# New Air EMS Company



## Star Air Life (Sep 29, 2010)

Good Afternoon All,

I am interested in hearing ideas, experiences or anything you would like to share with me.

I am interested in starting my own Air Emergency Medical Company. I live in a rural area where we do not have our own helicopter and it is greatly needed. 

We are doing approximately 47 flights per month with another city nearby having to come provide their services.

My Question to All, where can I start, what licenses do I need to operate, what beneficial information can you share with me so that I can develop this company.

Thanks to all of you in advance. 

Anthony.


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## 18G (Sep 29, 2010)

When you say start your own air medical service... I'm taking you mean your the one fronting the money or going after investors to get your venture off the ground? 

I'm no expert in this area but to lease space at an airport, buy or lease helicopters, frequent maintenance of the helicopters, the medical staffing, office staff, flight mechanics, etc... is going to be in the millions of dollars range. 

Have you considered contacting nearby air services to see if they would be able to re-locate a helicopter and crew closer to your area? This may be more feasible. Are the number of flights you anticipate performing high enough to cover all the operating expenses?

If your really serious about starting a company of this nature you may want to hire a consultant who has experience in setting up these type of operations first hand. They will be able to provide you with all the info you need.


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## usalsfyre (Sep 29, 2010)

First and foremost, how many of the 47 flights are *truly* medically justfied. If you went back and did chart review, I bet you would find a sizable portion (perhaps even most of them) could have been handled by a competent ground crew. You'll probably find a few of them that didn't even meet flight criteria. Lobbying to upgrade the ground service capabilities is significantly cheaper and better serves the community in the long run. 

Secondly, none of this is inexpensive. The cheapest, crapiest airframe even remotely usable in EMS (Bell 206L) is 1mil+ US dollars in medical trim, and it's ability to do the job is often called into question. 

Finally your starting this up in a market that is oversaturated with HEMS as it is. What, other than saving a couple of minutes that probably weren't clinically significant anyway, could your service offer that the other one doesn't? 

I hate to put a damper on your dream, but I'm sick of seeing flight crews turn into yard darts for no reason. Either it should be done right with capable airframes, up to date flight systems, well trained crews, NVGs ect (none of which is cheap) or not done at all.


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## Veneficus (Sep 29, 2010)

usalsfyre said:


> First and foremost, how many of the 47 flights are *truly* medically justfied. If you went back and did chart review, I bet you would find a sizable portion (perhaps even most of them) could have been handled by a competent ground crew. You'll probably find a few of them that didn't even meet flight criteria. Lobbying to upgrade the ground service capabilities is significantly cheaper and better serves the community in the long run.
> 
> Secondly, none of this is inexpensive. The cheapest, crapiest airframe even remotely usable in EMS (Bell 206L) is 1mil+ US dollars in medical trim, and it's ability to do the job is often called into question.
> 
> ...



We are certainly in agreement, but I often wonder... If people stopped applying for jobs at unsafe companies, maybe there would be less Airmed companies?

The people who are climbing aboard the helicopters to "chase the dream" have to bear some responsibility.


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## looker (Sep 29, 2010)

As ground ems owner, i can tell you that you have no clue what you're doing. The initial cost to open ems ambulance is really high, between obtaining hanger, employees, city permits, county permits, faa license etc it will cost millions to even get green light. You still need to find patients, bill for them etc. Unless you're very wealthy individual or know some who are, do not bother even trying to open one.


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## Star Air Life (Sep 29, 2010)

*Thank you for response*

@usalsfyre- All 47 flight per month are truly justified I have study and asked for past 3 years of flight records and this is the average number of flights done, all with medical justification flight criteria status. I live in a rural area and we do not have a trauma center or equipt to handle these type of situations. 

Ground Service is a great option, only thing that I am concerned about is that the distance to the closest big city that provides the services we dont is approximately 120 nautical miles. Ground Service is not an option when patient is in critical care, which again goes back to those 47 flights on average. 

I have been talking to small business here locally and other local banks and investors and we seem to be getting green light for this. We are looking into a Eurocopter 135 p2+ with a price tag around 4.7 million EMS ready and Vip Configuration. This rotocraft will allow us to transport two patients two nurses and a pilot and get there very very fast.   Take into consideration that it has the capability to be transformed into VIP configuration for, for hire luxury for Doctors or Executive transport

We have qualified medical staff on call to provide the services that we need while both on board and on ground. The Helicopter will be brand new and will have the latest flight systems including Night Vision capability and we have two pilots qualified myself included to handle the operation for flights.


@18G I personally will be one of the major investors in this company but will have an option and need others to join in. I have been speaking to small business and local investors that are excited of the idea.

Contacting and Leasing nearby services is what is being done at the moment, problem with that is that the are not nearby they are 120nm away.

Our local hospital has agreed to provide me a LOI- Letter of Intent that gives me first option to provide Air Emergency Services. 

We have done a study and it requires 10 flights per month for our expenses to break even.

I want to thank you both for your comments, its time for myself to study the situation futher and I will take your comments and suggestion into consideration. 

thanks,

Anthony


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## looker (Sep 29, 2010)

Starlife being that you do have the resources and other stuff lined up i suggest you first contact your state ems and find out their requirement. Next  contact city/county and also faa. You need to find out what it takes to get permission from FAA. Also download medi-care application and see what requirement they have. Understand that it takes about 2 month to get your provider # and you need to have the heli before you can apply etc. Good Luck!


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## Star Air Life (Sep 29, 2010)

looker said:


> As ground ems owner, i can tell you that you have no clue what you're doing. The initial cost to open ems ambulance is really high, between obtaining hanger, employees, city permits, county permits, faa license etc it will cost millions to even get green light. You still need to find patients, bill for them etc. Unless you're very wealthy individual or know some who are, do not bother even trying to open one.



I want to thank you for your response,

I well aware of the initial cost to open ems ambulance along with emplyees, pilots, hangers, city permits, county permits, faa license etc. 

price will be as follows 

europter 135 p2+ -4.7 million both VIP and EMS ready

Two Pilots with required FAA qualifications (myself included)- 160k/yr

Two RNs- 60K/yr

Hanger fees 1000/yr

TDSHS Provider inital Cost 500 and 180 per each helicopter

Insurance....

Patients are around 47 flights per month so we need this service locally.

etc etc.........

I am well aware of what im getting into and have been in the medical field for 20+ years. 

Im just looking for comments and tips you guys might have first hand for me.

Thanks for your response!

Anthony


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## medic417 (Sep 29, 2010)

Keep in mind what you bill and what you will actually get paid are far different amounts.  This could really change the number of flights required to make payroll, helicopter payments, insurance, etc.


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## rhan101277 (Sep 29, 2010)

If I am reading that budget right, it makes it seems like you are paying the 2 RN's $30,000/yr each for $60,000 total or is it $60,000 each?


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## Star Air Life (Sep 29, 2010)

rhan101277 said:


> If I am reading that budget right, it makes it seems like you are paying the 2 RN's $30,000/yr each for $60,000 total or is it $60,000 each?



I apologize that will be total of 120k/yr two RNs


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## medic417 (Sep 29, 2010)

Star Air Life said:


> I apologize that will be total of 120k/yr two RNs



They can only be on standby so many hours per day so you will need more than 2 to staff the service.  So salary will be much higher.


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## TransportJockey (Sep 29, 2010)

I'd say 6 RNs is a more realistic number... And probably 1 more pilot


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## Star Air Life (Sep 29, 2010)

medic417 said:


> Keep in mind what you bill and what you will actually get paid are far different amounts.  This could really change the number of flights required to make payroll, helicopter payments, insurance, etc.



The average pay per flight is at around 7k. To break even with all operating cost we need a total number of average 24 flights.


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## Star Air Life (Sep 29, 2010)

medic417 said:


> They can only be on standby so many hours per day so you will need more than 2 to staff the service.  So salary will be much higher.



They are currently hired by our local hospital and I have made an agreement with the Hospital Director and our Medical Director to have access to RNs EMTs as needed. The two in our budget ARE on standby. This is included in the letter of intent I received.


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## medic417 (Sep 29, 2010)

Star Air Life said:


> They are currently hired by our local hospital and I have made an agreement with the Hospital Director and our Medical Director to have access to RNs EMTs as needed. The two in our budget ARE on standby. This is included in the letter of intent I received.



But that may not meet the state or federal requirements.


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## Star Air Life (Sep 29, 2010)

medic417 said:


> But that may not meet the state or federal requirements.



I will check into that Medic. thank you for your comment.


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## looker (Sep 29, 2010)

Star Air Life said:


> The average pay per flight is at around 7k. To break even with all operating cost we need a total number of average 24 flights.



Does that exclude non collectable bad debt?


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## LonghornMedic (Sep 29, 2010)

looker said:


> Does that exclude non collectable bad debt?



I don't know what the collection rate is for helicopter EMS, but I know ground EMS runs less than 50 percent in most areas.


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## Star Air Life (Sep 29, 2010)

looker said:


> Does that exclude non collectable bad debt?



It does not inlcude bad debt, 

It is between 160-180k to break even just for operation cost. which is around 24 flights monthly.


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## LonghornMedic (Sep 29, 2010)

Star Air Life said:


> We are looking into a Eurocopter 135 p2+ with a price tag around 4.7 million EMS ready and Vip Configuration. This rotocraft will allow us to transport two patients two nurses and a pilot and get there very very fast.   Take into consideration that it has the capability to be transformed into VIP configuration for, for hire luxury for Doctors or Executive transport



In theory, an EC-135 can hold 2 patients. In actuality, it is usually one. I have not seen one yet that is set up for two. There isn't a lot of room as it is when it is set up for one. Then there is the issue of weight. I noticed you referenced TDSHS, so it will be operating in Texas? The heat and/or altitude, depending on where you are operating, will also limit the weight you can take on and thus typically limit you to one patient. The only helicopter that I've seen, that regularly takes on 2 patients, is the Bell 412.


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## Star Air Life (Sep 29, 2010)

This is correct Longhorn we are in texas and we will just be transporting one patient at a time, its just been pre set for two and VIP configuration.


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## Flight-LP (Sep 29, 2010)

I see I am not the only one that noticed the TDSHS comment. 

OP, sorry, but I think you need a strong dose of reality.

First and foremost, if you plan on doing scene responses, you cannot fly RN/RN, you must have a Paramedic on board. In addition, an EMT cannot be on the primary crew. they can fly third, but it is actually irrelevent as an EC-135 P2+ will not be able to carry such a load. 

Speaking of load capabilities, you may wish to take a closer look at your weight and balance. There is NO way a 135 in any configuration with sufficient fuel can carry two adult patients plus a full crew in the Texas heat.

I am curious to know what rural area is underserved by appropriate resources as Texas is HEAVILY saturated with air providers. Remember, just because a helicopter isn't near by, which is usually not really needed, a fixed wing can be farther away with the same capabilities and have the same response time.

To address the billing aspect, you can fly 100 flights per month, but if your payor mix is largely uninsured or State / Federal supported, you aren't going to get nearly the reimbursement you will need. You need a sufficient volume of medically necessary flights that you can actually get paid for. Also, is your hospital connection willing to sign on as payor of last resort? Are they willing to pick up the bill? If so, then why didn't they start a service themselves? It would be a much stronger strategic marketing move for their hospital system than bringing in a private for profit service.

Then you get the funnest part of your start up; the FAA. Simply put, they can just tell you no. Simple as that. Should they see an actual need for your operation, you will then have to go through red tape like you have never experienced before, not to mention fees and total costs nearing a cool mil.

You mentioned that you hold an FAA rating. Would you care to share a brief synopsis of your qualifications and experience? Give us some details and we may be able to offer some sound advice. But with your limited posts and far fetched ideas, honestly, I think you need to go back to the drawing board.......................


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## Flight-LP (Sep 29, 2010)

LonghornMedic said:


> The only helicopter that I've seen, that regularly takes on 2 patients, is the Bell 412.



You also have the S-75C++, S-76D, and AS-365N3+. All are quite capable of double loading in the Texas summer environment.

So many folks out there insist that the BK-117, EC-135, and EC-145 can also accomplish this. Apparently, they have never flown in 100 degree heat with a 6,000 foot density altitude..................................


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## Star Air Life (Sep 29, 2010)

Flight-LP said:


> I see I am not the only one that noticed the TDSHS comment.
> 
> OP, sorry, but I think you need a strong dose of reality.
> 
> ...




It seems you are either very familiar with this type of business or just simply do not read well enough, either way I happy to read your comment. 

Let me clarify once more to you. I will try to answer as best as I can,

I will not be doing scene responses as primary (although thanks for the idea) this business is being developed strictly as a home base operator serving a range of 120 nm radius that is greatly needed the hospital i have been dealing with have to wait a whole 30-45 min then take patient 30-45 back to where the patient needs attention. Wouldn't it be best just to have a local one? 

For the crew, we have two RNs on STANDBY but we can have access to as many EMTs or nurses as we may need. The helicopter we have chosen is the Eurocopter it allows us to carry 4 crew-pilot-second pilot-two emt or nurses or dogs or whatever you like and a patient. the option of a second stretcher is availble. Why would I want to carry more load the the EC can handle? just doesnt make sense, anyways lets continue.

Billing, do you know how much an air ambulance cost? It varies what I can tell you is the AVERAGE AVERAGE including self pay, private ins, medicare, medicaid. is around 7000.00. With this being said we have noticed that to maintain this Heli and business to run it will need 24 of those 7000.00 flights. we are doing 47 flight average of the 7000.00 flights. some more, some less 
but AVERAGE is 47-7000.00 flight a clear sign for us to give this company a go.

The hospital that gave me the LOI say it would give me first choice of all flights. If they don't have the resources or necessary interest in doing a heli service why would they bother even picking up my bill? It does not make sense. We will be following FAA,local,federal,guidelines to meet the requirements to develop this program. 

As for my qualification I am a General Surgeon-BC, also a pilot CFI,CFII,MEI with several power ratings. Let's just say I have completed my 207.5 required hours FAA tells me I need and experiences, I think I am capable of flying out backwards of a high rise helipad as required.

I would appreciate your sound advice if you have first had experience again I am not an expert, I have never done a company like this before, what I do know is that It is needed here and have studied and both we can serve the community as well as maintain so extra cash flow in our pockets. 

Thanks for your response,

Anthony


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## Ectopy (Sep 30, 2010)

Unfortunately Anthony your posts seem to imply lack of familiarity with the industry.

But just to understand better - where are your medical crew coming from? What is their training?

You're a General Surgeon who's going to be a primary pilot for this organization?


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## Flight-LP (Sep 30, 2010)

Star Air Life said:


> It seems you are either very familiar with this type of business or just simply do not read well enough, either way I happy to read your comment.
> 
> Let me clarify once more to you. I will try to answer as best as I can,
> 
> ...



Wow! Where to begin?????

Yes you may say I am somewhat familiar with the industry. I have been an active Pilot, Paramedic, and Air Medical Provider in Texas since 1996. You have a few flaws though that you may want to look at prior to wasting your money and making a complete fool out of you and potentially your client.

I'd first like to refer you to a manual officially known as Title 14 of the Code of Federal Regulations - Aeronautics and Space. You may have some familiarity with it already as you claim to be an aviator. Pay close attention to Part 135, which will cover your commuter and on demand operation. 135.243 specifically outlines the requirements to be qualified as PIC (pilot in command). You sir, with your 207.5 hours, come no where close to being qualified. You cannot even touch the controls on a 135 certificate unless you are running dual pilots. Any medical professional that chooses to fly with a PIC that has less than 2000 hours under their belt is an absolute moron. Regardless, I'm call bullsh!t on your "ratings". First off power ratings are not applicable when it comes to rotors, neither does an MEI rating. Second, the minimum hours required for a part 141 commercial license is 190 for airplane. To add a rotorcraft helicopter rating to that requires another minimum 30 hours. So now you are up to 220. Add to that a minimum of 5-10 hours per instructor rating and you come to around the 250 hour mark. If you trained under part 61, you are required to have 250 hours just for your commercial. So there is NO WAY YOU ACTUALLY HOLD THE RATINGS YOU CLAIM WITH 207.5 HOURS.

Now to address the medical side. You cannot just have any RN or medic just jump on the helicopter and go. Another reference you wish to become intimately familiar with is Texas Administrative Code 157.12 which governs the operations of rotor wing programs. It clearly defines equipment, staffing, and educational requirements that you must have to operate. Your described plan won't fly (no pun intended). 

Your above statement about the LOI is exactly why you need to rethink your business plan. You would be a complete idiot to not have a payor of last resort clause in place. Without it, you will lose your arse on the financial end. Do you really see yourself putting "extra cash flow in your pocket"? With a multi-million dollar aircraft that will cost you over a grand per hour to operate? In a rural, underserved area? SERIOUSLY?!?!?!?

I'd also be interested in knowing where you came up with your $7000 average. Show the proof as I think you have been seriously mislead.

I really don't know what to think. Honestly, I don't even know if you are serious about this or if your a troll. Regardless, I know for a fact that you will never get a provider license or a 135 operators certificate with your current plan.


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## Ectopy (Sep 30, 2010)

I'm calling Troll...

I bet he pops up on a certain other forum next....


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## Star Air Life (Sep 30, 2010)

Flight-LP said:


> Wow! Where to begin?????
> 
> Yes you may say I am somewhat familiar with the industry. I have been an active Pilot, Paramedic, and Air Medical Provider in Texas since 1996. You have a few flaws though that you may want to look at prior to wasting your money and making a complete fool out of you and potentially your client.
> 
> ...




It's pointless talking to someone like you, if you are in the industry like you say you are you would understand that you were in my shoes at one point.....with that being said I will purse this, I will happily offer my services to you if you ever need them. 

Worst case scenario Ill just turn the heli into Vip Configuration and back lease. 

Thanks Again for your response.

Anthony


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## Star Air Life (Sep 30, 2010)

Ectopy said:


> I'm calling Troll...
> 
> I bet he pops up on a certain other forum next....



A troll that has ambition and like to get things done...


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## Star Air Life (Sep 30, 2010)

Flight-LP said:


> Wow! Where to begin?????
> 
> Yes you may say I am somewhat familiar with the industry. I have been an active Pilot, Paramedic, and Air Medical Provider in Texas since 1996. You have a few flaws though that you may want to look at prior to wasting your money and making a complete fool out of you and potentially your client.
> 
> ...



Which Air Medical Provider in El Paso are you? I would like to research and learn more about your company, that is if you do have a company or maybe your just a paramedic that goes along for the air ride.......


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## WTEngel (Sep 30, 2010)

*Importance of crew*

You seem to place a heavy importance on the pilots (comments like "paramedic along for the air ride" indicate your contempt for the medical personnel) but you don't seem to understand that without QUALIFIED personnel, you are nothing more than a really really fast hearse.

First of all, flight qualified RNs will cost much more than 60,000/yr including benefits. In fact, you would be lucky to find qualified flight paramedics to work for that. If you want to hire non qualified individuals, I am sure you can find individuals who have been turned down by other flight services who will work for what you can pay them, but you get what you pay for.

The nurses you will be getting from the hospital will have no knowledge of flight physiology, CRM, AMRM, or other topics that are flight specific. Also, keep in mind that you may be a good pilot, but do you have the knowledge necessary to be a HEMS pilot? Have you flown SIC with a HEMS operation, worked with medical personnel in emergencies in the field, etc.

Also, you have notnfactored in the cost for a full time medical director, maintenance, engineering, consumable medical supplies, equipment, and the lost goes on and on. For consumable supplies and medical equipment alone you are looking at $200,000 at least...

Also, do you have any idea what it takes to obtain CAAMTS accreditation? If you want to be taken seriously in the aeromedical industry, CAAMTS is becoming a must have. 

I am helping set up the medical side of a HEMS operation in Saudi Arabia, and we literally have an unlimited budget, and we are still having issues (albeit some are political) but the point I am trying to make is simply having the financial plan to make it work is not enough, and I think if you were to actually begin making purchases for this operation you would realize that you estimates are grossly under the mark and short sighted.

It looks like you intend to lead the aviation side of things, but do you have anyone giving you input on the medical side? You need someone full time just to plan and administrate the operation. Simply coming to a forum does not cut it.

Anyway, I have said enough already...the list of issues with this plan literally is endless. If you are serious about this, forget this idea for at least the next 5-10 years, build your time and get a job as a HEMS pilot, and you will begin to understand how much is actually involved in this industry. It is more than having a few medical people, an aircraft, and a place to lift off and land....mentalities like the one you are exhibiting are what causes the inexcusable number of fatalities in the aerated industry each year. 

I say all of these things with the utmost respect for your altruistic ambitions....


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## WTEngel (Sep 30, 2010)

*Importance of crew*

You seem to place a heavy importance on the pilots (comments like "paramedic along for the air ride" indicate your contempt for the medical personnel) but you don't seem to understand that without QUALIFIED personnel, you are nothing more than a really really fast hearse.

First of all, flight qualified RNs will cost much more than 60,000/yr including benefits. In fact, you would be lucky to find qualified flight paramedics to work for that. If you want to hire non qualified individuals, I am sure you can find individuals who have been turned down by other flight services who will work for what you can pay them, but you get what you pay for.

The nurses you will be getting from the hospital will have no knowledge of flight physiology, CRM, AMRM, or other topics that are flight specific. Also, keep in mind that you may be a good pilot, but do you have the knowledge necessary to be a HEMS pilot? Have you flown SIC with a HEMS operation, worked with medical personnel in emergencies in the field, etc.

Also, you have notnfactored in the cost for a full time medical director, maintenance, engineering, consumable medical supplies, equipment, and the lost goes on and on. For consumable supplies and medical equipment alone you are looking at $200,000 at least...

Also, do you have any idea what it takes to obtain CAAMTS accreditation? If you want to be taken seriously in the aeromedical industry, CAAMTS is becoming a must have. 

I am helping set up the medical side of a HEMS operation in Saudi Arabia, and we literally have an unlimited budget, and we are still having issues (albeit some are political) but the point I am trying to make is simply having the financial plan to make it work is not enough, and I think if you were to actually begin making purchases for this operation you would realize that you estimates are grossly under the mark and short sighted.

It looks like you intend to lead the aviation side of things, but do you have anyone giving you input on the medical side? You need someone full time just to plan and administrate the operation. Simply coming to a forum does not cut it.

Anyway, I have said enough already...the list of issues with this plan literally is endless. If you are serious about this, forget this idea for at least the next 5-10 years, build your time and get a job as a HEMS pilot, and you will begin to understand how much is actually involved in this industry. It is more than having a few medical people, an aircraft, and a place to lift off and land....mentalities like the one you are exhibiting are what causes the inexcusable number of fatalities in the aeromed industry each year. 

I say all of these things with the utmost respect for your altruistic ambitions....


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## akflightmedic (Sep 30, 2010)

Interesting comments...you have been given great information from some very informed people.

I invite you to visit flightweb.com if you have not done so already. They will be much more helpful.  

Might I also recommend John Wade being hired as a potential consultant as he has a lot of experience in air operations start up. You will find him on flight web.


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## Flight-LP (Sep 30, 2010)

Star Air Life said:


> Which Air Medical Provider in El Paso are you? I would like to research and learn more about your company, that is if you do have a company or maybe your just a paramedic that goes along for the air ride.......



Native Air, an Omniflight Helicopters company.  www.omniflight.com

I am the Clinical Specialist for the three medical platforms based at Ft. Bliss and El Paso International Airport.

Drop me a PM, i'd be happy to share any further information that may be beneficial to your cause.


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## Star Air Life (Sep 30, 2010)

WTEngel said:


> You seem to place a heavy importance on the pilots (comments like "paramedic along for the air ride" indicate your contempt for the medical personnel) but you don't seem to understand that without QUALIFIED personnel, you are nothing more than a really really fast hearse.
> 
> First of all, flight qualified RNs will cost much more than 60,000/yr including benefits. In fact, you would be lucky to find qualified flight paramedics to work for that. If you want to hire non qualified individuals, I am sure you can find individuals who have been turned down by other flight services who will work for what you can pay them, but you get what you pay for.
> 
> ...





There is a company about 140nm away that hardly ever use their HEMS. I spoke to the Medical Director and Administration and they are willing to transfer or to give me operations for our community since paper wise we will be doing way more flights than what they use. Can you tell me pros and cons should i join with them or simply make my own from scratch?



I want to thank you for you post, this is the type of information I need to proceed in this. I will research a little more in these areas you have mentioned. For the Medical Director part I like to think I have an advantage I have had my own practice for over 20 years in a small 38000 town. Speaking to current HEMS pilots and people in charge for the current service provided to our city they are excited and willing to be more home based. We are in great need of nurses heck even DR. we only have 2 surgeons myself included So the nurses will work for whatever we can pay them at the moment. I brought this idea up with fellow workers and including an ambulance group and everyone seems to be liking the project. you are correct I have no clue what I am doing hence I have never done it before. Everyone locally including the city, county the region are opening arms and letting this idea slowly turn into a reality.  Again, I will research your ideas and comments and get a little more familiarized. 

This is a project that I feel will serve our local and surrounding community and with the right qualified crew and qualified equipment I think we can proceed. 

Thanks,

Anthony


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## FlightMedicHunter (Sep 30, 2010)

This is single-handedly the most disastrous idea I have ever heard of.......There are a million HEMS setups in regards to medcrew staffing but your plan to have 2 RNs on standby with an unlimited supply of other nurses and EMTs just waiting to fly for whatever you pay them is just simply laughable.  Please don't follow through with this ridiculous plan....


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## Pittsburgh77 (Sep 30, 2010)

FlightMedicHunter said:


> This is single-handedly the most disastrous idea I have ever heard of.......There are a million HEMS setups in regards to medcrew staffing but your plan to have 2 RNs on standby with an unlimited supply of other nurses and EMTs just waiting to fly for whatever you pay them is just simply laughable.  Please don't follow through with this ridiculous plan....



He asked for helpful ideas, not criticism.


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## FlightMedicHunter (Sep 30, 2010)

Pittsburgh77 said:


> He asked for helpful ideas, not criticism.



Hey, if he's gonna put himself out there with these crazy ideas than he is fair game.....


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## EmtTravis (Sep 30, 2010)

If they are crazy idea's and you have more informative idea's then why not try and tell him those instead of just laughing at him.


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## FlightMedicHunter (Sep 30, 2010)

EmtTravis said:


> If they are crazy idea's and you have more informative idea's then why not try and tell him those instead of just laughing at him.



Ummmm, because it is simply to funny to stop laughing......


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## JJR512 (Sep 30, 2010)

EmtTravis said:


> If they are crazy idea's and you have more informative idea's then why not try and tell him those instead of just laughing at him.



Because some people cannot survive the day unless they find someone to pick on. The only way they can feel good about themselves is to know they've at least tried to make others feel bad about themselves.


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## FlightMedicHunter (Sep 30, 2010)

JJR512 said:


> Because some people cannot survive the day unless they find someone to pick on. The only way they can feel good about themselves is to know they've at least tried to make others feel bad about themselves.



You nailed it!!!  You're right,,,,I'm not actually worried about the possibility of a horrible HEMS operation being put into place that puts the lives of countless people in danger and will no doubt provide shoddy patient care (based on Anthony's business plan).  I'm actually just here to pick on him.....


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## EmtTravis (Sep 30, 2010)

JJR512 said:


> Because some people cannot survive the day unless they find someone to pick on. The only way they can feel good about themselves is to know they've at least tried to make others feel bad about themselves.



Yea I understand there are people out there like that but here I go thinking that people in EMS are people that enjoy helping others.. Foolish me


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## EmtTravis (Sep 30, 2010)

FlightMedicHunter said:


> You nailed it!!!  You're right,,,,I'm not actually worried about the possibility of a horrible HEMS operation being put into place that puts the lives of countless people in danger and will no doubt provide shoddy patient care (based on Anthony's business plan).  I'm actually just here to pick on him.....



Like I said if you  have any experience or more informative idea's to where his company wouldn't be so dangerous or shoddy then maybe tell him.  He is asking for information and if you have information then share if not why bother posting on his thread besides being a troll.


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## JJR512 (Sep 30, 2010)

FlightMedicHunter said:


> You nailed it!!!  You're right,,,,I'm not actually worried about the possibility of a horrible HEMS operation being put into place that puts the lives of countless people in danger and will no doubt provide shoddy patient care (based on Anthony's business plan).  I'm actually just here to pick on him.....



Well, with only 16 posts under your belt, I can't tell yet for sure, but I hope you're not here _just_ to pick on him.

Also, +1 to what EmtTravis just said.


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## FlightMedicHunter (Sep 30, 2010)

He has already made it clear that he has the staffing issue figured out.  He already got frustrated with the other guy for having to explain it to him twice.  So, if there is a guy that is trying to put a HEMS operation in service utilizing the absolute bare minimum in safety and training then I am simply going to LAUGH at him in hopes that he will realize his fallacy and move on with his life....HAHAHAHAHHAHAHAHAHAHAHHAHAHAHAAHHAHAHAHAAAAHAAAAA


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## JJR512 (Sep 30, 2010)

FlightMedicHunter said:


> He has already made it clear that he has the staffing issue figured out.  He already got frustrated with the other guy for having to explain it to him twice.  So, if there is a guy that is trying to put a HEMS operation in service utilizing the absolute bare minimum in safety and training then I am simply going to LAUGH at him in hopes that he will realize his fallacy and move on with his life....HAHAHAHAHHAHAHAHAHAHAHHAHAHAHAAHHAHAHAHAAAAHAAAAA



Great, because laughing at someone you think is stupid is going to smarten them up. We all know how that works.

By the way, I'm laughing at YOU now. Are you smarter yet?


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## FlightMedicHunter (Sep 30, 2010)

Actually........I think it's working!!!!  I DO feel smarter!!!  Keep doing it!!  Tell everyone else to join in !!!!!   This....is......AWESOME!!!


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## Flight-LP (Sep 30, 2010)

JJR512 said:


> Great, because laughing at someone you think is stupid is going to smarten them up. We all know how that works.
> 
> By the way, I'm laughing at YOU now. Are you smarter yet?



While I do not usually condone this methodology in posting, he does have a point. His insufficiencies of operational, aviation, and safety aspects have been clearly and factually pointed out. Past that, he deserves what he gets for failing to listen. If this posters laughter and direct name calling is what it takes to prevent another uneducated individual who sees the false prophet of money from killing our co-workers, then so be it!

Regardless, it all is irrelevant. He will never get a rotor provider license issued from TDSHS with his current thought process.


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## Flight-LP (Sep 30, 2010)

FlightMedicHunter said:


> Actually........I think it's working!!!!  I DO feel smarter!!!  Keep doing it!!  Tell everyone else to join in !!!!!   This....is......AWESOME!!!



And with my previous post being made, your point is also made. No need to further dramatize with others who probably agree with the delivery, just not the delivery method.


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## Ectopy (Sep 30, 2010)

Because unfortunately the way he's presenting (and the way he writes) makes me question if this is for real.


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## Star Air Life (Sep 30, 2010)

The way I am presenting things, is how things are as of now. I am learning as I go, necessary help will be used. Joining this forum, was to assist myself in developing the appropriate steps into providing the ultimate goal of assisting those in need and of coarse why not try to make some money out of it?? I challenge myself to continue moving further learning what needs to be learned and getting things done and follow the set rules. If my crew is not qualified or not the correct one you guys think I am going to scratch my plan? Now that's the funny part.....I can guarantee you, qualified crew will be used, and I will follow all of the steps and little by little step by step this will come to a reality. I am in the point where people, income, and all other fountains of help are provided as of now why not keep going forward? I think you guys have way to much time on your hands, typing thousands of forums in an emtlife.com forum? Wow, why other crazy guys like myself are trying to figure out how to develop something needed to assist those in need? Please continue..........I applaud you guys. Now that is funny.


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## LonghornMedic (Sep 30, 2010)

Star Air Life said:


> * I think you guys have way to much time on your hands, typing thousands of forums in an emtlife.com forum?* Wow, why other crazy guys like myself are trying to figure out how to develop something needed to assist those in need? Please continue..........I applaud you guys. Now that is funny.



You say you are coming here looking for help and then you pop off with that comment? I think you just lost what little respect you *had *here. Personally, I didn't think this thread or you were legit, but I gave you the benefit of the doubt. But not anymore. I think you're a troll.


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## Flight-LP (Sep 30, 2010)

Star Air Life said:


> If my crew is not qualified or not the correct one you guys think I am going to scratch my plan? Now that's the funny part......



Yeah, you do not have a choice. You must have an appropriately educated crew specific to the needs  air medical patients (as previously mentioned multiple times). To assist you in this endeavor, I took the liberty of forwarding your ideas to some friends on Wall St. in Austin for their opinion. In case your not aware, these are the individuals at TDSHS that would either approve or deny your provider application. Needless to say, I think they will be closely scrutinizing any upcoming applications to ensure complete compliance with State regulations. Your welcome. 

Also, you never did specify your geographic underserved location. Care to enlighten us?


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## medicRob (Sep 30, 2010)

I apologize if someone has already said this, but I don't have time right now to read every comment. 

CAMTS would be a great place to start. They are the Commission on the Accredation of Medical Transport Systems and they run the show.

Remember, there are minimal standards and some pretty expensive safety issues that must be addressed before accreditation. For instance, If one of the blades ends up damaged, you usually will be required to take the chopper out of service and replace ALL Blades. If I am not mistaken (And I may be), that would cost over $25,000. 

Talk to some of the head honcho's at Air Evac Lifeteam, some Flight Nurses and Paramedics, as well as Air Medical Pilots and Base Managers. They can help you a lot.

Also, who will be funding this venture? Do you have a medical center or a funding agency behind you? There are not many people that I can think of right off hand that can come up with millions of dollars in venture capital to start a business of such magnitude, especially not one that will require regular maintenance that can cost tens if not hundreds of thousands.

You would probably get better information if you posted this question on let's say, FlightWeb where they specialize in Aeromedical and Ground Critical Care Transport.


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## Star Air Life (Sep 30, 2010)

LonghornMedic said:


> You say you are coming here looking for help and then you pop off with that comment? I think you just lost what little respect you *had *here. Personally, I didn't think this thread or you were legit, but I gave you the benefit of the doubt. But not anymore. I think you're a troll.



Longhorn my apologies, That message was to those forum guest that just simply obstruct the way. If you have something helpful to share I am all ears, if not your right to you and to other I am just a troll.


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## Star Air Life (Sep 30, 2010)

medicRob said:


> I apologize if someone has already said this, but I don't have time right now to read every comment.
> 
> CAMTS would be a great place to start. They are the Commission on the Accredation of Medical Transport Systems and they run the show.
> 
> ...



I have been passed the checklist from the tdshs and currently trying to go down the list and respond to every request needed. CAMTS will be followed once we get green light form the state. We are in the process of talking to a county hospital that is going to back us up and I work in a private medical center which is also opening arms. A gentleman provided FlightWeb, I am learning and researching tons of info there. 

Thank You for your response!


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## Star Air Life (Sep 30, 2010)

Flight-LP said:


> Yeah, you do not have a choice. You must have an appropriately educated crew specific to the needs  air medical patients (as previously mentioned multiple times). To assist you in this endeavor, I took the liberty of forwarding your ideas to some friends on Wall St. in Austin for their opinion. In case your not aware, these are the individuals at TDSHS that would either approve or deny your provider application. Needless to say, I think they will be closely scrutinizing any upcoming applications to ensure complete compliance with State regulations. Your welcome.
> 
> Also, you never did specify your geographic underserved location. Care to enlighten us?




HAHAHA, Thank You, make sure you pass the info to Barry over in Austin. (thats who is taking my application) Would you like their number? (512) 458-7111 oh and they are not in Wall St. my friend, but you would know that right?????  oh wait Im the troll I didnt know that.


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## medicRob (Sep 30, 2010)

LonghornMedic said:


> helicopter that I've seen, that regularly takes on 2 patients, is the Bell 412.



Our service just recently went from the Bell 412 air frame to the utilization of two choppers, the EC-135 P2+ with single pilot instrumentation flight certification, enhanced ground proximity warning systems, Air traffic advisory systems, Weather Radar, XM Satellite weather, and 3 axis Autopilot which we use as our primary and the BH 407, which is equipped with a state of the art Terrain avoidance system. moving map display, and is fully equipped for night vision. 

I used to love the BH412 because I could have a patient on each side of me and the side loading abilities, in my humble opinion were better than the rear-loading rotor-wings like the EC135 because they didn't involve having to enter the danger zone of the chopper (The Rear rotor). It kind of broke my heart to see the 412 retired, she was a great air craft. When we would hook up our headsets, and hear the little siren sound as the rotors started.. well let's just say, I miss her. 

Starlife, I forgot to ask you in my last post if you have planned for the training costs associated with certifying your crew in night vision training, and keeping them current with ACLS, PALS, etc. 

Also, how are you addressing specialty certifications like FP-C or CFRN? Will you be requiring your Nurse and Paramedic (btw, RN/RN config will not work, an RN who is an EMT on the flight will work, but not just RN/RN) to have FP-C (In the Paramedic's Case) or CFRN/CCRN (In the RN's case) within a certain time of employment? Also, will you be paying for them to get these certifications and to keep them current?

I assume you have some kind of agreement with a surgeon at the receiving medical center that will take on the responsibility of training the air crew in some of the more advanced skills that air medical providers can perform. 

Which business model did you model your plan after? Care to share?


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## Ectopy (Sep 30, 2010)

Don't. Feed. The "surgeon" Troll. 

Star Air Flight (Hmmm similar to STARFlight huh), prove me wrong. I would be very careful who you're "bashing" as they are indeed very respected people in the air medical industry in Texas. 

Also, going to an online forum isn't the way most people start a multimillion dollar healthcare venture. 

If you're really a "surgeon" could you pass along a website/anything with your name on it and your hospital proving it's you?

If so, the few of us on here who are actively involved in CCT/Flight will be glad to help you.


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## Star Air Life (Sep 30, 2010)

medicRob said:


> Our service just recently went from the Bell 412 air frame to the utilization of two choppers, the EC-135 P2+ with single pilot instrumentation flight certification, enhanced ground proximity warning systems, Air traffic advisory systems, Weather Radar, XM Satellite weather, and 3 axis Autopilot which we use as our primary and the BH 407, which is equipped with a state of the art Terrain avoidance system. moving map display, and is fully equipped for night vision.
> 
> I used to love the BH412 because I could have a patient on each side of me and the side loading abilities, in my humble opinion were better than the rear-loading rotor-wings like the EC135 because they didn't involve having to enter the danger zone of the chopper (The Rear rotor). It kind of broke my heart to see the 412 retired, she was a great air craft. When we would hook up our headsets, and hear the little siren sound as the rotors started.. well let's just say, I miss her.
> 
> ...



There is a company not to far away that are not using the Heli as much as we need it which is the Bell 430 with the following EMS features: EMS Modifications, Left and Right Hand Attendant Seat, Rear Bench Seat Modification, Medical Flooring with Fluid Dam, Oxygen Storage, Secondary Medical Panel & Equipment Bar, IV Hooks (4), High Intensity Cabin Lighting, Secondary Medical Patient Restraint, Modular Medical Cabinet, Air Methods Patient Loading System, Shore Power Panel. 

We are debating weather to lease company or start ourselves from scratch. I am interested in the EC 135p2+ with IFR capabilities, Satellite tracked Night Vision Goggles, Advanced medical equipment including LP-12 monitors, LV1000 ventilators, IV infusion pumps, advanced drug supply and Intra Aortic Balloon Pump,Two units of blood and all the other goodies. There is a great opportunity in Dallas with a brand new one that will give us the specs we want as well as a full VIP config. I will check with the County reguarding the training thanks.


We currently have two Flight RNs that are excited for the job, as well as access to paramedics, great question about the training and for this I will bring it up to the County Hospital that is backing us up and see if they are willing to fund us the training to qualify the crew we need. I am pilot myself, and have a guy up in Dallas that is very familiar with the EC and just got laid off and is willing to lend hands.

The medical center(s) that are receiving the current HEMS have an agreement with both the county hospital and the private medical center that we have and if we move forward on this the agreement would continue except we would be using our own heli.

Our business plan is still in development gathering ideas, references etc. once we get everything we think we need, we will then pursue this with a proper organization that deals with setting up these type of service. We have the local city and surrounding counties including several Physicians that want to either invest or be a part of this dream. 

Great info MedicRob thank you!


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## Star Air Life (Sep 30, 2010)

Ectopy said:


> Don't. Feed. The "surgeon" Troll.
> 
> Star Air Flight (Hmmm similar to STARFlight huh), prove me wrong. I would be very careful who you're "bashing" as they are indeed very respected people in the air medical industry in Texas.
> 
> ...



I came to this Forum to get first hand knowledge from active EMS Flight personnel, I will be gladly to release my info once we move forward. In the mean time I will continue to be Dr. Troll to you. 

Thanks for your help........


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## Ectopy (Sep 30, 2010)

Why do you need a IABP when you are transporting from a county hospital with no trauma services?


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## WTEngel (Sep 30, 2010)

What area are you located in? Just wondering...

I was born and raised in Fort Worth, worked as a ground medic in the metroplex for 5 years and then flew with CMC Dallas doing CCT transports, fixed and rotor, throughout the country, and Western hemisphere.

Anyway...the aeromed community is small and tight knit, so I am trying to figure what part of the HUGE lone star state you are in...


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## WolfmanHarris (Sep 30, 2010)

I feel like successfully starting up in any industry requires a certain level of experience and expertise in that industry. This not only provides knowledge and understanding necessary to know what's required, but networking to find and recruit like-minded individuals with varying backgrounds to fill in their weak spots and build a successful team. It seems self-evident to me that if one is compelled to turn to an anonymous forum as a resource than they are either lacking either expertise, experience or both.

To the OP, I don't know you or your background. I have no experience in HEMS and frankly limited experience in EMS in general. I do have some advice though. If you want to make a go of any business and you don't have the expertise to answer all the questions and problems you come across, go find the best people you can to partner with and compensate them well. Any help you get online will at best be of limited utility.


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## looker (Sep 30, 2010)

WolfmanHarris said:


> I feel like successfully starting up in any industry requires a certain level of experience and expertise in that industry. This not only provides knowledge and understanding necessary to know what's required, but networking to find and recruit like-minded individuals with varying backgrounds to fill in their weak spots and build a successful team. It seems self-evident to me that if one is compelled to turn to an anonymous forum as a resource than they are either lacking either expertise, experience or both.
> 
> To the OP, I don't know you or your background. I have no experience in HEMS and frankly limited experience in EMS in general. I do have some advice though. If you want to make a go of any business and you don't have the expertise to answer all the questions and problems you come across, go find the best people you can to partner with and compensate them well. Any help you get online will at best be of limited utility.



Not to take this offtopic but it's possible to start a business that you have little experience in. I started EMS company without ever working in one or knowing anyone that worked in one. Granted i had 10 years experience in NEMT but still it's totally different animal. So OP could get this to work but he needs to make sure he got enough money to hold on till revenue starts to come in.


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## CAOX3 (Sep 30, 2010)

What's with the hostility.

There is tons of information on this forum sometimes you just need a shovel and some boots to find it.

Good luck with your business.


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## looker (Sep 30, 2010)

CAOX3 said:


> What's with the hostility.
> 
> There is tons of information on this forum sometimes you just need a shovel and some boots to find it.
> 
> Good luck with your business.



It's human nature. As professionals, they feel that if you get in to type of  business you should know what you're doing and not ask any basic questions. Which exactly what happened here.


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## Flight-LP (Sep 30, 2010)

WTEngel said:


> What area are you located in? Just wondering...
> 
> I was born and raised in Fort Worth, worked as a ground medic in the metroplex for 5 years and then flew with CMC Dallas doing CCT transports, fixed and rotor, throughout the country, and Western hemisphere.
> 
> Anyway...the aeromed community is small and tight knit, so I am trying to figure what part of the HUGE lone star state you are in...



I'm gandering a guess here, but I'd say San Antonio. AirLIFE is the only service in Texas flying 430's. Despite having 15 helicopters in a 150 mile radius, our OP feels an additional need for air services. Oh well, I wish him the best.

Star Air Life - If you are successful in making a positive outcome in even one high acuity patient's life, then I applaud you. Just please understand that you have a huge learning curve ahead. You cannot just throw together an air medical service. Despite advice from others comparing apples to oranges by comparing your dream to a ground ambulance service, you have to have a sound business and medical plan or you will not be successful. Quite possibly not even allowed to operate. We all are happy to offer assistance, but do not come into our online home and start talking crap about people who have demonstrated a superior level of knowledge of this industry. You asked the questions, don't get pissy when you get the answers. Good luck!


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## terrible one (Oct 1, 2010)

CAOX3 said:


> What's with the hostility.
> 
> There is tons of information on this forum sometimes you just need a shovel and some boots to find it.
> 
> Good luck with your business.



Type A personalities.


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## DarkStarr (Oct 1, 2010)

wow, for a minute i forgot i was on emtlife and thought i was reading the firehouse.com forums.


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## LonghornMedic (Oct 1, 2010)

Flight-LP said:


> I'm gandering a guess here, but I'd say San Antonio. AirLIFE is the only service in Texas flying 430's. Despite having 15 helicopters in a 150 mile radius, our OP feels an additional need for air services. Oh well, I wish him the best.



I hope not for his sake. Everyone and their brother has HEMS down there. All of Texas is pretty well covered by HEMS. I'd like to know where it is he's talking about.


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## usalsfyre (Oct 1, 2010)

There are a few places in far South and Southwest Texas that are served by the San Antonio area HEMS services, and it can take a long time to get the folks out. That said, you have to wonder if those few areas are not better served by a fixed wing service.


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## medicRob (Oct 1, 2010)

usalsfyre said:


> There are a few places in far South and Southwest Texas that are served by the San Antonio area HEMS services, and it can take a long time to get the folks out. That said, you have to wonder if those few areas are not better served by a fixed wing service.



I am not very familiar with Texas or Tx Hems at all, but from what I have read so far about the area from this discussion, fixed wing does sound like the way to go.


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