The increasing popularity of skiing as a recreational sport has resulted in a greater number of major thoracic and abdominal injuries. These injuries, unlike the more common orthopedic injuries, are often life threatening. This 8-year study reviews 44 thoracic and abdominal ski injuries managed at an urban trauma center since the inception of a helicopter air evacuation program with in-flight resuscitation capabilities. Twenty-five per cent of the injured had signs of hemorrhagic shock, and nearly 60% required a major operation. The injuries were caused by high-speed collisions with stationary objects or other skiers and by falls. Three were penetrating injuries. Organs injured were: heart, lung, kidney, spleen, liver, rectum and abdominal wall, and more than half were multiple injuries. Almost half had associated orthopedic trauma. Resuscitation was initiated on helicopter arrival in these seriously injured patients (78% of helicopter-transported patients came to operation), and apparently contributed to the low mortality of 4.5%.