OBJECTIVES: To determine overtriage rates (where air ambulance transport could have been avoided without compromising patient care) by reviewing the records of air ambulance transports from isolated coastal communities to the small rural hospital in Port McNeill, British Columbia, a remote coastal community on Vancouver Island. The category of patient being transported to this hospital by the air ambulance service was also examined.DESIGN: A 1-year chart review from Apr. 1, 1996, to Mar. 31, 1997.MAIN OUTCOME MEASURES: Demographics of the study group, site of origin of each air ambulance transfer, whether the liaison was a community health representative (CHR) or a registered nurse, and the final diagnosis by the receiving physician were all determined. In addition, subsequent management and patient outcome were also noted. After reviewing all of this information, a subjective decision was made as to whether the air ambulance transport was necessary or not.RESULTS: Forty-eight separate air ambulance transfers were carried out, all by helicopter, transporting a total of 51 patients (43 adults, 8 children). Forty-eight percent of evacuations originated from 2 communities off Vancouver Island. The overtriage rate was calculated at 22%. The area of minor trauma was particularly prone to overuse of the air ambulance.CONCLUSIONS: Just over 20% of emergency air ambulance transfers to Port McNeill Hospital probably were not necessary. This overtriage rate is consistent with that reported for air ambulance transports that take place between primary care hospitals and secondary or tertiary care hospitals.