I've flown air ambulance and medevac in piston, turboprop, and turbojet equipment, from dirt runways to busy international locations. Quality of equipment and quality of life runs the gamut from excellent to substandard and anywhere in between.

I have done jobs that are nothing but administrative transports, and I've had patients put on the aircraft that are spraying bodily fluids, badly burned, axe and gunshot wounds to the face, and all kinds of infectious conditions. I've had to take a series of shots after transporting a patient. I've transported children dying of cancer, and dead children. Some transports have been rewarding, some heartbreaking, some in unfavorable conditions.

The one absolute in any ambulance operation is that decisions are made based on safety of flight and nothing else. I have turned around and gone home, cancelling harvest of a heart, because of safety of flight circumstances. I have turned flights down for safety of flight, when the pressure was on to make the flight by nurses, general managers, owners, chief pilots, etc. I have taken airplanes off the line and grounded them due to maintenance at busy ambulance operations, making them unavailable. No one will help you there, and often won't back you...but as a professional you need to know what you can and cannot do, what's safe and what is not, and you need to be able to draw a line when no one else will.

I worked at a particular operation that took all comers; that is, any call for a patient, we went, regardless of the patient's ability to pay. We didn't ask. We got stiffed on about 50% of our lifts; patients refused, insurance wasn't there, whatever. We also got a lot more calls from hospitals and clinics, because they knew we'd come.

By comparison, every one of our competitors had earned the reputation of only flying when the patient could pay. If the flight was being dispatched and the company learned that the patient didn't have good insurance, the aircraft mysteriously broke down, but was available five minutes later for a different call. Not legal Not ethical. Very common.

I refuse to work for operations like that. It's always been an important element of my employment that I find the work rewarding. I don't feel that way with a shady operation, and there are many. Use caution, and don't ever take a job that you're not willing to drop in a heartbeat. The life you save won't only be your own.