Are there still services out there using the amount of damage to a vehicle as a standard for determining treatment and transport decisions? I thought that changed a few years ago?

I find it interesting that this type of change was made. It is also interesting that in the world of EMS when there is a problem like this, the first step is to involve a physician. This is not necessarily a patient care issue. Yes, I agree there are many flights that are not truly warranted. The problem here is training, when and when not to utilize air transport. States should setup guidelines that assist EMS crews in making decisions about air transport. I have worked in systems that either had a system or not. In the system that did not a guide was setup locally by our service still some patients were over triaged and discharged before 24 hours. In the system with a guide setup by the state I still fly a number of patients that are discharged within 24 hours. I feel that consulting with a doctor on this situation is like calling for orders on simple care issues, and this does not address the root cause of the problem. The root cause of the problem being flight crews that push the limits or compete to get the "numbers". Recently two aircraft crashed into each other on a clear day in mid air. Would a physician consult have prevented this? I say the air medical services should police theirselves and come up with the ideas on preventing these incidents.

I am a paramedic in a small rural area. Our closest trauma center is 70 miles away. I agree that some flights are unwarranted, however when you have a small rural hospital and no on-site radiologist to read x-rays then time is of the essence in some situations. I beleive that we should ere on the side of caution as caregivers in the field because it is not the doctors who can see injuries on scene. I personally would like to keep my license to work in this field.