INTRODUCTION: This study investigated the use of fixed-wing air ambulance in Iceland between 2012 and 2020. MATERIAL: Medical records were filled out during each flight and information afterwards entered into an electronic database. METHODS: The annual number of patient transports nationwide; triage scale category; reason for transportation, age and gender; and departure and arrival airports were analyzed. Response time and total transport time were compared between years and locations. Poisson regression analysis was used to compare the yearly number of transports. One-way ANOVA was used to compare response time and total transport time by year and departure site. RESULTS: In total, 6011 patients were transported in fixed-wing air ambulances during the study period. Majority were male (54.3%). Median age was 64 years (range 0-99 years). Most patients were transported due to medical conditions; 15.8% due to trauma. Thirty percent of women aged 20 to 44 years were transported due to pregnancy or childbirth. Two-thirds of patients were transported to Reykjavik (n=3937), and one-fifth to Akureyri (n=1139). Median response time for acute transports was 84 minutes (range 0-2870 minutes). Median total transport time was 150 minutes (range 50-2930 minutes). Differences were found in total transport time from departure locations (F=32.19; DF 9, 2678; p<0.001). Egilsstaðir, Norðfjörður, Höfn, and, partly, Ísafjörður had the longest total transport times. CONCLUSION: Icelandic air ambulance flights are often long, likely affecting outcomes for patients with time-sensitive medical conditions. Access to specialized healthcare is unequal among places of residence, and it is important to address this.