From Highway to Hospital: How Air Medical Teams Coordinate with Ground EM

When a major car crash blocks the highway, when a farmer suffers a crushing injury miles from town, or when a cardiac arrest strikes far from a hospital, minutes matter. In those moments, lives often hinge on the coordinated efforts of two groups: ground emergency medical services (EMS) and air medical crews.

Together, they form a chain of response that stretches from roadside to hospital bed. Each link in this chain must be strong. Each handoff must be seamless. And each decision—whether to request a helicopter, how to stabilize a patient, or where to deliver them—carries life-or-death consequences.

At PHI Air Medical, coordination with ground EMS isn’t just part of the job—it is the heart of the mission. With more than 80 bases across the United States and over 22,500 patients transported annually, PHI’s flight nurses, flight paramedics, and pilots work daily with first responders to ensure patients receive timely, specialized care. But how does this system actually work? What happens between the 911 call and the hospital doors?

This article follows the patient journey, step by step, to show how ground and air teams combine forces in a process designed to save lives.

Step One: The 911 Call

The chain of survival begins with a call to 911. Dispatchers quickly triage the emergency, gathering crucial details about the incident, the number of people involved, and the severity of injuries.

In most cases, ground responders—paramedics, firefighters, or law enforcement—are dispatched first. Once they arrive, they make an initial assessment: Is the patient stable enough for ground transport? Or does the situation require the speed and specialized care of an air ambulance? In many communities, it is these ground crews who formally request a helicopter through dispatch.

The U.S. Department of Transportation’s guidelines for Helicopter Emergency Medical Transport highlight this process, stressing that every state EMS system must establish clear procedures for flight requests and dispatch. This ensures helicopters are launched appropriately—whether directly after the 911 call or after on-scene evaluation by trained responders.

Whether the call comes directly from dispatch or through a request on scene, the decision to activate an air ambulance is always made with one goal: to get the patient to the right care, as quickly and safely as possible.

Step Two: Stabilization on the Ground

When ground EMS arrives, their first priority is to stabilize the patient and begin essential care. Paramedics may secure airways, control bleeding, administer medications, or use defibrillators depending on the situation. These rapid interventions provide a bridge to the advanced resources of the air medical team.

If a helicopter has been requested, responders also prepare a landing zone (LZ). The site must be clear, well-marked, and safe for the aircraft to land. Firefighters and law enforcement often assist by directing traffic, maintaining crowd safety, and keeping the perimeter secure while EMS manages the patient.

The Journal of Emergency Medical Services (JEMS) notes that pre-established protocols make this coordination more effective. By defining in advance who communicates with dispatch, who handles the landing zone, and how updates are relayed, EMS systems avoid confusion and ensure smooth teamwork when the helicopter arrives.

For flight crews like those at PHI Air Medical, every response is different, and the handoff from ground to air is rarely predictable. As Louise Sandoval, CFRN, explains:

“The most challenging is facing the unpredictable nature of emergencies, where split-second decisions can make the difference between life and death. The most rewarding is knowing that your expertise directly impacts someone’s chance at survival.”

Her perspective captures the essence of why these partnerships matter: ground EMS and air medical teams bring different skills to the scene, and together they form a safety net for patients in crisis.

Step Three: The Handoff

When the helicopter touches down, the focus turns to the handoff. Ground EMS provides the flight team with a rapid but detailed report: vital signs, injuries, treatments given, medications administered, and any changes in condition since their arrival.

This communication is critical. A clear, structured handoff allows the air medical crew to continue care seamlessly, without repeating steps or missing vital details.

PHI Air Medical flight teams include pilots, Certified Flight Registered Nurses (CFRNs), and Certified Flight Paramedics (FP-Cs). These clinicians often come from years of ICU, ER, or advanced pre-hospital care backgrounds, and their training equips them to handle highly complex cases in flight. With the transfer complete, the patient is loaded into the aircraft, and the next stage begins.

Step Four: In the Air

Inside the helicopter, the environment transforms into a flying intensive care unit. Patients are monitored continuously, and flight nurses and paramedics deliver interventions that require advanced expertise.

These professionals undergo specialized training beyond their already extensive experience in emergency and critical care. Their skillsets include advanced airway management, ventilator operation, blood transfusion protocols, and the administration of critical care medications. Many hold
advanced certifications such as CFRN or FP-C, requiring mastery of intensive care principles tailored to the unique challenges of flight medicine.

This advanced capability ensures that patients receive a higher level of support during transport. Whether it’s stabilizing a traumatic brain injury, managing burns, supporting a cardiac arrest patient, or transporting someone with a complex neuro emergency, flight crews provide hospital-level interventions en route.

The principle of the “Golden Hour”—the critical 60 minutes following a severe injury—remains central. Research published in StatPearls/NCBI shows that helicopter EMS reduces transport times and improves survival for patients with severe trauma, especially when distance or geography would otherwise delay definitive treatment.

Meanwhile, communication continues throughout the flight. Pilots maintain contact with dispatch, and the medical crew relays updates to the receiving hospital. By the time the helicopter lands, the trauma team is already prepared and waiting.

Step Five: Hospital Handoff

The last link in the chain is the transfer from air crew to hospital team. Because updates have been flowing throughout transport, the receiving physicians, surgeons, and nurses are ready as soon as the patient arrives.

Guidelines from the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons (ACS) Committee on Trauma reinforce this process. Their Field Triage Guidelines emphasize getting the right patient to the right hospital—meaning that patients may bypass closer facilities if those hospitals cannot provide the necessary trauma or specialty care.

“The purpose of field triage is to match the severity of the injury with the optimal level of care … Air medical services may be considered when timely ground transport to an appropriate trauma center is not possible.”

The hospital handoff marks the completion of a carefully coordinated journey, but for the patient, it may be the beginning of recovery.

Safety and Standards: CAMTS Accreditation

Air medical transport carries unique challenges, and safety is always the highest priority. The Commission on Accreditation of Medical Transport Systems (CAMTS) sets rigorous standards for training, safety, and patient care across the industry.

Accreditation through CAMTS requires demonstration of excellence in areas such as pilot qualifications, medical staffing, communication systems, and coordination with ground EMS. For patients and families, it is reassuring that their care is in the hands of a provider committed to the highest standards.

Community Partnerships: More Than Emergencies

The partnership between PHI Air Medical and local EMS extends far beyond a single flight. Crews frequently conduct joint training sessions on landing zone safety, trauma protocols, and patient handoffs. These drills build trust and ensure smoother collaboration when real emergencies occur.

Most transports PHI handles involve time-sensitive medical events such as heart attacks, strokes, severe burns, neuro emergencies, and traumatic injuries. While air medical services also support large-scale accidents or mass-casualty incidents, the majority of missions are focused on these urgent, individual crises.

By preparing together and responding side by side, PHI and ground EMS strengthen the system of care for every community they serve.

The Human Factor

Behind every dispatch system and every protocol are people. Dispatchers who take frantic calls. Paramedics who stabilize patients roadside. Pilots who guide helicopters through challenging conditions. Flight nurses and paramedics who deliver advanced care while offering reassurance mid-flight.

It is this human factor—dedication, compassion, and skill—that turns an emergency response into a coordinated chain of survival.

Financial Protection: PHI Cares Membership

Even after a successful emergency transport, families may face another out-of-pocket cost for their air ambulance transport, and insurance coverage often leaves large gaps in coverage.

That’s why the PHI Cares Membership exists. For less than $6 a month, an entire family—and up to three additional non-dependents at the same address—is covered for medically necessary PHI Air Medical transports. Members pay nothing out of pocket: no copays, deductibles, or co-insurance.

This program gives families peace of mind that in an emergency, they will not be burdened by financial hardship on top of medical stress.

A System Built on Trust

From the first 911 call to the hospital doors, the patient’s journey depends on a chain of handoffs between ground EMS and air medical crews. Each link must be strong, each handoff precise, and each team ready to step in at the right moment.

National standards (FAA, CDC, ACS, CAMTS), clinical evidence (NCBI), and EMS best practices (JEMS) all point to one truth: integration saves lives.

PHI Air Medical stands at the center of this system—bridging highways and hospitals, patients and trauma centers, families and hope. As Michele Guthrie, CFRN, said best:

“I chose to become a Flight Nurse because flying is cool, but more importantly, because I get to be the best part of someone’s worst day.”

Sources

• U.S. Department of Transportation. Guidelines for Helicopter Emergency Medical Transport.
  ems.gov
• Journal of Emergency Medical Services (JEMS). Ground-Air Intercept Lessons Learned.
• Sandoval, Louise, CFRN. Flight Nurse quote.
• Guthrie, Michele, CFRN. Flight Nurse quote.
• StatPearls/NCBI. Helicopter Emergency Medical Services in Trauma Care. 2022.
• Centers for Disease Control and Prevention (CDC) & American College of Surgeons (ACS).
  Field Triage Guidelines of Injured Patients.
• Commission on Accreditation of Medical Transport Systems (CAMTS). Standards and
  Accreditation Overview.