The Commission on Accreditation for Medical Transport Systems (CAMTS) did a survey in 1998 to determine what motivated a service to apply for accreditation. Findings were surprising in that 77% of the participants chose “to demonstrate a level of quality” as their foremost motivating factor. In 2006, CAMTS will conduct a follow-up survey. We expect to find a larger number of programs applying for accreditation primarily because it is needed for state requirements or managed care contracts or because their competitors are accredited. There have been many changes in the way air medical transport services do business since 1998. There are fewer hospital-based and more independently owned services. In 1998, there were many single-based rotor-wing services. Today, we see many more rotor-wing services with multiple bases surrounding a coverage area like spokes on a wheel. Fixed-wing services are still primarily owned by aviation charter companies. In 1998, only two states required CAMTS accreditation (Rhode Island and Utah). Today six states (Rhode Island, Utah, Washington, Michigan, Colorado, and New Mexico) require CAMTS accreditation to obtain a state license. Several counties in California and Nevada require CAMTS accreditation, with several more states working on a CAMTS accreditation requirement as part of their licensing process. Massachusetts has started a trend of requiring CAMTS accreditation for licensing ground critical care services. CAMTS is also more recognized today than it was 8 years ago. For example, British Airways recently asked for a referral list of all the accredited services that provide long distance fixed-wing transport. They will no longer transport stretcher patients and will refer customers with that need to CAMTS-accredited services. No matter how the face of doing business has changed or what the motivating factor is, the benefits of going through the accreditation process remain fairly constant. For example, when a program is preparing for accreditation, the entire staff becomes involved. Often initial and continuing education is updated or introduced that had not previously been provided to medical personnel. Jonathan Godfrey tells how his program was preparing for accreditation and how the survival course they received was still fresh in his mind when he became the only survivor of a fatal crash in January 2005. After the LifeEvac EC135 helicopter crashed, Jonathan found himself ejected from the aircraft with traumatic injuries and still strapped into his seat, completely submerged in the Potomac River. Recalling the survival principles he was taught, Jonathan was able to save his own life. The value of an audit, such as that provided by CAMTS site surveyors, is also a benefit of accreditation that cannot be underestimated. As one program stated, “The site surveyors were very thorough in their inspection, and that is exactly what we wanted.” Whether the accreditation decision is favorable or not, the process of measuring a service against national standards is a positive learning experience. As another program stated, “Our survey was very in-depth, and it was a great learning experience. We thought we would be criticized if things weren't right, but instead we really learned a lot.” About 65% of the medical transport services that are site surveyed for the first time do not achieve full accreditation. Most of these services have worked hard to improve patient care and safety and often achieve accreditation after the second attempt. This is ultimately the value of accreditation and the main purpose of CAMTS—to improve safety and the quality of patient care and to be advocates for services with those same goals. As one program stated, “Achieving accreditation speaks volumes about the quality of our program. We are proud of the improvements we made while striving to achieve CAMTS accreditation.”