Points toward a dedicated air ambulance
The patient is unstable or at meaningful risk of deteriorating in flight. They require ventilation, continuous infusions or intensive monitoring. They cannot sit upright and no stretcher option is available on the route. The transport is urgent and cannot wait for airline clearance. The location has limited or no suitable scheduled services.
Points toward a medical escort
The patient is stable and their condition is not expected to change materially in flight. They can tolerate the seated journey, or a lie-flat premium seat. Their equipment needs are modest and can be approved by the airline. The route is well served by carriers. Cost matters and the clinical picture allows the lower-cost option.
The middle ground
A commercial airline stretcher covers some patients who cannot sit but do not need intensive care, where the airline offers it and there is enough lead time to arrange it.
How the decision is actually made
By reviewing the current medical report against the specific journey: duration, connections, altitude considerations, and what happens if the patient's condition changes en route. A responsible provider will recommend the lower-cost option when it is safe, and refuse it when it is not.