Germany was the first country worldwide to introduce physician-staffed Helicopter Emergency Medical Services (HEMS), with the inaugural mission flown in 1970. Since then, a dense and highly coordinated network has developed, supported by multiple operators under a national dispatch framework. This pluralistic system, combining public and private non-profit providers, has allowed for both stability and innovation—but also revealed systemic challenges over time.

This lecture will trace the historical development of HEMS in Germany and place it within the wider European context. It will highlight key structural characteristics, such as medical staffing, integration with ground EMS, and the importance of centralized clinical governance. Drawing from recent quality assurance efforts, the talk will discuss how Germany has begun to systematically identify weaknesses—ranging from inconsistent clinical standards to operational fragmentation—and how targeted initiatives now seek to address them.

Special attention will be given to areas currently under discussion in Japan, including night-time operations and overwater missions. European experiences in these domains will be shared, with a focus on safety, training, and regulatory approaches that may offer useful parallels or cautionary lessons.

The session aims to provide practical insights for countries seeking to strengthen or reform their HEMS systems through structured analysis and continuous improvement.

London's Air Ambulance has stood at the leading edge of prehospital critical care for over three decades, pioneering a model of consultant physician-delivered intervention in one of the world's most challenging urban trauma environments. This lecture traces the service's evolution—from a bold experiment placing doctors at the roadside, to a world-leading platform for innovation in trauma care.

We will explore the operational context that enabled the development of landmark clinical interventions, including prehospital emergency anaesthesia, resuscitative thoracotomy, and the early adoption of on-scene blood transfusion for major haemorrhage. As the scope of care has expanded, so too has the sophistication of intervention—arterial access, endovascular strategies for haemorrhage control, and the emerging frontier of prehospital ECMO are redefining the boundaries of what is possible before hospital arrival.

Through the lens of London's unique experience, this session will examine the principles, risks, and ongoing challenges in delivering complex interventions at the roadside—and how they inform the future of trauma care systems globally.