Sometimes there are outpatients that are not US citizens and/or have a medical necessity to be transferred, so these patients employ medflight services. As they require a nurse , and an IV monitor and care for narcotics , med flight fleets have to be coordinated with. Occasionally there are men or women who require an experienced nurse or a complete ICU/CCU setup while they fly. Everyday there are jet ambulance charters that are in service in whatever country they may be in. Med flight fleets occasionally are contacted by clients with a trained case worker.