Helicopters have been used for the evaluation of civilian casualties since the 1960s. This trend has been increasing and a number of helicopter emergency services have now commenced in the UK. Despite these developments, little attention has been paid to their exact role, and the potential benefits to patients. In addition, the costs of such services are high, and the risks to patients and staff from air accidents are considerable. Similar or improved results may be obtained through the use of more cost-effective ground-based units. Judicious placement of both helicopter emergency services and land-based 'flying squads' in an integrated accident service may contribute usefully to better care of patients. However, enthusiasm for helicopters should not lead to a waste of resources and should be accompanied by careful consideration, planning and audit of their use.