This session will focus on the implementation of HEMS transport throughout the US. The presentation will place an emphasis on how HEMS agencies are dispersed throughout the nation and how they are utilized in different regions. There will be a focus on flight physiology and important aspects of flight physiology that must be considered prior to making the decision to transport someone by air. This area of training is often lacking in resident education and can place a large financial and logistical burden on the healthcare system as a whole. After this lecture the audience should be able to clearly identify when HEMS is needed and how to manage patients appropriately to set each one up for a successful flight. This session was recorded on Tuesday, April 30, 2024 at the 30th Annual Scientific Assembly (AAEM24) in Austin, TX.