Whilst the public view of ‘air ambulance’ may be influenced by the profound media interest in helicopter emergency medical services (HEMS), the use of fixed wing air (FW) ambulances goes back almost as far as the history of powered flight itself and is little understood by the general public. FW patient transfer services may be regarded as ‘Cinderella’ services by some, but they collectively move thousands of patients around the globe every year, and all very quietly, without media interest, and often without recognition. Despite enormous leaps of technology and the establishment of aeromedevac criteria that occurred during the second world war and later times of conflict, modern international aeromedical transport bears little resemblance to the systems and services that were founded in the post WW2 era. Current fixed wing air ambulances are not just modern aircraft with state-of-the-art propulsion systems and complex avionics. They are also fitted with dedicated and often bespoke clinical interiors and aircraft-patient interface systems, as well as being loaded with modern complex air-portable medical equipment and ‘bedside’ laboratory analysers, and are staffed with expert critical care and emergency care health care professionals specifically trained in transfer medicine.