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Category: EMS Operations

Topic: Air Medical

Level: EMR

19 minute read

Safe Air Medical Operations

Criteria for Utilizing Air Medical Response Indications for Patient Transport

Every agency has specialized criteria for the specific types of patients that should be transported by air medical.

Some of these criteria may include, but are not limited to:

  • Extended transport time by ground concerning the patient's condition.
  • The presence of a suitable landing area
  • Specialized care needed by the patient that you are unable to provide (med administration, advanced airways, chest tubes, etc).
  • Mass Casualty Incidents
  • Medical calls - Stroke, Myocardial infarctions
  • Trauma calls - MVC with serious injuries; Spinal cord injuries; Motorcycle accidents; head trauma; scuba diving accidents; near-drownings; skiing, boating, hiking, or environmental accidents; limb amputations; or burn victims.
  • Patients in need of specialized equipment or hospitals (hyperbaric chamber, burn center, venomous bite).
  • Air Medical may also be useful during search and rescue attempts.
  • Activation Local and State guidelines, state statutes, and administrative rules may exist when activating air medical. Make sure to know your agency's standards.
  • When you are making the decision to request air medical there are several factors you should take into consideration.


Types of Aircraft

There are 2 types of medical aircraft. Rotary-wing and Fixed-wing.

  1. ROTOR-WING: A rotor-wing aircraft has a set of blades that rotate above the aircraft, more commonly known as a helicopter. Helicopter emergency medical services or HEMS for short is ideal for short-distance transportation, especially if the patient is in a remote location where a runway is not available. Transportation by helicopter has become a standard of care for critically injured or ill patients from the scene to an appropriate medical center.
  2. FIXED-WING: A fixed-wing aircraft has stationary wings and a propeller or jet engines. Airplanes are mainly used for the transportation of patients over long distances, most commonly between specialized care centers or between countries. 


Air ambulances have advantages over ground ambulances in that

  • Provide specialized care, supplies, and equipment.
  • Typically reduce transport time to definitive treatment 
  • Can access remote areas
  • Can Access many hospitals as most maintain helipads at or near their emergency departments to receive rotor-wing aircraft.



Air ambulances also have several disadvantages. While certain weather and environmental conditions do not affect many fixed-wing operations at controlled airports, rotor-winged aircraft are different.

  • Rotor-winged aircraft responding to remote locations and uncontrolled airspace is restricted by weather and other environmental factors.
  • Altitude restrictions in certain airspace and/or difficult terrain may prevent an aircraft from responding to locations.
  • In addition, the cost to the patient for an air ambulance should also be considered a disadvantage.
  • Aircraft cabin size can be a limitation to their use for large patients and cabin size will limit the number of responders that can perform procedures for critically ill or injured patients.

Patient Transfer

You should be acquainted with the methods, abilities, and protocols for accessing helicopters in your area. Patients should be packaged before the flight crew arrives, if possible, and a comprehensive report about the patient and the scene should be given to the flight crew during patient transfer.


Establishing and ensuring a landing zone is the responsibility of the EMS ground crew.

You must be ready to take action to make sure that the flight crew can land and take off safely. This involves more than just making sure that you have a clear space.

The following should be considered when setting up landing zones:

  • The ideal landing zone is 100’ x 100', day or night. The minimum landing area varies based on the aircraft and your local jurisdiction but a minimum of 60' x 60' is commonly accepted in a situation with ideal visibility and weather conditions. 
  • The landing location should be free of obstacles, hazards, and debris.
  • The site should be firm, and avoid slopes greater than five degrees, if possible.

Soft sand or dirt landing sites should be avoided but can be wet down as a last resort.

  • It can be difficult for pilots to see small obstructions from the air. A survey of the site should include, overhead power, telephone, or other obstructions; antennas, buildings, or tall trees, with an attempt to remove or limit any of these obstructions from the landing location. If any of the objects are present at the landing location, it will be important to notify the flight crew of their presence. They may want you to find a different location.
  • Mark the landing zone. 

To do this, use weighted cones or position emergency vehicles at the corner of the landing zone with headlights facing inward to form an X.

  • If strong winds exist, it will be helpful to inform the flight crew of the wind direction and speed.
  • Ensure that all nonessential personnel, bystanders, and vehicles are at least 200 ft from the landing zone.
  • Personnel operating near the landing zone should be prepared for high wind and noise.
  • Responders should have all PPE in place during take-off and landings, including helmets with chin straps, ear protection, and face shields or other eye protection.


  • Many air ambulance organizations prefer that responders never approach an aircraft.

It is important to develop relationships with organizations in your area and understand their wishes for operating around aircraft.

  • If a responder must approach an aircraft, NEVER approach from the rear or any location aft of the pilot's field of vision.

Only approach an aircraft after making eye contact with the pilot and receiving an acknowledgment to approach.

  • Become familiar with hand signals used by your air ambulance service.
  • Once the helicopter has landed, make sure you position yourself in front of the aircraft (12 o’clock) at 10-15 yards from the rotor disk.
  • Make sure that all equipment and the patient is properly secured.
  • Be aware that some helicopters may load patients from the side, where others may load patients in the back.

Always follow the same path when you are moving away from the helicopter. (Regardless of where you load the patient always approach the helicopter from the front)

  • The flight crew will exit the helicopter and make contact with you and obtain any details not relayed during the response.


In some locations, it may be impossible to contact an approaching helicopter by radio. If this is the case, it will be important to provide as much detail about the landing location, patient, and other pertinent information when the initial request is made to the air ambulance service. If additional, important information must be sent to the helicopter, an intermediary, such as the helicopters dispatch, will have to relay that information.

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