tions have centered largely on state efforts to control growth in air medical capacity through the certificate-of-need process. However, other questions regarding the federal preemption of state law have not been definitively resolved. Pennsylvania recently established a protocol requiring air ambulance operations to transport patients to the nearest trauma center, rather than to the base hospital. The air medical provider contested the protocol, saying that it was preempted by federal law. However, the FAA acknowledged in a letter to the state that it had never intended to regulate the medical aspects of air medical operations, and the case was never taken to court.

Some states currently have no regulatory framework in place to govern the medical care aspects of air ambulance providers. However, a key objective for state regulatory agencies should be to ensure coordination and improve the allocation of available assets, including air ambulances. Currently, ground EMS and 9-1-1 dispatch centers sometimes call for air medical support without coordination, resulting in more than one air medical provider being dispatched to a scene. This is a problem especially where there are multiple air medical services competing in the same coverage area. These providers typically market their services to EMS agencies, and when multiple EMS agencies are dispatched to the same event, they may each call for the air medical provider best known to them, resulting in multiple responses.

In light of the above issues, the committee recommends that states assume regulatory oversight of the medical aspects of air medical services, including communications, dispatch, and transport protocols (5.1). The regulatory authority of the FAA should extend to helicopters, fixed-wing aircraft, pilots, and company sponsors; however, the state should regulate the medical aspects of the operations, including personnel on board (nurses, paramedics, physicians), medical equipment, and transport protocols regarding hospitals and trauma centers. In addition, states should establish dispatch protocols for air medical response and should incorporate air medical providers into the broader emergency and trauma care system through improved communications. These measures are essential to more coordinated and efficient use of air capacity.

Interfacility Transport

In addition to transport from the scene of an incident directly to a medical facility, air medical helicopters are used extensively to transport patients from a hospital to a definitive care location. This often occurs, for example, with patients suffering a myocardial infarction or stroke, or pediatric patients who are critically ill or injured. This type of interfacility transport is probably the most common use of air medical services today.

Ground and air ambulances may also be used for nonemergency trans-



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