The paramount problem for the delivery of the medical services in the Orkneys has been that of effective transport. The development of an efficient air-ambulance service has had a major impact on medical care. The service started in 1934, but was abolished at the outset of the Second World War and did not recommence until 1967. This paper examines the evolution of the air-ambulance service in the Orkney Islands, and describes alternative proposals for the use of aircraft in this region.