Both military and civilian settings have shown that a team approach through an excellent prehospital Emergency Medical Services system, an organized communication system, access to rapid air evacuation with a 'complete' medical team on board, and dedicated trauma resources allows a critically ill or injured patient optimal chances for survival. The Life Saver airborne emergency service, operated by Carraway Methodist Medical Center in Birmingham, Alabama, is a 'complete team' concept with a well trained emergency physician and a critical care flight nurse anboard every flight. The physician upgrades the level of care at the scene of an accident, lessens the referring physician's anxiety, maintains an intensive care unit environment during transport and intervenes of a life threatening emergency occurs, which cannot be predicted prior to lift-off. This report describes the development, operations, and results in the aeromedical transport of 1047 patients from January 2, 1981 to December 31, 1982. Trauma transports accounted for 47.5%, nonsurgical problems 47.8% and nontraumatic surgical patients representing the remaining 4.7%. The in-flight mortality was 0%. This type service is not appropriate for all hospitals to provide, but should be considered by major trauma and cardiac referral centers.