Certified medevac fleets are contacted by clients with the help of the phone book. As they can not go on the usual airplanes , air ambulance crews have to be used. There are case patients that necessitate a top notch flight paramedic and emergency medical technician .. and these are the cases that are not good to be transported on the everyday commercial airplane charters. There usually are women and men that seek the services of fixed wing air ambulance operations because of the fact that they are noncitizens and need to be transferred to a specialized care center. There are air evacuation outfits which help patients anywhere in the world.