The battlefields of Korea and Vietnam saw the first large-scale uses of aeromedical transport for critically wounded individuals. It was estimated that in Vietnam no soldier was more than 35 minutes from definitive care due to helicopter transport, resulting in improved outcomes from multiple trauma. Despite this success, however, it was not until 1972 that the first hospital-based aeromedical transport program was started in Denver, Colorado. Since then, the number of helicopters in the United States has grown to 200, with each generation undergoing numerous changes. Each modification has brought with it increased safety and greater patient diversity. There are specific issues related to safety, cost, patient outcome, and time savings, however, that must be considered during program development. Operational guidelines and emergency medical services (EMS) protocols must be designed to consider each of these issues in determining appropriate utilization. Research has demonstrated that rotor-wing air medical transport services have the capability of extending regional trauma services by 150 miles with safe and efficient patient care. With ongoing research, the next generation of transport systems will have a more clearly defined role and function within EMS.