Air medical services
Air medical services is a comprehensive term covering the use of air
transportation, airplane or helicopter, to move patients to and from
healthcare facilities and accident scenes. Personnel provide
comprehensive prehospital and emergency and critical care to all types
of patients during aeromedical evacuation or rescue operations aboard
helicopter and propeller aircraft or jet aircraft.
The use of air transport of patients dates to World War I, but its
role was expanded dramatically during the Korean and Vietnam
Helicopters are used to transport patients between
hospitals and from trauma scenes; fixed-wing aircraft are used for
2 Indications for air transport
3 Air ambulance
3.2.2 Multiple purpose
3.2.4 Donated by business
3.2.5 Public donations
3.3.1 Aircraft and flight crews
3.3.2 Medical control
3.3.3 Equipment and interiors
4 Medical personnel
4.1 Retrieval Doctor/Physician
4.2 Flight Paramedic
4.3 Flight Nurse
Civilian Flight Nurses
Military Flight Nurses
4.4 Transport Respiratory Practitioner
5 Associations and organizations
6 Air medical organizations
7 See also
The advantages of medical transport by helicopter may include
providing a higher level of care at the scene of trauma and improving
access to trauma centers. Helicopter-based emergency medical
service (EMS) also provides critical care capabilities during
interfacility transport from community hospitals to trauma centers.
Indications for air transport
Effective use of helicopter services for trauma depends on the ground
responder's ability to determine whether the patient's condition
warrants air medical transport. Protocols and training must be
developed to ensure appropriate triage criteria are applied.
Excessively stringent criteria can prevent rapid care and transport of
trauma victims; relaxed criteria can result in the embarrassing and
costly situation of transporting a patient by helicopter only to have
the patient discharged in good condition from the emergency
Crew and patient safety is the single most important factor to be
considered when deciding whether to transport a patient by helicopter.
Weather, air traffic patterns, and distances (e.g., from trauma scene
to closest level one trauma center) must also be considered. Another
reason for cancelling a flight is based on Flight
Crew comfort with
the flight. The general rule of safety is upon the crew, when there is
one pilot and two medical crew is: 3 to go, 1 to say "NO". If one
Flight Member is not comfortable with the flight for whatever reason,
the flight is cancelled.
Some have questioned the safety of air medical services While
the number of crashes may be increasing, the number of programs and
use of services has also increased. Factors associated with fatal
crashes of medical transport helicopters include flying at night and
during bad weather, and postcrash fires.
Eurocopter EC 145
Eurocopter EC 145 of Switzerland's Rega air rescue service
An air ambulance is a specially outfitted helicopter, or fixed wing
aircraft, that transports injured or sick people in a medical
emergency or over distances or terrain impractical for a conventional
ground ambulance. Fixed wing aircraft are also more often used to move
patients over long distances and for repatriation from foreign
countries. These and related operations are called aeromedical. In
some circumstances, the same aircraft may be used to search for
missing or wanted people.
Like ground ambulances, air ambulances are equipped with medical
equipment vital to monitoring and treating injured or ill patients.
Common equipment for air ambulances includes medications, ventilators,
ECGs and monitoring units,
CPR equipment, and stretchers. A medically
staffed and equipped air ambulance provides medical care in
flight—while a non-medically equipped and staffed aircraft simply
transports patients without care in flight.
Military organizations and
NATO refer to the former as medical evacuation (MEDEVAC) and to the
latter as casualty evacuation (CASEVAC).
Air Traffic Control (ATC) grants special treatment to air ambulance
operations, much like a ground ambulance using lights and a siren,
only when they are actively operating with a patient. When this
happens, air ambulance aircraft take the call sign MEDEVAC (formerly
LIFEGUARD) and receive priority handling in the air and on the ground.
As with many
Emergency Medical Service
Emergency Medical Service (EMS) innovations, treating
patients in flight originated in the military. The concept of using
aircraft as ambulances is almost as old as powered flight itself.
Although balloons were not used to evacuate wounded soldiers at the
Siege of Paris in 1870, air evacuation was experimented with during
the First World War. The first true Air
Ambulance flight was made when
a Serbian officer was flown from the battlefield to hospital by a
plane of the French Air Service. French records at the time indicated
that the mortality rate of the injured was reduced from 60% to just
under 10% if they were evacuated by air.
The first recorded British ambulance flight took place in 1917 in
Turkey when a soldier in the Camel Corps who had been shot in the
ankle was flown to hospital in a de Havilland DH9 in 45 minutes. The
same journey by land would have taken some 3 days to complete. In the
1920s several services, both official and unofficial, started up in
various parts of the world. Aircraft were still primitive at the time,
with limited capabilities, and the effort received mixed reviews.
Ambulance Junkers Ju 52, Balkans, 1941
Exploration of the idea continued, however, and France and the United
Kingdom used fully organized air ambulance services during the African
and Middle Eastern Colonial Wars of the 1920s. In 1920, the British,
while suppressing the "Mad Mullah" in Somalialand, used an Airco DH.9A
fitted out as an air ambulance. It carried a single stretcher under a
fairing behind the pilot. The French evacuated over 7,000
casualties during that period. By 1936, an organized military air
ambulance service evacuated wounded from the
Spanish Civil War
Spanish Civil War for
medical treatment in Nazi Germany; this service continued during the
Second World War.
American casualty evacuated by helicopter, Korean War, 1951
The first use of medevac with helicopters was the evacuation of three
British pilot combat casualties by a US Army Sikorsky in Burma during
WW2, and the first dedicated use of helicopters by U.S. forces
occurred during the Korean War, between 1950 and 1953. The French used
light helicopters in the First Indochina War. While popularly depicted
as simply removing casualties from the battlefield (which they did),
helicopters in the
Korean War also moved critical patients to hospital
ships after initial emergency treatment in field hospitals.
Knowledge and expertise of use of air ambulances evolved parallel to
the aircraft themselves. By 1969, in Vietnam, the use of specially
trained medical corpsmen and helicopter air ambulances led U.S.
researchers to determine that servicemen wounded in battle had better
rates of survival than motorists injured on California freeways. This
inspired the first experiments with the use of civilian paramedics in
the world. The
US military recently employed UH-60 Black Hawk
helicopters to provide air ambulance service during the
Iraq War to
military personnel and civilians. The use of military aircraft as
battlefield ambulances continues to grow and develop today in a
variety of countries, as does the use of fixed-wing aircraft for
long-distance travel, including repatriation of the wounded.
Currently, a NATO working group is investigating unpiloted aerial
vehicles (UAVs) for casualty evacuation.
Early air ambulance efforts
Airco DH.9A D.3117 in Somaliland 1920
Royal Australian Air Force
Royal Australian Air Force de Havilland Express air ambulance in 1942
SAI KZ III
SAI KZ III version of a Danish air ambulance
Light helicopters like this
Bell 47 Sioux removed the wounded from the
battlefield during the Korean War
The first civilian uses of aircraft as ambulances were probably
incidental. In northern Canada, Australia, and in Scandinavian
countries, remote, sparsely populated settlements are often
inaccessible by road for months at a time, or even year round. In some
places in Scandinavia, particularly in Norway, the primary means of
transportation between communities is by boat. Early in aviation
history, many of these communities began to rely on civilian "bush"
pilots, who fly small aircraft and transport supplies, mail, and
visiting doctors or nurses. Bush pilots probably performed the first
civilian air ambulance trips, albeit on an ad hoc basis—but clearly,
a need for these services existed. In the early 1920s, Sweden
established a standing air ambulance system, as did Siam (Thailand).
In 1928 the first formal, full-time air ambulance service was
established in the Australian outback. This organization became the
Royal Flying Doctor Service and still operates. In 1934, Marie
Marvingt established the first civil air ambulance service in Africa,
in Morocco. In 1936, air ambulance services were established as
part of the
Highlands and Islands Medical Service to serve more remote
areas of Highland Scotland.
Australia's Royal Flying Doctor Service
Pilatus PC 12/45
Air ambulances quickly established their usefulness in remote
locations, but their role in developed areas developed more slowly.
After World War II, the Saskatchewan government in Regina,
Saskatchewan, Canada, established the first civilian air ambulance in
North America. The Saskatchewan government had to consider remote
communities and great distances in providing health care to its
citizens. The Saskatchewan Air
Ambulance service continues to be
active as of 2017.
J. Walter Schaefer founded the first air ambulance service in the U.S,
in 1947, in Los Angeles. The Schaefer Air Service, operated as part of
Ambulance Service. Schaefer Air Service was also the
first FAA-certified air ambulance service in the United States. When
the Saskatchewan and Schaefer services began, paramedicine was still
decades away, and unless a physician or nurse accompanied the patient,
air ambulances primarily provided medical transportation. A great deal
of the early use of aircraft as ambulances in civilian life,
particularly helicopters, involved the improvised use of aircraft that
belonged to the military. Eventually, this became more organized. This
occurred not only in the United States, but also in other countries,
and persists today. Today in the U.S., helicopters and airplanes carry
out approximately a half million transports per year.
Military aircraft supporting civilian air ambulance
Irish Air Corps
Irish Air Corps use an AW139 helicopter operate Ireland's only
Emergency Aeromedical Service
Swedish search and rescue
Israeli military helicopter as air ambulance
Polish navy helicopter W-3 as air ambulance, search and rescue
Ambulance and rescue of Automotive Union of Yugoslavia helicopter
Two research programs were implemented in the U.S. to assess the
impact of medical helicopters on mortality and morbidity in the
civilian arena. Project CARESOM was established in Mississippi in
1969. Three helicopters were purchased through a federal grant and
located strategically in the north, central, and southern areas of the
state. Upon termination of the grant, the program was considered a
success and each of the three communities was given the opportunity to
continue the helicopter operation. Only the one located in
Hattiesburg, Mississippi did so, and it was therefore established as
the first civilian air medical program in the United States. The
second program, the
Military Assistance to
Safety and Traffic (MAST)
system, was established in Fort Sam Houston in San Antonio in 1969.
This was an experiment by the Department of Transportation to study
the feasibility of using military helicopters to augment existing
civilian emergency medical services. These programs were highly
successful at establishing the need for such services. The remaining
challenge was in how such services could be operated most
cost-effectively. In many cases, as agencies, branches, and
departments of the civilian governments began to operate aircraft for
other purposes, these aircraft were frequently pressed into service to
provide cost-effective air support to the evolving Emergency Medical
Government Agency Aircraft Performing Double Duty
Government Flying Service
German 'Christoph' Air
Ambulance of the Federal Ministry of the
Italian Dauphin used in mountain rescue missions
As the concept was proven, dedicated civilian air ambulances began to
appear. On November 1, 1970, the first permanent civil air ambulance
helicopter, Christoph 1, entered service at the Hospital of
Harlaching, Munich, Germany. The apparent success of Christoph 1
led to a quick expansion of the concept across Germany, with Christoph
10 entering service in 1975, Christoph 20 in 1981, and Christoph 51 in
1989. As of 2007, there are about 80 helicopters named after Saint
Christopher, like Christoph Europa 5 (also serving Denmark), Christoph
Brandenburg or Christoph Murnau am Staffelsee. Austria adopted the
German system in 1983 when Christophorus 1 entered service at
The first civilian, hospital-based medical helicopter program in the
United States began operation in 1972.
Flight For Life Colorado
began with a single
Alouette III helicopter, based at St. Anthony
Central Hospital in Denver, Colorado. In Ontario, Canada, the air
ambulance program began in 1977, and featured a paramedic-based system
of care, with the presence of physicians or nurses being relatively
unusual. The system, operated by the Ontario Ministry of Health, began
with a single rotor-wing aircraft based in Toronto. An important
difference in the Ontario program involved the emphasis of service.
"On scene" calls were taken, although less commonly, and a great deal
of the initial emphasis of the program was on the interfacility
transfer of critical care patients. Operating today through a private
contractor (ORNGE), the system operates 33 aircraft stationed at 26
bases across the province, performing both interfacility transfers and
on-scene responses in support of ground-based EMS. Today, across the
world, the presence of civilian air ambulances has become commonplace,
and is seen as a much-needed support for ground-based EMS systems.
In other countries of Europe, like SFR Yugoslavia, first air ambulance
appeared in the 1980s. The most of the fleet was previously used in
military service. With the increased number of car accidents in 1979
on highways, the Yugoslavian government made a decision to buy new or
redistribution of use of old helicopters.
Ambulance operates 2 MD902s - ideally suited to the city
environment with its
NOTAR design and small dimensions. It was the
first UK service to carry a specially trained Doctor on all missions.
Modern civilian air ambulances
Ambulance - England
STARS - Alberta, Canada
SAMU - France
Mobiel Medisch Team - Netherlands
Swedish King Air
Air ambulance service, sometimes called
Aeromedical Evacuation or
simply Medevac, is provided by a variety of different sources in
different places in the world. There are a number of reasonable
methods of differentiating types of air ambulance services. These
include military/civilian models and services that are
government-funded, fee-for-service, donated by a business enterprise,
or funded by public donations. It may also be reasonable to
differentiate between dedicated aircraft and those with multiple
purposes and roles. Finally, it is reasonable to differentiate by the
type of aircraft used, including rotary-wing, fixed-wing, or very
large aircraft. The military role in civilian air ambulance operations
is described in the History section. Each of the remaining models is
explored separately. It should also be noted that this information
applies to air ambulance systems performing emergency service. In
almost all jurisdictions, private aircraft charter companies provide
non-emergency air ambulance service on a fee-for-service basis.
Ambulance Service - The UK's only
Government funded air
In some cases, governments provide air ambulance services, either
directly or via a negotiated contract with a commercial service
provider, such as an aircraft charter company. Such services may focus
on critical care patient transport, support ground-based EMS on
scenes, or may perform a combination of these roles. In almost all
cases, the government provides guidelines to hospitals and EMS systems
to control operating costs—and may specify operating procedures in
some level of detail to limit potential liability. However, the
government almost always takes a 'hands-off' approach to actual
running of the system, relying instead on local managers with subject
matter (physicians and aviation executives) expertise. Ontario's ORNGE
program and the Polish Lotnicze Pogotowie Ratunkowe (LPR) are examples
of this type of operating system. The Polish LPR is a national
system covering the entire country and funded by the government
through the Ministry of Health but run independently, there is no
independent HEMS operator in Poland. In North East Ohio, including
Cleveland, the Cuyahoga County-owned MetroHealth Medical Center uses
its Metro Life Flight to transport patients to Metro's level I trauma
and burn unit. There are 5 helicopters for North East Ohio and, in
addition, Metro Life Flight has one fixed-wing aircraft.
In the United Kingdom, the Scottish
Ambulance Service operates two
helicopters and two fixed-wing aircraft twenty-four hours per day.
These represent the UK's only government-funded air ambulance service.
Snowy Hydro SouthCare Bell 412 helicopter in Australia
In some jurisdictions, cost is a major consideration, and the presence
of dedicated air ambulances is simply not practical. In these cases,
the aircraft may be operated by another government or quasi-government
agency and made available to EMS for air ambulance service when
required. In southern New South Wales, Australia, the helicopter that
responds as an air ambulance is actually operated by the local
hydroelectric utility, with the New South Wales
providing paramedics, as required. In some cases, local EMS provides
the flight paramedic to the aircraft operator as-needed. In the case
of the Los Angeles County Fire Department the helicopters are brush
fire choppers also configured as air ambulances with a paramedic
provided from whichever fire department rescue unit has responded.
Sometimes the air ambulance may be run as a dual concern with another
governmental body - for example the Wiltshire Air
Ambulance is run as
Ambulance Service and police unit.
In other cases, the paramedic staffs the aircraft full-time, but has a
dual function. In the case of the Maryland State Police, for example,
the flight paramedic is a serving State Trooper whose job is to act as
the Observer Officer on a police helicopter when not required for
Switzerland REGA Fee-for-service
In many cases, local jurisdictions do not charge for air ambulance
service, particularly for emergency calls. However, the cost of
providing air ambulance services is considerable and many, including
government-run operations, charge for service. Organizations such as
service aircraft charter companies, hospitals, and some
private-for-profit EMS systems generally charge for service. Within
the European Union, almost all air ambulance service is on a
fee-for-service basis, except for systems that operate by private
subscription. Many jurisdictions have a mix of operation types.
Fee-for-service operators are generally responsible for their own
organization, but may have to meet government licensing requirements.
Switzerland is an example of such a service.
Donated by business
German Auto Club
In some cases, a local business or even a multi-national company may
choose to fund local air ambulance service as a goodwill or public
relations gesture. Examples of this are common in the European Union,
London the Virgin Corporation previously donated to the
Helicopter Emergency Medical Service, and in
Germany and the
Netherlands a large number of the 'Christoph' air ambulance operations
are actually funded by ADAC, Germany's largest automobile club and
DRF Luftrettung. In
Australia and New Zealand, many air ambulance
helicopter operations are sponsored by the Westpac Bank. In these
cases, the operation may vary, but is the result of a carefully
negotiated agreement between government, EMS, hospitals, and the
donor. In most cases, while the sponsor receives advertising exposure
in exchange for funding, they take a 'hands off' approach to daily
operations, relying instead on subject matter specialists.
Public donations supported
In some cases, air ambulance services may be provided by means of
voluntary charitable fundraising, as opposed to government funding, or
they may receive limited government subsidy to supplement local
donations. Some countries, such as the U.K., use a mix of such
systems. In Scotland, the parliament has voted to fund air ambulance
service directly, through the Scottish
Ambulance Service. In England
and Wales, however, the service is funded on a charitable basis via a
number of local charities for each region covered, although the
London receives some of its funding through the National
Great strides have been made in the UK, with the 'Association of Air
Ambulance (AAA)'. This organization is widely credited for having
created the political climate that made the helicopter industry and
National Health Service recognise the enormous contribution charities
make to trauma care in the United Kingdom. In 2013, the AAA published
the "Framework for a High Performing Air
Ambulance Service" which
details many of the developments from 2008 to 2013.
In recent years, the service has moved towards the physician-paramedic
model of care. This has necessitated some charities commissioning
clinical governance services, however many air ambulances operate
under the tasking ambulances services clinical governance. The AAA now
publishes Best Practice Guidance on a range of operational and
clinical functions and provides a code of conduct that all full
members, both ambulance services and charities must uphold.
A final area of distinction is the operation of large, generally
fixed-wing air ambulances. In the past, the infrequency of civilian
demand for such a service confined such operations to the military,
which requires them to support overseas combat operations. Military
organizations capable of this type of specialized operation include
the United States Air Force, the German Luftwaffe, and the British
Royal Air Force. The Swedish National Air
Medevac - SNAM is an
exception to the military only rule where the system is owned by the
Swedish Civil Contingencies Agency Myndigheten för samhällsskydd och
beredskap and the
Boeing 737 Next Generation#737-800
Boeing 737 Next Generation#737-800 aircraft is
provided under contract when so required by Scandinavian Airlines.
Each operates aircraft staffed by physicians, nurses, and
corpsmen/technicians, and each can providing long distance transport
with full medical support to dozens of patients simultaneously.
However, in recent years, exceptions to the "military-only" rule have
grown with the need to quickly transport patients to facilities that
provide higher levels of care, or to repatriate individuals. Air
medical companies use both large and small fixed wing aircraft
configured to provide levels of care that can be found in Trauma
centers for individuals who subscribe to their own health insurance or
affiliated travel insurance and protection plans.
Heavy Lift Capability
United States Air Force
United States Air Force
C-9 Nightingale air ambulance
German Air Force
German Air Force Airbus A310
German Auto Club Fairchild Dornier 328JET
Royal Flying Doctor Service
Royal Flying Doctor Service of
Australia Hawker 800
Mercy Jets Worldwide Air
Ambulance Gulfstream IV
Aircraft and flight crews
In most jurisdictions, air ambulance pilots must have a great deal of
experience in piloting their aircraft because the conditions of air
ambulance flights are often more challenging than regular
non-emergency flight services. After a spike in air ambulance crashes
in the United States in the 1990s, the U.S. government and the
Commission on Air Medical Transportation Systems (CAMTS) stepped up
the accreditation and air ambulance flight requirements, ensuring that
all pilots, personnel, and aircraft meet much higher standards than
previously required. The resulting
CAMTS accreditation, which
applies only in the United States, includes the requirement for an air
ambulance company to own and operate its own aircraft. Some air
ambulance companies, realizing it is virtually impossible to have the
correct medicalized aircraft for every mission, instead charter
aircraft based on the mission-specific requirements.
While in principle
CAMTS accreditation is voluntary, a number of
government jurisdictions require companies providing medical
transportation services to have
CAMTS accreditation to be licensed to
operate. This is an increasing trend as state health services agencies
address the issues surrounding the safety of emergency medical
services flights. Some examples are the states of Colorado,
New Jersey, New Mexico, Utah, and Washington.
According to the rationale used to justify the state of Washington's
adoption of the accreditation requirements, requiring accreditation of
air ambulance services provides assurance that the service meets
national public safety standards. The accreditation is done by
professionals who are qualified to determine air ambulance safety. In
addition, compliance with accreditation standards is checked on a
continual basis by the accrediting organization. Accreditation
standards are periodically revised to reflect the dynamic, changing
environment of medical transport, with considerable input from all
disciplines of the medical profession.
Other U.S. states require either
CAMTS accreditation or a demonstrated
equivalent, such as Rhode Island, and Texas, which has adopted
CAMTS' Accreditation Standards (Sixth Edition, October 2004) as its
own. In Texas, an operator not wishing to become
CAMTS accredited must
submit to an equivalent survey by state auditors who are
CAMTS-trained. Virginia and Oklahoma have also adopted CAMTS
accreditation standards as their state licensing standards. While
the original intent of
CAMTS was to provide an American standard, air
ambulance services in a number of other countries, including three in
Canada and one in South Africa, have voluntarily submitted themselves
In the UK, the AAA has a Code of Conduct that binds one of the most
regulated areas of operation together. It brings the Fundraising
Standards Board, CAA / EASA and the CQC together ensuring fundraising,
air and clinical operations are inline with national regulation and
best practice. The code goes further with an expectation of mutual
support and working within its policy and best practice guides.
Japanese Physician Delivery Helicopter
The nature of the air operation frequently determines the type of
medical control required. In most cases, an air ambulance staffer is
considerably more skilled than a typical paramedic, so medical control
permits them to exercise more medical decision-making latitude.
Assessment skills tend to be considerably higher, and, particularly on
inter-facility transfers, permit inclusion of functions such as
reading x-rays and interpretation of lab results. This allows for
planning, consultation with supervising physicians, and issuing
contingency orders in case they are required during flight. Some
systems operate almost entirely off-line, using protocols for almost
all procedures and only resorting to on-line medical control when
protocols have been exhausted. Some air ambulance operations have
full-time, on site medical directors with pertinent backgrounds (e.g.,
emergency medicine); others have medical directors who are only
available by pager. For those systems operating on the
Franco-German model, the physician is almost always physically
present, and medical control is not an issue.
Equipment and interiors
Most aircraft used as air ambulances, with the exception of charter
aircraft and some military aircraft, are equipped for advanced life
support and have interiors that reflect this. The challenges in most
air ambulance operations, particularly those involving helicopters,
are the high ambient noise levels and limited amounts of working
space, both of which create significant issues for the provision of
ongoing care. While equipment tends to be high-level and very
conveniently grouped, it may not be possible perform some assessment
procedures, such as chest auscultation, while in flight. In some types
of aircraft, the aircraft's design means that the entire patient is
not physically accessible in flight. Additional issues occur with
respect to pressurization of the aircraft. Not all aircraft used as
air ambulances in all jurisdictions have pressurized cabins, and those
that do typically tend to be pressurized to only 10,000 feet above sea
level. These pressure changes require advanced knowledge by flight
staff with respect to the specifics of aviation medicine, including
changes in physiology and the behaviour of gases.
There are a large variety of helicopter makes that are used for the
civilian HEMS models. The commonly used types are the Bell 206, 407,
and 429, Eurocopter AS350, BK117, EC130, EC135, EC145, and the Agusta
Westland 109 & 149 and Sikorsky S-76. Fixed wing aircraft
varieties commonly include the
King Air 90, King Air 200, Pilatus PC-12, and Piper Cheyenne. Due to
the configuration of the medical crew and patient compartments, these
aircraft are normally configured to only transport one patient but
some can be configured to transport two patients if so needed.
Additionally, helicopters have stricter weather minimums that they can
operate in and commonly do not fly at altitudes over 10,000 feet above
Equipment and interiors
Typical helicopter interior
Typical helicopter interior
Beginning in the 1990s, the number of air ambulance crashes in the
United States, mostly involving helicopters, began to climb. By 2005,
this number had reached a record high. Crash rates from 2000 to 2005
more than doubled the previous five year's rates. To some extent,
these numbers had been deemed acceptable, as it was understood that
the very nature of air ambulance operations meant that, because a life
was at stake, air ambulances would often operate on the very edge of
their safety envelopes, going on missions in conditions where no other
civilian pilot would fly. As a result, nearly fifty percent of all EMS
personnel deaths in the United States occur in air ambulance crashes.
In 2006, the United States National Transportation
Safety Board (NTSB)
concluded that many air ambulances crashes were avoidable,
eventually leading to the improvement of government standards and
Whilst some air ambulances do have effective methods of funding, in
the UK, they remain almost entirely charity funded, as improved
cost-benefit ratios are generally achieved with land based attendance
and transfers. Health outcomes, for example from London's Helicopter
Emergency Medical Service, remain largely the same for both air and
ground based services.
Medical personnel historically has been a Physician/Nurse combination,
Paramedic/Nurse, or a Nurse/Nurse combination. The need for a
Physician/Nurse combination has diminished with more protocol and
evidence-based applications for care by nurses and other clinicians
and so the inclusion of respiratory therapists in all modes of air
transport is becoming more prominent.
Retrieval Doctor/Physician — Criteria for working as a medical
doctor (known as "physician" in the USA) in aeromedical services
depends on the jurisdiction. In Australia, where aeromedical retrieval
medicine is a well-established medical field, retrieval doctors must
be experienced in a critical care specialty (i.e. anaesthesia,
emergency medicine, intensive care medicine) as fully qualified
specialists; specialty registrars in advanced stages of
training; or general practitioners (i.e. family physicians)
with broad experience in critical care and obstetrics.
Paramedic — A licensed paramedic with additional training as
a certified flight paramedic (FP-C). The flight paramedic is usually
highly trained with at least 5 years of autonomous clinical experience
in high acuity environments of both pre-hospital emergency medicine
and critical care transport. Flight paramedics may be certified as a
FP-C or a CCEMT-P. Some hold certificates as instructors in various
fields and educational topics.
Main article: Flight nurse
Flight Nurse — a nurse specialized in patient transport in the
aviation environment. The flight nurse is a member of an aeromedical
evacuation crew on helicopters and airplanes, providing in-flight
management and care for all types of patients. Other responsibilities
may also include planning and preparing for aeromedical evacuation
missions and preparing a patient care plan to facilitate patient care,
comfort and safety. Flight nurses may obtain certification in
Emergency Nursing (CEN), Flight Nursing (CFRN) or Critical Care
Civilian Flight Nurses
Civilian flight nurses may work for hospitals, federal, state, and
local governments, private medical evacuation firms, fire departments
or other agencies. They have training and medical direction that
allows them to operate with a broader scope of practice and more
autonomy than many other nurses. Some states require that flight
nurses must also have paramedic or EMT certification to respond to
Military Flight Nurses
The military flight nurse performs as a member of the aeromedical
evacuation crew, and functions as the senior medical member of the
aeromedical evacuation team on Continental United States (CONUS),
intra-theater and inter-theater flights - providing for in-flight
management and nursing care for all types of patients. Other
responsibilities include planning and preparing for aeromedical
evacuation missions and preparing a patient positioning plan to
facilitate patient care, comfort and safety.
Flight nurses evaluate individual patient's in-flight needs and
request appropriate medications, supplies and equipment, providing
continuing nursing care from originating to destination facility. They
act as liaison between medical and operational aircrews and support
personnel in order to promote patient comfort and to expedite the
mission, and also initiate emergency treatment for in-flight medical
Transport Respiratory Practitioner
Main article: Respiratory practitioner
Transport Therapist — A highly trained respiratory practitioner
(also called a respiratory therapist), typically utilized in
long-distance transport situations, though able to provide care during
shorter transfer. Transport Therapists may obtain Adult Critical Care
Specialist (ACCS), Neonatal Transport Specialist (NPT) and Neonatal
Pediatric Specialist (NPS) certifications from the National Board for
Associations and organizations
Aerospace Medical Association
Aerospace Medical Association — an umbrella group providing a forum
for many different disciplines to come together and share their
expertise for the benefit of all persons involved in air and space
Air medical organizations
BCAS - British Columbia
Helicopter Association International
IAFCCP - International Association of Flight & Critical Care
Paramedics (formerly NFPA)
RFDS - Royal Flying Doctor Service
Air ambulance services in Greece
Air ambulances in the United Kingdom
Air ambulances in the United States
Commission on Accreditation of Medical Transport Systems
Emergency Medical Retrieval Service
Emergency medical services
Golden hour (medicine)
Royal Flying Doctor Service
Royal Flying Doctor Service of Australia
Safety of emergency medical services flights
Westpac Life Saver Rescue
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