A minor surgical advantage (≈ 5 min) was restricted to NACA 3 (p < 0.01) and clinically negligible. Specialty effects disappeared in sensitivity analyses. Specialty-specific practice patterns (e.g. surgeons’ higher ketamine/TXA use, anesthesiologist’ opioid preference) did not affect OST. In this standardized Austrian HEMS system, patient severity and mission complexity (not physician specialty) were the main determinants of on-scene time. Physician specialty showed no clinically relevant influence on pre-hospital time metrics. As this study assessed time-related parameters only, no conclusions can be drawn regarding system efficiency or overall quality of care. On-scene time should therefore be interpreted as one performance dimension among multiple quality indicators in HEMS systems.