1. Ground transport times > 30 minutes from time of arrival at patient.
2. Remote or rugged terrain or ambulance transport impeded by road conditions or traffic.
3. Using ground ambulance would leave the local community without ambulance coverage.
4. Mass casualty incidents.
5. Need for diagnostic testing not available locally.
6. When time is critical to survival:

1. Trauma history:

   Rollover or ejection from vehicle
   High speed collision
   Prolonged extrication > 15 minutes
   Death of an occupant in the same car
   Deformity of the INTERIOR of the car of 18" or greater
   Car-pedestrian accidents
   Multiple victims
   Falls > 20 feet
   Penetrating injury to the head, chest or abdomen
   Extremity amputations
   Near drowning
   

2. Physical Exam:

   Glascow coma score less than 12 or CRAMS 8 or less, skull penetration or CSF leak
   Respiratory rate > 30 or < 10 and/or a need for airway intervention
   Systolic B/P <90, HR <50 or >120 (in adult)
   Major chest wall, abdominal or pelvic injury (any trauma involving two or more organs)
   Two or more extremity fractures
   Spinal cord injury
   Burns > 15% or airway involvement

3. Medical History:

          Chest Pain
          Respiratory distress
          Signs of stroke
          Uncontrolled seizures
          Shock of any kind
          Coma of unknown cause