Abstract Since the early helicopter developments, there has been tremendous progress in performance, handling qualities, comfort and efficiency. This is why helicopters have conquered their niche in the aircraft market despite their very limited capabilities in terms of maximum speed and range or fuel efficiency, especially when compared with modern fixed wing aircraft. However, some features make helicopters very useful for many missions, which to date cannot be performed by any other contemporary series production aircraft. These features include their capability to hover, to climb or sink either vertically or almost vertically, to fly slowly in any horizontal direction (even backwards) and still maintain good handling qualities. When compared to other aircraft which are able to hover (e.g. tiltrotors or fixed wing vertical take-off and landing aircraft), they even show in that flight regime superior flight performances. These features allow helicopters to fly “nap of the earth” at low altitudes within an obstacle backdrop and land almost anywhere, even in confined areas (provided any obstacles do not present a threat level which is too high). These capabilities make helicopters prone not only to simply rescue people in distress (e.g. from mountains or ships in emergency situations), but also to provide full emergency medical service. This service is called helicopter emergency medical service (HEMS). No other aircraft is more suitable for such a service than helicopters. This is why many nations have established professional HEMS systems in their countries; ranging from young systems such as that adopted in Japan to the oldest one, located in Germany. This paper aims to first give an overview on some historical aspects on the development of HEMS. Secondly, it outlines HEMS Systems established in various nations like Germany, Switzerland, Japan, and the United States of America. Next the paper gives a short survey on statistical data on rescue helicopters and to some extent on noise aspects of helicopters in general. The latter topic will be discussed briefly, since noise problems are linked to all helicopters not just to rescue helicopters. Following this, some sobering facts on HEMS will be reviewed, more precisely the high number of accidents. Finally, the paper concludes with some remarks and gives a brief outlook on a research concept dubbed the “Rescue Helicopter 2030” which has been started recently at the Deutsches Zentrum für Luft- und Raumfahrt (DLR, German Aerospace Center).