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Air Ambulance Utilization Standard

General Directive

Requests for an on-scene air ambulance helicopter response should meet at least one of the bulleted operational criteria PLUS one of the clinical criteria (e.g. known clinical criteria as listed in the Field Trauma Triage Standard or from the bulleted list of medical or obstetrical criteria listed below).


The paramedic shall:

  1. assess the scene response to meet one or more of the following operational criteria:
    1. The land ambulance is estimated to require more than 30 minutes to reach the scene and the air ambulance can reach the scene quicker.
    2. The land ambulance is estimated to require more than 30 minutes to travel from the scene to the closest appropriate hospital* and the air ambulance helicopter can reach the scene and transport the patient to the closest appropriate hospital* quicker than the land ambulance.
    3. The estimated response for both land and air is estimated to be greater than 30 minutes, but approximately equal, and the patient needs advanced paramedic level care which cannot be provided by the responding land ambulance.
    4. There are multiple patients who meet the clinical criteria and the local land ambulance resources are already being fully utilized.
  2. if the scene response meets the requirements of paragraph 1 above, assess the patient to determine if he/she meets one or more of the following clinical criteria:
    1. Patients meeting the criteria listed in the Field Trauma Triage Standard.
    2. Patients meeting one or more of the following:
      1. i. Medical:
        1. Shock, especially hypotension with altered mentation (e.g. suspected aortic aneurysm rupture, massive GI bleed, severe sepsis, anaphylaxis, cardiogenic shock, etc.)
        2. Acute stroke with a clearly determined time of onset or last known to be normal <3.0 hours
        3. Altered level of consciousness (GCS <10)
        4. Acute respiratory failure or distress
        5. Suspected STEMI or potentially lethal dysrhythmia
        6. Resuscitation from respiratory or cardiac arrest
        7. Status epilepticus
        8. Unstable airway or partial airway obstruction
      2. Obstetrical:
        1. Active labour with abnormal presentation (i.e. shoulder, breech or limb)
        2. Multiple gestation and active labour
        3. Umbilical cord prolapse
        4. Significant vaginal bleeding (suspected placental abruption or placenta previa or ectopic pregnancy);
  3. in conjunction with the ACO, assess if an on-scene air ambulance helicopter is appropriate, based on:
    1. a. the perceived severity of the reported injuries and without confirmation that the clinical criteria have been met, or
    2. b. the patient cannot reasonably be reached by land ambulance (e.g. sites without road access such as islands; geographically isolated places, etc.);
  4. if the requirements listed in paragraph 2 or 3 above are met, request an on-scene air ambulance helicopter response:
    1. Provide the ACO with the information set out in operational and clinical criteria above. In order for the ACO to determine if an air ambulance response and transport will be quicker than land ambulance, the paramedic will provide the ACO with the estimated time to prepare the patient for transport, identify separately any time required for patient extrication, provide the estimated land ambulance driving time to the closest appropriate hospital* and any additional information as required.
    2. The paramedics shall not delay patient transport by waiting for the air ambulance helicopter, unless the air ambulance helicopter can be seen on its final approach to the scene. If the air ambulance helicopter is en route but not on final approach to the scene, and the land paramedics have the patient in his/her ambulance, then the land ambulance will proceed to the closest local hospital with an emergency department. The air ambulance helicopter will proceed to that local hospital and, if appropriate, assist hospital personnel prepare the patient for rapid evacuation.
    3. While en route to the local hospital, paramedics may rendezvous with the air ambulance helicopter if:
      1. the air ambulance helicopter is able to land along the direct route of the land ambulance; and
      2. it would result in a significant reduction in transport time to the most appropriate hospital*.

*Note: The closest appropriate hospital for on-scene call patients assessed as meeting the criteria specified within the Field Trauma Triage Standard is the closest LTH.

  1. if the call’s circumstances and patient(s) fail to meet the criteria set out in this standard and an air ambulance helicopter is known to be responding based on the merits of the initial request for ambulance service, contact the CACC/ACS and advise that an on-scene air ambulance helicopter response is not required and why it is not required.


Air Ambulance Helicopter Landing Site Safety and Coordination

Upon confirmation that the air ambulance helicopter is responding, the paramedic shall designate a Landing Site Coordinator. One rescuer (selected from the police, fire, or ambulance personnel) shall be chosen to assume the role of Landing Site Coordinator and take the following actions to coordinate the safe landing of the air ambulance helicopter while maintaining the safety of the scene.

Wear Safety Apparel

  • Don and secure a high visibility vest or coat
  • Don and secure a safety helmet with visor
  • Wear safety goggles or safety eyewear

Landing Site Selection

The air ambulance helicopter pilot-in-command is responsible for selecting the landing site and has the final decision on whether or not to land. Using the air ambulance helicopter airborne vantage point, the pilot-in-command will select a site that best meets the following conditions:

  • A site that will not affect the rescue efforts underway.
  • A clear area of approximately 45 meters x 45 meters.
  • A safety area, extending approximately an additional 30 meters for the purpose of controlling vehicle and personnel access during landing and take-off.
  • The landing site should be away from overhead wires and utility poles.
  • The surface should be as flat as possible.
  • No loose debris should be within the landing site or the safety area; check ditches.
  • Gravel and sand sites should be avoided, if possible, due to the potential of injury from flying dust particles and reduced visibility.

Site Safety

  • No vehicles or personnel are allowed within the landing site and safety area during landing and take-off.
  • Vehicle doors, windows, and access compartments should be closed.
  • Stretchers should be left in the ambulance and all loose articles secured.
  • If requested by the flight crew, the Landing Site Coordinator will stand at the upwind edge of the safety area, back to the wind and facing the site, to maintain security during landing and take-off.
  • Firefighters should not lay out hoses; any lines that have been laid should be charged.
  • If site security is compromised, such as personnel or vehicles entering the safety area, the Landing Site Coordinator is to wave off the air ambulance helicopter by crossing outstretched arms over his/her head.

Safely Working Around a Helicopter

  • Stay out of the safety area and landing site during landing and take-off.
  • Approach or depart only when directed by a member of the air crew.
  • Do not approach the helicopter from the rear as the tail rotor is difficult to see.
  • If on uneven ground, approach and depart from the downhill side.
  • Carry all equipment horizontally at or below waist level, never over shoulder.
  • Ensure hats, scarves, gloves, glasses and any other loose articles are secure before entering the safety area.

Other Use of Air Ambulance Helicopter

  • Air ambulance helicopters are not permitted to respond to night calls which require a landing at a site other than night licensed airports, helipads or night approved remote landing sites.
  • Air ambulance helicopters are not permitted to conduct search and rescue calls. For purposes of this section, Search and Rescue is defined as “The act of looking diligently to find a patient whose exact location is not known, and, once located, requires removal from the location using specialized tools and skills outside the scope of EMS practice.”
  • In cases where a land ambulance can reach the patient(s) and an on-scene response by air ambulance helicopter is appropriate, the ACO will assign a land ambulance and continue the land response until the flight crew requests that the land ambulance be cancelled.
  • In cases where a land ambulance arrives on-scene prior to the air ambulance helicopter, paramedics shall inform the CACC/ACS as clinical events occur.


Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5