The Perils of 'Helicopter Shopping'

Published on March 25, 2026

The Perils of 'Helicopter Shopping'

Montana’s air medical operations are central to the provision of care in austere, rural, and often frontier environments throughout this state.

The care team and specialists needed for the care of a specific patient’s diagnosis may be hundreds of miles away, yet still in state. Couple this need with Montana’s collapsing Emergency Medical Service (EMS) industry with 60% of EMS services listed as volunteer and every Montana county listed as an Ambulance Desert, and there is a clear and evident need for safe and efficient Air Medical Transport (AMT) (Montana EMS, Trauma Systems & Injury Prevention Program).

Helicopter shopping — the practice of contacting multiple air medical providers after one declines a mission — may pose a serious threat to patient and crew safety if proper notifications are not made. This article explores the origins, risks, and ethical implications of helicopter shopping and proposes actionable solutions to mitigate its occurrence.

Helicopter shopping refers to the act of calling successive helicopter air ambulance providers after one declines a mission, often due to weather or safety concerns, in hopes of finding one that will accept the flight. While intended to expedite patient care, this practice undermines safety protocols and increases the risk of fatal accidents.

Montana’s air medical industry has grown rapidly over the past decade, with increased competition among providers and technological advances in dispatch systems and aircraft. However, this growth has also led to fragmented communication and inconsistent safety standards.

Each provider caring for a patient has an ethical responsibility to provide definitive care for their patient, which may or may not include the need for legal transfer through EMTALA (Frew & Giese, 2019). That ethical and legal obligation is also balanced with the need to provide a realistic risk versus benefit discussion for the transfer of the patient. Montana’s weather is such that often the benefit outweighs the risk. However, there are times throughout the year that the balance shifts with the weather and the risk becomes greater. Often this risk rebalances within hours, not days.

Risks and Consequences

• Accepting a flight previously declined due to weather or mechanical issues statistically increases the likelihood of crashes.

• Flight crews may feel pressured to accept marginal flights to remain competitive or meet performance metrics, depending on internal Safety Management Systems (SMS) of individual programs.

• Helicopter shopping undermines the judgment of the initial provider and fosters a culture of risk tolerance. Proper reporting of declined missions assists in mitigating this risk.

• Pilots may violate FAA safety standards and compromise CAMTS accreditation (National Transportation Safety Board).

Case Studies and Data

Several tragic incidents have been linked to helicopter shopping. According to the National Transportation Safety Board (NTSB), weather-related crashes often involve flights that were initially declined by other providers. The International Association of Flight Paramedics (IAFP) has published a position paper detailing the dangers and prevalence of helicopter shopping (International Assosciation of Flight Paramedics, 2006). EMS Flight Safety Network also highlights the ethical and operational failures that contribute to these outcomes (Shaffer, 2016).

• A position paper authored by the International Association of Flight Paramedics, now the International Association of Flight and Critical Care Paramedics (IAFCCP) advocates for centralized dispatch systems and transparency in weather-related turndowns.

• EMS Flight Safety Network has emphasized the moral responsibility of dispatchers and medical personnel to respect safety decisions (Shaffer, 2016).

• The Emergency Nurses Association (ENA), the International Association of Flight & Critical Care Paramedics (IAFCCP), and the Air & Surface Transport Nurses Association (ASTNA) supports selective resource management and responsible helicopter utilization through hazard information sharing so pilots and air medical crews are capable of making an informed decision (Air & Surface Transport Nurses Assosciation, Emergency Nurses Association, International Association of Flight and Critical Care Paramedics, 2018).

• The Federal Aviation Administration (FAA) and National Emergency Medical Services Pilot Association (NEMSPA) encourage education and awareness campaigns to reduce unsafe flight acceptance practices (United States Department of Transportation, 2025), (National EMS PIlots Association).

Recommendations


• Weather and hazard logging. Montana specifically highly encourages operators to use the Weather Turndown service.

• Complete outreach provider education on the risks of helicopter shopping without sharing the information with another service.

• Require dispatch centers operating within the state to ask, “Has this request been turned down by another service?”

• Education and training to EMS, hospital staff, and public service access points about the risks of helicopter shopping.

• Adopt helicopter shopping education into quarterly advisory councils with trauma and EMS as an annual update to compensate for the continual turnover of staff.

Conclusion

Helicopter shopping is a preventable hazard that endangers lives and undermines the integrity of air medical services. Montana cannot afford to lose valuable critical resources to preventable mishaps, incidents, and accidents that can be avoided. Montana can help lead the industry by initiating informed policy, timely, and simple education, and ethical leadership, which will protect both patients and providers.

Current Air Medical Subgroup Membership
  • Benefis Mercy Flight
  • Sidney Care Flight
  • LifeFlight Network
  • Billings Clinic MedFlight
  • Logan Health Alert
  • Montana Medical Transport
  • Intermountain Health HELP Flight
  • Two Bear Air
  • Northeast Montana Stat Air Ambulance
  • Montana State Trauma Committee
  • Montana State Emergency Medical Services Advisory Council
  • Referring and Receiving Hospital representatives
References

Air & Surface Transport Nurses Assosciation, Emergency Nurses Association, International Association of Flight and Critical Care Paramedics. (2018). Joint position statement: Responsible "helicopter shopping" through selective resource management.

Frew, S. A., & Giese, K. (2019). EMTALA field guide: Quick risk and compliance answers. Loves Park, IL: MedLaw.

International Assosciation of Flight Paramedics. (2006, September). Position Paper on Helicopter Shopping. Retrieved October 22, 2025, from https://cdn.ymaws.com/i-capp.org/resource/resmgr/docs/helicoptershopping.pdf

Montana EMS, Trauma Systems & Injury Prevention Program. (n.d.). EMS, trauma, and injury prevention systems. Retrieved October 20, 2025, from Montana's EMS agencies and trauma centers: A system in crisis: https://dphhs.mt.gov/assets/publichealth/EMSTS/Trauma/SystemInCrsisInfographic.pdf

National EMS PIlots Association. (n.d.). The hazards of helicopter shopping. Collierville, TN, United States. Retrieved October 24, 2025, from REsou: https://www.nemspa.org/education

National Transportation Safety Board. (n.d.). Safety research: Accident data. Washington, DC, United States. Retrieved October 28, 2025, from https://www.ntsb.gov/safety/data/Pages/Data_Stats.aspx

Shaffer, T. (2016, August 11). EMS helicopter shopping: Dead wrong. Retrieved from Flight Safety: https://flightsafetynet.com/helicopter-shopping-price-worth-paying/

United States Department of Transportation. (2025, October 28). Providing the safest, most efficient aerospace system in the world. Retrieved from Federal Aviation Administration: https://www.faa.gov/