Recruiting and retaining qualified personnel has become one of the defining challenges facing the helicopter emergency medical services (HEMS) sector. Operators are competing for talent across healthcare, aviation, and technical professions while adapting to evolving mission requirements, changing workforce expectations, and increasing demand for emergency care.
Workforce development will be among the key topics discussed at AirMed World Congress 2026, hosted by ADAC Luftrettung and taking place Sept. 16 to 18 in Munich, Germany.
Ahead of the event, Vertical Valor Plus spoke with Dr. Matthias Ruppert, executive board member of the European HEMS and Air Ambulance Committee (EHAC) and chief medical officer of ADAC HEMS Academy, about the workforce challenges facing HEMS operators and the strategies needed to recruit, train, and retain the next generation of personnel.
This interview has been edited for length and clarity.
Vertical Valor Plus: What are the biggest workforce challenges facing European HEMS operators today, and how have they
evolved over the past decade?
Dr. Matthias Ruppert: From ADAC Luftrettung’s perspective, the key workforce challenge is not simply recruiting enough people. It is securing enough highly qualified and long-term available professionals with the right attitude for an exceptionally demanding operational environment.
Over the past decade, the issue has shifted from a traditional recruitment challenge to a broader question of system resilience. HEMS operators now compete with hospitals, ground EMS providers, airlines, maintenance organizations, and other specialist employers for talent.
At the same time, mission profiles are becoming more complex, with increased night operations, hoist missions, digital integration, tele-emergency consultation structures, and advanced clinical care.
Compared with North America, many challenges are similar. Shortages among pilots, medical personnel, and aviation maintenance professionals are major concerns on both continents.
The European difference lies in fragmentation: multiple healthcare systems, federal or regional EMS structures, national regulations, language requirements, qualification recognition processes, and funding models. Workforce strategy must therefore be understood as a combined medical, aviation, operational, and health-policy issue.
VV: Beyond compensation, how are HEMS organizations attracting and retaining skilled personnel in competition with hospitals, airlines, and other employers?
M.R.: Compensation matters, but it is not the only lever. For many HEMS organizations, the strongest employer proposition lies in the purpose of the mission, strong teamwork, professional standards, and the opportunity to save lives in a highly specialized environment.
Compared with hospitals, HEMS offers a distinctive combination of prehospital medicine, aviation, teamwork, and professional autonomy. For paramedics and emergency medical specialists, the technical crew HEMS role can extend beyond patient care to navigation, communication, and tactical mission coordination.
Compared with airlines, HEMS cannot compete solely through conventional career pathways. Instead, it offers pilots a strong mission purpose, demanding flying profiles, operational precision, and a strong safety culture. For maintenance and engineering professionals, the differentiator is that their work directly affects the readiness of a lifesaving system.
Retention depends on more than salary. It requires good leadership, predictable scheduling, fair working-time models, high-quality training, psychological safety, and a sense of belonging to a professional, high-trust system. Ultimately, employer attractiveness will increasingly be decided by one question: Can people work here effectively, safely, healthily, and with pride over the long term?
VV: How can the industry better prepare aspiring HEMS clinicians, pilots, and maintenance professionals for careers in the field, and what barriers should be addressed?
M.R.: The industry would benefit from clearer pathways into HEMS roles. Many candidates may be interested in air rescue but do not fully understand the experience, qualifications, medical fitness, operational suitability, and training required.
Entry into HEMS should be structured rather than informal. Selection, onboarding, supervised practice, simulation, mentoring, and recurrent training can help candidates transition into the specific requirements of HEMS. One important factor is that we hire for attitude and not only for skills.
For pilots and HEMS crew members, training must address both technical and non-technical skills, including communication, situational awareness, coordination, risk assessment, and operational decision-making. Structured crew resource management programs are one example of an approach that brings together pilots, medical personnel, maintenance staff, and other stakeholders.
For maintenance personnel, earlier exposure to aviation maintenance careers may be important. Training partnerships with technical schools, apprenticeships, and clearer career information may help reduce entry barriers.
VV: What workforce strategies from Germany and Europe could be applied more broadly, and what challenges are limiting their adoption?
M.R.: One element from the German and European HEMS context that may be relevant internationally is the emphasis on interdisciplinary training and standardization. HEMS requires coordination between medical staff, pilots, technical personnel, dispatch centers, hospitals, regulators, and public authorities, so workforce development needs to reflect that interdependence.
Three areas appear particularly transferable: interdisciplinary CRM and human factors training; practical, simulation-based training; and system-level planning.
Aeromedical CRM addresses communication, teamwork, leadership, situational awareness, and decision-making across the professional groups involved in HEMS. Simulation and other hands-on training methods help teams prepare for complex operational scenarios in a safe environment.
At the system level, workforce planning should be supported by flexible staffing models, digital integration, and coordinated approaches to service planning and quality standards.
Broader adoption, however, is often limited by regulatory, educational, and funding differences. Across Europe, varying healthcare systems, qualification requirements, and financing mechanisms can slow workforce reforms even when operational needs are widely recognized.
VV: How will demographic shifts and changing workforce expectations shape HEMS staffing over the next decade, and what should the industry do now to prepare?
M.R.: Demographic change will affect HEMS in two ways: demand for emergency care is likely to remain high, while parts of the healthcare and aviation workforce are aging or moving toward different employment expectations. Younger professionals often place greater emphasis on predictable schedules, development opportunities, psychological safety, digital tools, and compatibility between work and private life.
Air rescue is also no longer primarily associated with road traffic accidents. Today, crews treat a broad spectrum of critically ill and injured patients, ranging from rapid transport cases to situations requiring invasive intensive care in an out-of-hospital environment.
For workforce strategy, this means HEMS providers will need to focus more on long-term employability. This includes predictable roster models where possible, fatigue risk management, structured career development, leadership training, health management, peer support, and options for different career phases.
If these issues are not addressed, the consequences could include reduced aircraft availability, higher workloads for existing crews, loss of experienced personnel, slower onboarding of new staff, and increased pressure on operational safety and service reliability.
VV: How can technologies such as simulation, telemedicine, and AI help improve efficiency and address workforce challenges in HEMS?
M.R.: Technology can help reduce some workforce pressures, but it cannot remove the need for qualified personnel. Its main value lies in improving training, supporting decision-making, reducing administrative workload, and making scarce expertise more accessible.
Simulation is one of the most practical tools for HEMS workforce development. It allows teams to train rare or high-risk scenarios without exposing patients or crews to operational risk. This is particularly relevant for medical emergencies, NVIS operations, hoist missions, crew coordination, communication, and decision-making under pressure.
Telemedicine and tele-emergency physician models may help deploy medical expertise more efficiently, enabling specialist support to be provided when and where it is needed.
AI and decision-support tools may support dispatch analysis, weather and risk assessment, documentation, training planning, predictive maintenance, and crew scheduling. However, these tools require clear governance, reliable data, human oversight, and good usability. Poorly implemented technology could increase workload rather than reduce it.
Overall, technology should be viewed as a support mechanism. It can improve efficiency and training quality, but it does not replace the need for experienced clinicians, pilots, maintenance personnel, and operational decision-makers.
VV: Why is workforce development such a critical topic for AirMed World Congress 2026, and what lessons do you hope attendees take home?
M.R.: The workforce discussion is important now because HEMS depends on several labor markets that are already under pressure, including healthcare, aviation, engineering, emergency services, dispatch, and technical training. Shortages in any one of these areas can affect operational availability and service quality.
AirMed World Congress 2026 is important because it brings these groups together to share ideas and practical solutions to common workforce challenges.
Key takeaways could include treating workforce planning as part of operational risk management; creating clearer pathways for medical, aviation, and technical personnel; expanding mentoring, simulation, and recurrent training; improving rostering, fatigue management, and retention measures; strengthening cooperation with hospitals, EMS providers, flight schools, and technical education institutions; and using technology where it demonstrably reduces workload or improves care.
Ultimately, HEMS workforce issues should be understood as a structural challenge. Equipment and technology are important, but service availability depends on whether organizations can recruit, train, retain, and support enough qualified personnel over time.