Background: Helicopter Emergency Medical Services (HEMSs) improve trauma outcomes by enabling rapid transport to specialized centers. In Saudi Arabia, HEMS is expanding through a partnership between The Helicopter Company and the Saudi Red Crescent Authority. However, regional outcome data remain limited. This study examines the characteristics and outcomes of trauma patients transported by HEMS to a Level I trauma center in Riyadh. Methods: This retrospective study reviewed 541 adult trauma patients transported by air ambulance to a tertiary hospital in Riyadh between January 2021 and July 2024. Data from the hospital’s trauma registry and electronic medical records were analyzed for demographics, injury mechanisms, prehospital interventions, trauma team activation, and survival outcomes. Results: Most patients were young men (85.4%), with motor vehicle accidents (87%) as the leading cause of injury. Blunt trauma accounted for 98% of cases. Prehospital interventions included intubation (13.1%) and chest tube insertion (7.4%). Trauma team activation occurred in 28.5% of cases. More than half of the patients were discharged home without requiring emergency interventions, suggesting potential overtriage. Survival analysis showed rates of 95.2% at 14 days and 93.3% at 30 days, with trauma severity, head and abdominal injuries, and prehospital intubation significantly associated with mortality. Conclusion: This study highlights the need to optimize HEMS utilization and prehospital triage protocols. Future multicenter studies should assess the broader impact of HEMS on trauma care in Saudi Arabia

Keywords: Helicopter Emergency Medical Services, trauma, emergency department, traumatic injuries.