An analytical framework for prioritizing barriers and public–private partnership solutions in civil helicopter emergency medical services

Abstract

Civil Helicopter Emergency Medical Services (CHEMS) are vital for improving emergency healthcare access, particularly in remote or congested areas. While widely implemented in high-income countries, CHEMS remain underutilized in low- and middle-income countries (LMICs) due to financial, regulatory, and logistical barriers. In response, public–private partnership (PPP) models have gained attention as a viable mechanism to overcome these barriers. However, the absence of context-specific decision-support frameworks hampers effective implementation. This study introduces a comprehensive multi-criteria decision-making (MCDM) framework to facilitate the deployment of CHEMS through PPPs in LMICs, with Thailand serving as a case study. The proposed framework integrates several methodologies: the Delphi method to identify critical factors; Level-Based Weight Assessment (LBWA) for eliciting subjective expert weights; Integrated Determination of Objective Criteria Weights (IDOCRIW) for objective weighting; and the Compromise Ranking of Alternatives based on Distance to Ideal Solution (CRADIS) for prioritizing strategic options. To accommodate uncertainty and vagueness in expert judgment, the framework employs the interval-valued q-rung orthopair fuzzy set (IVq-ROFS) approach. The analysis identifies eight major barriers and seven potential PPP collaboration models. The most critical obstacles include flight safety concerns, lack of regulatory support, and inadequate coordination with ground-based emergency services. The top-ranked PPP strategies emphasize regulatory streamlining, integrated emergency response systems, and co-financing mechanisms. These findings provide actionable insights for policymakers and EMS stakeholders, enabling more informed and context-sensitive decision-making. Furthermore, the proposed framework is adaptable to other EMS contexts in LMICs, contributing to the broader discourse on emergency healthcare delivery and public–private collaboration.