There are high mountains around Oslo, which is located at the foot of the Oslo Fjord. The winter is rough, with snowstorms and secondary roads often closed, and people often ski long distances. Avalanches have buried many people. We started a physician-staffed ambulance helicopter service on June 1, 1978 out of the Central Hospital of Akershus, Oslo, primarily to get a physician to the scene as soon as possible. The helicopter is on alert 24 h a day and can take off in 2 min in the daytime and 15 min at night. In 86% of the cases, the helicopter can land within 50 m of the patient. At night, the landing places have to be more secure. The helicopter is a Bolkow BO 105, which can carry 2 patients, 1 pilot, 1 rescuer or paramedic, and 1 physician. In case of an accident on a lake, the paramedic is a frogman and in case of an avalanche we take a specially trained dog along. The pilot has vase experience with helicopter duty, and the paramedic has good medical and rescue experience. The physician has to be a specialist in emergency medicine and is usually an anesthesiologist. The team is always on duty at the hospital where the helicopter is stationed, only 100 m from the emergency entrance of the hospital.