ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
Geospatial Optimization of Air-Mobile Stroke Unit Deployment in Norway: Expanding the Frontiers of Neurocritical Care
Caroline J. Jagtenberg 1
Annemijn M. Boer 1
Marius Rehn 2,3,4
Jo Røislien 4,5
Maren R. Hov 6,7,4
Karianne Larsen 6,4
1. Department of Operations Analytics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway
3. Division of Pre-Hospital Services, Oslo University Hospital, Oslo, Norway
4. Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
5. Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
6. Department of Neurology, Oslo University Hospital, Oslo, Norway
7. Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Abstract
Introduction: Rural and remote communities face disadvantages in acute stroke care. An Air-Mobile Stroke Unit (Air-MSU), adapting traditional MSUs for aircraft, could enable timely prehospital assessment in underserved regions. This modelling study aimed to identify the optimal Air-MSU base in Norway to maximize patient coverage, using increased geographic reach within 4.5 hours as a proxy for clinical efficacy and improved outcomes. Materials and methods: All Helicopter Emergency Medical Services (HEMS) bases in Norway were evaluated as candidate sites using 2022 Norwegian Stroke Registry data at the postal-code level. Postal codes within a 15-minute drive of a hospital were excluded to reflect realistic ground-ambulance coverage. Additional analyses focused on rural patients located more than 150 minutes from a hospital, assumed ineligible for hyperacute treatment within 4.5 hours of onset. A Maximum Covering Location Problem (MCLP) model identified the HEMS base that maximized patient coverage within a 150-minute response window. Results: Positioning the Air-MSU at Dombås in Central Norway covered 87.5% of stroke patients, increasing nationwide hyperacute treatment availability from 91.8% to 94.8%. For rural patients, the optimal base was Harstad in Northern Norway, covering 14.7% of all stroke patients but increasing the total proportion eligible for treatment within 4.5 hours to 97.2%. Discussion: Locating an Air-MSU in Harstad would most effectively improve access to hyperacute stroke care in rural and remote Norway. Geospatial modelling combined with mathematical optimization supports strategic planning of future prehospital stroke services.
Summary
Keywords
acute stroke treatment, Air mobile stroke Unit, Emergency Medical Services, geospatial analysis, Helicopter emergency medical services
Received
30 November 2025
Accepted
18 February 2026
Copyright
© 2026 Jagtenberg, Boer, Rehn, Røislien, Hov and Larsen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Karianne Larsen
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.