Nursing Competencies in Helicopter Emergency Medical Services (HEMS) in Spain: A Qualitative Study of Professional Profiles and Advanced Training.

AIM(S): To explore how HEMS professionals perceive the role, competencies, training and professional development of nursing within aeromedical transport services in Spain, incorporating the perspectives of different professional profiles involved in HEMS operations.

DESIGN: An interpretative qualitative study using phenomenologically informed thematic analysis.

METHODS: Semi-structured, in-depth interviews were conducted and analysed using phenomenologically informed thematic analysis. Data were systematically coded through open coding and organised into themes and subthemes using ATLAS.ti.

DATA SOURCES: Primary qualitative data were obtained from 17 purposively selected HEMS professionals through individual interviews. Interviews lasted 45-60 min, were audio-recorded and transcribed verbatim.

RESULTS: Four main categories emerged from the analysis: (1) access to the HEMS environment; (2) technical skills and competencies; (3) professional perspective and role development; and (4) structured professionalisation of the HEMS profile. Participants perceived that extensive prior experience in critical care settings, specialised academic training, supervised practice and advanced clinical simulation were necessary. Fully online training was widely perceived as insufficient. Participants identified core competencies, including advanced technical skills, knowledge of aerophysiology, aviation safety training, Crew Resource Management and Helicopter Underwater Escape Training. In addition, participants identified emotional resilience and physical fitness as personal attributes relevant to HEMS practice.

CONCLUSION: According to participants, HEMS nursing in Spain was described as a complex and highly specialised professional profile, characterised by extensive critical-care experience, advanced technical competencies and structured, practice-oriented training. The absence of a formalised training pathway contrasts with international standards and points to a perceived need for greater professional recognition and standardisation of competencies to support safe and high-quality care.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings provide qualitative evidence that may inform the future development of structured training pathways, competency frameworks and professional recognition for HEMS nurses in Spain. The findings may also inform future research on standardised education, advanced simulation and aviation safety training. Further research is needed to determine whether these educational approaches improve clinical decision-making, patient safety and operational effectiveness in aeromedical transport.

IMPACT: The findings highlight the lack of a clearly defined and standardised competency framework and training pathway for HEMS nursing professionals in Spain. Participants perceived effective HEMS practice as requiring extensive prior critical-care experience, advanced technical competencies, supervised practical training and specific personal attributes, including emotional resilience and physical preparedness. These findings are relevant to HEMS nurses, educators, policymakers and healthcare managers involved in aeromedical services in Spain and may also contribute to international discussions on advanced nursing practice in air medical transport.

REPORTING METHOD: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.