According to the World Health Organization, cardiovascular diseases such as heart attack and stroke accounted for an estimated 19.8 million deaths in 2022, making them the leading cause of death globally. In the United States alone, the Centers for Disease Control and Prevention reported that accidents and unintentional injuries were the third-leading cause of death in 2023.
These realities make the timely delivery of lifesaving medical care essential. Yet, even as demand continues to rise, the air medical industry — a key component of the acute care ecosystem — is facing significant headwinds.
Aside from ever-rising operational costs and complex regulatory and cost-recovery environments, the human factor is perhaps the industry’s most pressing challenge. Across the board, air medical providers report investing more effort in recruiting the pilots, clinicians, and aircraft maintenance technicians needed to keep their aircraft flying.
Part of this is due to increased competition for pilots and maintenance technicians. The Aircraft Owners and Pilots Association (AOPA) reported that major airlines hired more than 12,000 pilots during the post-pandemic surge of 2022 and 2023. In 2026, as many as 8,000 pilots could be hired as airlines respond to rising travel demand and mandatory pilot retirements.
Big operators need to pull their pilots from somewhere. Generally, they are vacuumed up from the regional airlines and smaller operations — including air medical providers — which then feel the staffing pinch. Whether it’s fixed-wing or rotary-wing, smaller operators typically can’t compete with the salaries and perks offered by the major airlines.
What air medical does offer, however, is career fulfillment. Britney Ratcliff, director of human resources at Metro Aviation in Shreveport, Louisiana, said it’s not uncommon for her to hear that transporting someone for lifesaving care is a feeling like no other.
“You are impacting someone’s life and the lives of their loved ones,” she explained. “People tell me that flying or maintaining an aircraft that does that important work gives them an incredible feeling of career satisfaction.”
Metro is a family-run company that currently operates from 132 bases across 29 U.S. states, employing about 600 pilots and 375 maintenance technicians. In total, the company owns and/or operates 169 helicopters and 17 fixed-wing aircraft.
On the aviation side, Ratcliff said the company’s biggest challenge is finding pilots with the required 2,000 to 2,500 hours of flight time.
“Many pilots who come to us at recruiting events are certainly qualified, but they do not meet the total flight time requirement for the position,” she said.
“On the maintainer side, it’s somewhat similar in that sometimes they only have experience with a certain airframe. We are helicopter focused. Maybe they’ve only ever worked on fixed-wing aircraft.”
For both positions, Ratcliff said location can also be a challenge, as bases in remote areas or regions with a high cost of living are sometimes difficult to staff.
While airline hiring “presents a challenge to our entire industry,” Metro counters with a variety of incentives to attract new staff, including sign-on and retention bonuses, relocation assistance, a competitive benefits package, continuing education, tuition reimbursement, and many company-paid benefits.
Metro also emphasizes high-quality training, with a helicopter flight training center attached to its Shreveport headquarters. The company is also breaking ground on a new onsite maintenance training facility.
Career development is another priority, with the company’s MetroU leadership training program welcoming students from every department.
To reach the next generation, Metro cultivates relationships with top schools.
“We want to educate students on the air medical option,” Ratcliff said. “We know it’s so common for them to sign up for flight school or A&P school so they can work at the airlines. But their options are so broad.”
The military is another important source of talent. Forty-three percent of Metro’s staff are veterans, and the company has participated in the U.S. Department of Defense SkillBridge program for the past five years.
Building reserves
At Texas-based Global Medical Response (GMR) — a conglomerate of leading air and ground emergency medical services providers — veterans represent a critical talent pool. According to the company’s self-reported data, roughly 67% of its helicopter pilots and 59% of its air maintenance technicians are military veterans.
REACH Air Medical Services is a division of GMR, operating primarily rotary-wing air medical services across seven western states. It employs more than 225 pilots, 130 maintenance technicians, and 350 clinical personnel.
Vicky Spediacci, chief operating officer at REACH, said pilots, maintenance staff, and medical clinicians are all in high demand, driven by industry growth and competition from other aviation sectors. This includes the airlines, as well as utility operations and aerial firefighting. On the clinical side, attrition can occur when professionals decide to return to a hospital setting.
To address workforce challenges, Spediacci said REACH maintains a reserve pool, or “strike team,” that can be deployed to fill staffing gaps at its bases.
“It has been our standard business model to have a reserve pool,” she explained. “But the number has changed in recent years, due to things like attrition and base growth. REACH now has 25 reserve pilots who are deployed to cover paid time off, short-term leaves or base growth.”
When it comes to recruitment and retention, Spediacci — herself a 32-year employee and the company’s first female helicopter pilot — said parent company GMR’s size, scope, and breadth are major advantages.
“We have ground or air operations in pretty much all U.S. states, so people can move to another state. Also, we grow our own leaders,” she said, adding that the organization’s size allows it to offer strong opportunities for both lateral and vertical career moves.
GMR offers a range of professional training through its in-house Leadership Development Program, designed to prepare employees for increasingly complex leadership responsibilities. Within that, the Regional Leadership Academy combines classroom instruction with operational and practical leadership development. The academy’s goal, Spediacci said, is to help regional
leaders build the skills needed to manage and lead high-performing teams.
“Getting the story out there” is key to attracting the next generation, Spediacci said.
“We’re not an everyday conversation at the kitchen table,” she explained. “We encourage our professionals to connect with the younger generation by speaking at colleges and interfacing with other professionals. We have an obligation to get our message out there, so people can get more interested in this unique profession.”
To bridge the pilot experience gap, Spediacci said GMR has hired candidates with slightly fewer than 2,000 hours of total flight time, then assigned them to ferry aircraft between bases to help them build the required experience.
Looking ahead at future workforce trends in helicopter emergency medical services (HEMS), Spediacci pointed to a U.S. Army plan to cut roughly 6,500 helicopter-related positions, including pilots and maintainers.
“That’s a potential threat when it comes to the pilot pool. The military is a very heavy pipeline for our industry. If that does transpire, how might that affect our network?”
As traditional talent pipelines continue to evolve, GMR is actively exploring innovative recruitment, training, and workforce development strategies aimed at strengthening the next generation of air medical professionals.
Developing soft skills
Colorado-headquartered Air Methods has been delivering air medical services in 48 U.S. states for more than 45 years. Today, it employs 1,237 pilots, 1,596 medical staff, and 679 maintenance technicians.
Stephanie H. Nelson, senior vice president of human resources at Air Methods, said there is intense competition for the same talent, including from hospitals operating their own flight teams, airlines, and other aviation operators. When one competitor raises compensation levels, for example, it often sets off a chain reaction.
“Base compensation is just the start,” Nelson said. “We are constantly looking at incentives, especially for harder-to-staff areas. We have sign-on bonuses, shift incentives and overtime pay opportunities.”
Air Methods also offers a leadership development program and provides an 8% match on employees’ 401(k) retirement savings contributions.
Every employee has access to SIREN, the company’s confidential mental health hotline — a service Nelson described as “an EAP [employee assistance program] on steroids.”
She added: “We are in such a critical environment and we need to support our teams. That means investing in the basics, like where do they live on-shift, investing in GLP-1 medications for employee weight loss, expanding all types of training, tuition reimbursements, discounts on gym memberships, and other perks.”
Several times each week, facilitators host online leadership development classes that include podcast and reading recommendations, targeted at lead pilots and clinical base leads.
“Most of our teams are away from their families for a significant amount of time when they are working,” Nelson added. “That can be tough. It’s important to develop soft skills to equip people to be great leaders. They must also understand our business model so they can think about how we can constantly improve.”
She said Air Methods’ ideal candidates are those with air medical experience or military backgrounds.
“Both categories are trained well. From a clinical standpoint, having that drive and ER experience is really key for all clinicians. We really are an in-air ICU.”
To elevate clinicians’ skills, Air Methods founded Ascend, a collection of premium educational courses — offered both online and in person — led by seasoned industry veterans. Ascend courses qualify for continuing education credits and are open to all members of the profession, not just Air Methods clinicians.
To attract young people, Air Methods offers internship programs, attends monthly college recruiting events, and maintains an extensive social media presence.
“I’m not worried about the next gen,” Nelson said. “It’s apparent they want to serve. I will say that this is a 24/7 operation and it’s very fast-paced. Saving lives speaks to a lot of people.”
Air Methods also values employees with military backgrounds.
“The military has a fast pace, high-risk approach,” she noted. “We somewhat speak the same language and we have such a military base here already. It’s important to support those who served our country; we can give them some skills that translate into civilian life.”
Creating clear pathways
The Association of Air Medical Services (AAMS) advocates on behalf of more than 600 air medical and critical care ground transportation providers around the world. Jana Williams, AAMS president and CEO, believes the future of air medical services will be defined not only by advances in technology and clinical care, but also by the industry’s ability to invest in its people.
“As healthcare continues to evolve and demand for critical care transport grows, our industry must remain focused on building a strong, resilient workforce equipped to meet tomorrow’s challenges,” she told Vertical Valor Plus.
To achieve that, clear pathways must be created for the next generation of clinicians, pilots, maintainers, communicators, and leaders. This includes expanding opportunities for mentorship and professional development while ensuring people have the tools they need to build fulfilling careers.
AAMS has invested in leadership programs that develop operational, safety, and resilience expertise throughout its member organizations. It is also working to cultivate a culture of mentorship across the industry.
“Our Flight Ready Institute is developing the next generation of flight crew members through hands-on training for critical care transport roles,” Williams explained. “On that same track, we also host our annual Air Medical Transport Conference, providing an invaluable opportunity to foster connections among people who have dedicated their lives to this work.”
One thing is certain: Demand for critical care transport is growing rapidly. To meet tomorrow’s needs, air medical providers are investing in their people today through targeted recruiting initiatives, competitive incentives, and professional development opportunities.
“AAMS believes workforce development is not simply one priority among many; it is the foundation upon which patient access, safety, innovation, and the long-term sustainability of transport medicine all depend,” Williams concluded.