A critical care registered nurse gauged the medical appropriateness of flights based on criteria from the Medicare Benefit Policy Manual, industry guidelines from the Commission on the Accreditation of Medical Transport Systems (CAMTS), Air Medical Physicians Association (AMPA) position papers, the Center for Disease Control?s guidelines for field triage, and Medicare reimbursement appeal decisions.  

Records indicating a possible inappropriate flight were further reviewed by a senior quality assurance/quality improvement nurse or a senior medical director. Additionally, the reviewers of Air Evac Lifeteam?s flights used a higher level of scrutiny for flights under 30 miles in distance. Utilizing this process, the reviewers found that only 1.4% of the flights that year could be deemed medically inappropriate. 

The authors of the study noted that on-scene flights were more likely to be classified as medically unnecessary than transfer flights and that the most common reason a flight was deemed medically unnecessary was because it met the criteria for ground rather than air transportation.  

Though the rate of medically inappropriate flights was found to be very low, the researches stated that a lack of EMS resources in rural areas may be falsely elevating this rate. For example, a patient who does not meet the criteria for air transportation may nevertheless need to be transported by helicopter because of inadequate ground resources.