Having worked in remote areas of the southwest and southeast United States we experienced many situations where the decision to utilize the helicopter was not determined based on specific established protocols or patients medical needs but rather on the requirement for continuous availability of local ground EMS support in the area. As an example, utilizing ground transport from White River, AZ to either Phoenix or Tucson removes the local EMS unit (first responders) from the area for as much a 16 hours. That was coverage they could not afford to lose on a Saturday evening.