Frequently Asked Questions about AAMS and Air Ambulance / Medevac

When was AAMS founded?

AAMS (Association of Air Medical Services) was founded in 1980, under the original name ASHBEAMS (American Society of Hospital Based EMS Air Medical Services).

Why was AAMS founded?

AAMS was founded to serve providers of air and surface medical transport systems by encouraging and supporting its members in maintaining a standard of performance reflecting safe operations and efficient, high-quality patient care.  AAMS is built on the idea that representation from a variety of medical transport services and businesses can be brought together to share information, collectively resolve problems and provide leadership in the air medical industry.

How many emergency medical transport locations are in the AAMS membership?

AAMS represents more than 600 air and ground medical base locations.

What are the membership demographics?

Within the AAMS membership, there are 530 rotor wing, 182 fixed wing, and 202 critical care ground vehicles. 

Is AAMS membership limited to US programs, companies and individuals? 

No, AAMS also has 47 international members representing nations such as Australia, Canada, the Dominican Republic, South Africa, and Turkey.

How many people are employed in the organization?

AAMS currently employs (8) full-time staff members:

Dawn Mancuso, CAE - Executive Director
Blair Marie Beggan - Communications & Marketing Manager
Amber Bullington - FARE Project Manager
Christopher Eastlee - Government Relations Manager
Melissa Kraft- Membership Manager
Natasha Ross - Education & Meetings Manager
Yogendra Sheth - Finance & Accounting Manager
Nila Vehar - FARE Development Manager
Open - Office Manager

Are only helicopters used to do air medical transport?

No. Airplanes (also known as fixed-wing aircraft) are also employed to transport patients.

a. What types of aircraft are typically used in air medical transport?
There is no standard aircraft utilized in air medical operations. Airplanes vary in size from single-engine turboprops such as the Pilatius PC-12 to twin-engine aircraft like the Cessna Citation, Beech B-200, and Lear 35.  Most are either turboprop or jet aircraft which lends to faster, more versatile performance. In helicopter operations, again, no one make or model is the standard. Helicopters are chosen for a myriad of reasons such as payload capability, range, economy of operation, and geographic location.  The most common helicopters found in air medical use are the Bell 206/407, and Eurocopter AS-350 for single-engine aircraft. For multi-engine the medium sized Bell 222/230, Eurocopter BO-105, BK-117, and Agusta A-109 are widely used. The largest multi-engine helicopters in service with programs across the nation are the Sikorsky S-76, Bell 412, and the Eurocopter AS-365. All aircraft used in air medical service have proven themselves with thousands of safe transports.

b. What are the benefits of twin-engine vs. single engine?
The debate among users continues with this issue. Some pilots and passengers have always believed two is better than one. On certain levels this is still true today. Anyone flying 100 miles offshore, or over mountainous terrain at night feels better knowing that there are two engines working for him or her. However, with the advent of truly reliable turbine engines, the probability of and engine failure is greatly reduced making the single-engine helicopter a safe and economical choice. A great deal depends on the type of missions flown, and the space required to accomplish it. All medium and large capacity helicopters are multi-engine, needed for the power required to lift the payload.

 c. What does “IFR” mean? 
"IFR" stands for "Instrument Flight Rules." It refers to a set of rules governing the conduct of flight under weather conditions where navigation by Visual Flight Rules (VFR) is no longer reliable. The conditions for IFR flight and the flight rules themselves are contained in the FAA's "Instrument Flying Handbook. (Advisory Circular 61-27C)."

d. What weather conditions can be flown in?
The weather minimums for safe flight operations are found within the Federal Aviation Regulations. AAMS recommends that all medical transport services, regardless of AAMS membership, follow the CAMTS recommended standards of operation.  Please visit www.camts.org for more information.

How many air medical transports does the Air Medical Community (AMC) complete each year? 

We estimate that there are nearly 500,000 rotor wing transports annually, with an additional 150,000 patient flown by fixed wing aircraft each year. (US only)

When did “Fixed Wing” aircraft begin to be utilized for medical transport?

Fixed Wing aircraft were the first aircraft used in air medical transport. A medical section of the Army Air Corps was created as early as June 1, 1925 using converted DeHaviland aircraft.  Helicopters did not see use as medical transports until 1944. [Note: Please see Bell Helicopter's web site for details.] 

Why are patients flown by fixed wing?

Patients are flown by fixed wing for many different reasons.

These can range from the stable patient involved in an accident, or with a long-term medical condition, wishing to relocate closer to family for rehabilitative care, to the critical heart failure patient requiring intensive care transfer to receive a transplant.

The fixed wing environment differs from the rotor wing environment primarily in that fixed wing travels farther, faster and higher. The fixed wing is primarily a facility-to-facility transport, typically long distance in nature.

Secondly, there are typically more choices of different types of aircraft, and selections that are less expensive per mile and/or per hour to operate.  With licensure and accreditation standards available and easily verifiable, the care provided in the fixed wing environment is the same as the helicopter.  The fixed wing is typically not in competition with the rotor wing in that the rotor wing service typically is for moving a patient from a scene to a primary care facility, or a tertiary care facility to a primary care facility.

What is the typical cost of an air medical transport?

The cost of air medical transport varies greatly depending on the region, distance flown, and other factors. According to the 2000 Annual Transport Statistics & Fees Survey (published in the Air Medical Journal, July/August 2002), the average cost can range from $2591.72 to $6152.22 per flight. This information was pulled from a relatively small sample and should NOT be considered representative of the entire community in present day.

     a. Does insurance / Medicare pay for the transport?  Some, but not all, insurance companies cover the part or all of the cost of an air   medical transport. Each insurance company decides, individually, how much coverage, if any, it wishes to provide. If you have questions regarding how far your coverage extends, we suggest contacting your insurance company.

Medicare does cover part, or all, of certain types of air medical transports. In general, those flights must be considered medically necessary and must be to the nearest appropriate facility. Medicare can refuse to pay for flights if the reasons behind the flight do not meet their set of guidelines.

What are the company names of the helicopter and plane manufacturers/vendors in the AAMS Membership that provide medical aircraft?

What are the different types of team configurations?

There are many but some of the most common are: Nurse/Nurse, Nurse/Paramedic, Nurse/Respiratory Therapist, Nurse/Physician, Paramedic/Paramedic.

When was the first Air Medical Transport completed?

In 1926, the United States Army Air Corps used a converted DeHaviland aircraft to transport patients from Nicaragua to France Army Base in Panama, one hundred and fifty miles away. The first civilian air medical transport was completed in 1928 when a DeHaviland Fox Moth aircraft in the service of Australia's Royal Flying Doctor Service took off on its first mission. The Royal Flying Doctor Service holds the distinction of being the first civilian air medical transport program. [Note: Please see the Bell Helicopters web site and the Air Medical Journal, March-April 2001 for the full story]

Who can request a medical transport?

Physicians, Nurses, Pre-hospital personnel, Law Enforcement and any other personnel determined by state or local protocols.

What are the types of medical conditions for which patients are flown?

Trauma, medical (seizure, pulmonary, etc) spinal, burn, pediatric, replant, neonate, organ procurement, High risk OB, non-trauma neuro, and cardiac.

What is the typical mission profile for air medical transport?

54% Inter-facility transports (hospital to hospital), 33% Scene response, and 13% Other (organ procurement/transport)

Do helicopters respond to accident scenes or do they do only hospital-to-hospital transports?

Helicopters do respond to accident scene when the pre-hospital personnel’s evaluation of the patient/scene meets local air medical transport guidelines.

Is there a governing body over the Air Medical Community?

There is no single "governing body" over air medical services.  Each service is independent, or could be part of a group of similar programs.  There are however, several agencies that may have licensing or over sight for air medical services.  For the aviation components of air medical, programs must adhere to rules and regulations established by the Federal Aviation Administration (FAA). They are also subject to periodic inspections by the FAA.

Minimal standards for reimbursement and/or licensing could also be established by third party payers (Medicare, Medicaid, managed care organizations) or by local legislation (state, county or city laws).  Most states have minimum licensing requirements for air medical personnel and the program.

In addition, air medical services may also follow national or regional standards.  For those air medical programs that are hospital based, if the hospital is accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHCO) or other such organizations, such as the American College of Surgeons for trauma verification, the program must also meet those minimum standards.

a. What is CAMTS certification?
The Commission of Accreditation of Medical Transport Systems (CAMTS) is an independent commission, comprised of representatives from fourteen member organizations, each representing some component of critical care medical transport.  Each member brings with them a wealth of experience and knowledge in their field of expertise.  Together the commission members develop standards for all levels of medical transport, both air and ground.  These standards are shared with the member organizations for their comments and suggestions.

Accreditation by CAMTS is granted to those programs that voluntarily apply and prove to the CAMTS Board that they are in substantial compliance with the CAMTS standards.  This is done through submission of documentation as well as a site survey performed my trained CAMTS surveyors.

b. What is the accreditation process for air medical programs? 
Accreditation begins with an application form. The form indicates the program’s intentions to complete the process and services as a request for the Program Information Form (PIF).  The PIF is a rather extensive documented self-evaluation of the program, based on the CAMTS Standards.  Response to the PIF requires copies of documentation of some process and policies as well as a series of questions asking the program to verify that it adheres to each of the CAMTS Standards.

Once the PIF is complete and returned to the CAMTS office, it is reviewed by the CAMTS staff for completeness and sent to two Board members for “pre-review”.  The staff and two Board members complete a “workbook” with questions and suggestions for the site surveyors that will be assigned to the on-site visit.  Two site surveyors are then appointed, based on their experience and background related to the type of program (air/ground; fixed/rotor; ALS/Specialty Care, etc.) and any concerns noted by the two Board members.

The site visit is then scheduled at a time agreeable to both the program and site surveyors.  Once onsite the surveyors will conduct a series of interviews of the program personnel, look at training records, quality improvement programs, safety policies, etc.   Their comments and observations are then added to the workbook, paying particular attention to the questions raised as part of the pre-review.

The completed workbook is then returned to the original two Board members for post-review and presentation of the facts and their recommendations for an accreditation action to the full Board.  Only the two Board members giving the presentation know the name or location of the program.

c. Is this a required certification?
CAMTS accreditation is voluntary, however many states and some governmental agencies have accepted or require CAMTS Accreditation for licensing, contracts or reimbursements.

Do pilots get involved in medical care / treatment of the patient?

No. Pilots are charged with the safe and efficient transport of the crew and patient without regard to what is happening " in the back". By isolating pilots from patient involvement, they can make crucial flight decisions without influence.

What is the typical shift worked (i.e. 8, 12, 24 hour shifts)?

Pilots are limited to 12 hour shifts and medical crews typically work either 12 or 24 hour shifts.

Where are patients flown (types of facilities)?

Level 1 Trauma Centers, Tertiary Care Centers, and Specialty Hospitals

Have the events of September 11, 2001 effected or changed the Air Medical Community?

The most notable changes in the air medical community are the security issues, especially in programs/services in close proximity to unguarded U.S. borders.  There is also a noted increase in the use of satellite tracking systems on aircraft to enhance tracking and communications.