During the last ten years, both in Western Europe and in the USA, the attitude towards medical transport activities has radically changed. From being a purely transportation vehicle the ambulance is now increasingly regarded as an extended arm of medical care. At the same time as ambulance crews have received more qualified medical training, the equipment of the ambulances themselves has been improved. In several countries such as the USA, France and West Germany, a differentiated ambulance organization has been built up, with specially equipped emergency ambulances manned by paramedics, and standard ambulances with emergency technicians for planned transports. During this time helicopters have been put into increasing use as a supplement to ambulances for emergency long distance transport to units such as trauma and burn centers.