We describe our method of transporting critically ill patients in both fixed-wing aircraft and ground ambulances. The transport of critically ill patients has evolved from the military need to evacuate patients away from the battlefield. Trauma patients benefit from speedy transfers to tertiary centers. In “medical” patients, stabilization before transfer seems to be more important than speed. Specially equipped air and ground ambulances can function as mobile intensive care units. Our transport teams are composed of a physician, nurse, and respiratory therapist. Transfers are made from rural hospitals to tertiary care centers. Physicians trained in critical care can stabilize patients before transfer and decrease the risk of transport. Knowledge of the pitfalls of practicing medicine in ground and air ambulances can decrease adverse outcomes. Physiologic changes associated with flight in fixed-wing aircraft are easily managed when recognized. Public policy for the transfer of patients has been described in the 1986 Consolidated Omnibus Budget Reconciliation Act (COBRA), and this knowledge can help physicians avoid liability during inter-hospital patient transfers.