Geospatial optimization of Air-Mobile Stroke Unit deployment in Norway: expanding the frontiers of neurocritical care

Caroline J Jagtenberg; Annemijn M Boer; Marius Rehn; Jo Roislien; Maren R Hov; Karianne Larsen

doi:10.3389/fneur.2026.1740806

Geospatial optimization of Air-Mobile Stroke Unit deployment in Norway: expanding the frontiers of neurocritical care

Front Neurol. 2026 Mar 9:17:1740806. doi: 10.3389/fneur.2026.1740806. eCollection 2026.

Authors

Caroline J Jagtenberg¹, Annemijn M Boer¹, Marius Rehn^{2

3

4}, Jo Roislien^{2

5}, Maren R Hov^{2

6

7}, Karianne Larsen^{2

6}

Affiliations

¹ Department of Operations Analytics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
² Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway.
³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁴ Division of Pre-Hospital Services, Oslo University Hospital, 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.

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 modeling study aimed to identify the optimal Air-MSU base in Norway to maximize patient coverage, using increased geographic reach within 4.5 h 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-min drive of a hospital were excluded to reflect realistic ground-ambulance coverage. Additional analyses focused on rural patients located more than 150 min from a hospital, assumed ineligible for hyperacute treatment within 4.5 h of onset. A Maximum Covering Location Problem (MCLP) model identified the HEMS base that maximized patient coverage within a 150-min 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 h 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 modeling combined with mathematical optimization supports strategic planning of future prehospital stroke services.

Keywords: Air Mobile Stroke Unit; Helicopter Emergency Medical Services; acute stroke treatment; emergency medical services; geospatial analysis.