Jimmnn - I am currious as to why your avatar is of two medical helicopters if you are so against them. Never mind it is no big deal. Much of your last post as to why helicopters are used is very biased and only half accurate. I would be currious to know what your involvment with EMS, Fire or Law is. Helicopter agencies do as you stated market to ground agencies for the business; however it is upto ground agencies to call a helicopter when needed; based on their protocols, transport distance and time and nature of injury or illness. There are no kickbacks and agencies only call helicopters when they have the patients best interst in mind. There isn't a single ground ambulance that can beat a helicopter as far as transport time goes even with landing, loading, and lifting off figured in. Secondly the medics and RN's on the helicopters have far and away higher level of skills and procedures then your ground counterparts. Many of specialized skills due to take room, so it is performed in the back of the ambulance by the flight crew as they are the only ones allowed to do many of the procedures. But you would be amazed with how much they can do in the air. Have you ever flown with a Med Evac crew? I have. Finally they are able to bypass your little level 4, 3 and a lot of times 2 hospitals and get the patient to definitive care based on the patient needs, especially pediatrics, burns, cardio, and neuro. As stated before a lot of hospitals due have the same ranking ie Level II or I, however like everything else in life certain hospitals excel a certain types of Patients. Swedish for example is probably the vest at neuro, University and NCMC are great for burns, Saint A's central is great for overall truama. They can all handle any patient, some are just better than others at certain ones. Helicopters will not go away, and it is upto the ground crews to use them intelligently.