Quality Assurance (QA) is a vital aspect of the Connecticut Helicopter Emergency Medical Service (HEMS). The program has three components: 1. scene flight audit, 2. random chart audit, and 3. biweekly patient care QA conferences. The scene flight audit identifies patients who, in retrospect, may not have required helicopter transportation. These patients are identified by the following criteria: trauma score greater than 12 and injury severity score less than 16, emergency department deaths, discharged within 24 hours, medical patients. Patient care QA involves review of all flights. A random chart audit is a method of peer review of the written flight record for completeness. The scene flight audit was from 6/85 to 12/87, with 17/107 (16%) in group one, 0/137 (0%) in group two, 5/29 (17%) in group three, and 8/54 (15%) in group four not justified. There were four audit review periods, each with a feedback mechanism to share results with providers. Each audit resulted in a decrease in the number of non-justified flights. There were 57 patient care QA conferences with 231 cases presented. Technical errors and policy issues decreased over time. Random review of five charts/month were reported quarterly. Omitted elements of standard documentation decreased over time. QA can be accomplished in HEMS. Monitored areas should include appropriateness of flights, proper documentation, and patient care review. A QA program improves appropriateness of flights, medical record keeping, and care given.