The rapid increase in the use of helicopters for hospital transport during the 1980s is the culmination of several hundred years of military medical innovation. Mass battefield casualties spurred both technologic and medical changes necessary for today's sophisticated helicopter systems in use worldwide, particularly in the United States. The Napoleonic Era and the American Civil War provided the framework for the evolution of today's state-of-the-art emergency medical techniques. The use of airplanes to evacuate the wounded eventually led to using helicopters for rescue missions in World War II. The combat experiences of the United States in Korea, the British in Malaya, and the French in Indochina proved that rotary-wing aircraft were invaluable in reducing battlefield death rates. Any skepticism about the efficacy of helicopter medical evacuation was erased during the Vietnam conflict. As an integral part of the modern battlefield, these specialized aircraft became a necessity. The observations and experience of American servicemen and medical personnel in Vietnam established the foundation for the acceptance of helicopter transport in modern hospital systems.