If you are someone who lives in a rural area and have an accident that is life threatening, para-medics are called to assess the situation. If indeed, your injury is a life and death matter, a medical helicopter may be called to transport you to hospital. In this situation, you are at a disadvantage as a patient. You and family are frightened and feel you must rely on the judgment of the medic. In some instances, a helicopter may not be the right decision and may leave the family straddled with an incredible medical bill for transport. One’s insurance may or may not cover helicopter transport. In some instances, a patient may be billed up to $40,000 with no real means to pay for service. The medical helicopter industry rapidly grew with for-profit carriers. With this came patient consumer complaints and pleas for help as families were dogged for payment they could not meet. Unfortunately federal law has not helped to provide consumer protection. There is inadequate regulation of air ambulances that needs to be addressed at the state level. The federal Airline Deregulation Act of 1978 preempts states from regulating rates, routes or services of any air carrier. The Department of Transportation concludes that air ambulances are “air carriers.” Therefore, states are preempted from regulating their services. The big question is how to correct this gap and protect consumers who unsuspected are slammed with an exorbitant bill?