As 2017 begins, civilian helicopter medevac seems to still be an industry with ongoing accidents injuring or claiming lives still on the radar. At the same time, there’s news of a new helicopter service for children in Atlanta, called an “flying ICU” the first of its kind that can transport critically injured children and their parents. So there’s the potential for good news or ongoing bad news. This seems to be an industry that must inevitably have to make hard line decisions. Given the cost of a helicopter and staff to provide critical care intervention, one must consider how effective helicopter medevac service really is. There are perceptions that this is a glutted helicopter market serving few patients. Health care costs have not stopped escalating. There was a study in the Silicon Valley area of California that reviewed 947 trauma patients transported to their trauma center. Their findings were: only 22.8% of those patients possibly benefited from transport. In addition, they found that 33.5% of those patients were discharged from the ER and not admitted to the hospital. So what’s the problem? Are field personnel in need of greater training to be able to make more effective assessments? Another good question is: Did those transported between facilities by air have better outcomes than those transported by ground? Without a doubt, more research is needed so that the industry can make sound decisions that will improve life for those injured, and avoid tragic accidents claiming lives. Continued high cost transport certainly drives escalating health care costs. What can/ should the helicopter industry do? What might constitute best business practice?