Europe is facing major challenges in security, health, and climate, which place increasing demands on emergency medical systems. While European cooperation is advancing in sectors like defence and energy, emergency medicine remains largely nationally or regionally structured. Despite significant differences in funding, staffing and mission profiles, HEMS systems across Europe share many similarities, especially regarding patient population and professional standards. The newly founded European Governance Alliance in HEMS aims to use these commonalities to foster cross-border learning and collaboration, based on the principles of Clinical Governance. Through regular international "Debrief & Discussion" (D&D) meetings and peer learning visits, the Alliance promotes a culture of open reflection, shared learning, and continuous improvement. The long-term goal is to define and implement common governance standards and establish sustainable structures for peer-based quality development. This initiative offers a first concrete step towards structured, international cooperation in European air rescue- with the aim of improving systems, not individuals.
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