- Air ambulance is indicated when ground transport takes ≥30 minutes, when an island/maritime transfer is required, or when trauma criteria are met (e.g., adult trauma score <12) per the Ministry of Health Circular B.10.0.TSH.0.16.08, §7.3.
- In Türkiye the Ministry of Health operates 15 helicopter bases plus a three-aircraft fleet based at Ankara Esenboğa; helicopters fly only sunrise-to-sunset, aircraft 24 hours.
- Absolute contraindications: untreated pneumothorax (or similar pressure-sensitive pathologies), undecontaminated chemical/radioactive exposure, and violent psychiatric cases.
- Use ground ambulance for in-city emergencies and stable planned intercity transfers; reserve air ambulance for time-critical trauma and geographically isolated patients.
- Nova Ambulans operates its own ground ambulances (emergency and ICU configurations); for planned and international transfers it coordinates air ambulance (medical jet) charter, medical escort on scheduled flights, and cross-border road ICU transport (to Europe and neighbouring countries) end to end via accredited partners. Only emergency in-country public air-ambulance tasking routes through 112 and the Health Command and Control Centre (SKKM).
In an emergency, the choice between air ambulance and ground ambulance is not the patient's family's call — it is the output of a decision table. In Türkiye that decision table is set by the Circular B.10.0.TSH.0.16.08 — Principles for the Operation of Ambulance Aircraft, issued by the Ministry of Health in 2008 and still in force. [1] Sections 7.3 and 7.4 of the Circular specify which clinical picture warrants which transport mode using thresholds on Glasgow Coma Score, blood pressure, distance and geography.
But this decision table governs only the public emergency system. For planned intercity and international (repatriation) transfers the picture changes: which transport mode is used — air ambulance, medical escort on a scheduled flight, or road ICU transport — is decided by the patient, their family or their insurer together with a private transport operator such as Nova Ambulans. This article covers both contexts: first the public emergency air-ambulance system and its indications, then how Nova Ambulans coordinates air and multimodal logistics for planned and international transfers.
Quick Answer
In Türkiye, air ambulance is indicated when ground transport time exceeds 30 minutes, when island or maritime transport is required, or when life-threatening trauma criteria are met. According to the Ministry of Health's Directorate General of Emergency Health Services, in the first eight months of 2025 the 15-base helicopter ambulance fleet flew approximately 4,000 hours and transported 2,600 patients. [5] Most in-city emergencies are handled by ground ambulance — cheap, immediately available, and not weather-dependent.
In an emergency: Citizens cannot directly summon the Ministry of Health's public air ambulance. All emergency calls go to 112; the duty advising physician at the Health Command and Control Centre (Sağlık Komuta Kontrol Merkezi, SKKM) decides whether a public helicopter or aircraft is dispatched. [1] For planned or international transfers: For non-emergency scheduled transfers and international repatriation, you can approach a private operator such as Nova Ambulans directly to arrange an air ambulance (medical jet), medical escort on a scheduled flight, or road ICU transport. We detail this channel in the section "How Nova Ambulans Steps In for Air and Multimodal Transport" below.
How the Turkish Air Ambulance System Works
Türkiye runs air ambulance operations as a joint project between the Ministry of Health and the Directorate General of Civil Aviation (Sivil Havacılık Genel Müdürlüğü, SHGM). The SHGM corporate page states that the "Ambulance Helicopters project was launched in coordination with the Ministry of Health" [6]. The legal definition of an air ambulance is set out in Article 5(1)(b) of the 8 January 2025 Regulation (RG-8/1/2025-32776): the aircraft must be "airworthiness-certified by the Directorate General of Civil Aviation" and carry the medical equipment specified in Annex-3; Article 7(2) requires "at least one physician and one health professional" on board [4]. The fleet has two main classes: helicopter ambulances and aircraft ambulances.
Helicopter Ambulances: 15 Bases, 400 km Radius
The Ministry of Health's Directorate General of Emergency Health Services notes that "a total of 15 ambulance helicopters provide uninterrupted air ambulance service throughout the country" [2]. Bases are stationed in: Ankara, Çanakkale, İstanbul, İzmir, Adana, Antalya, Konya, Samsun, Trabzon, Erzurum, Kayseri, Malatya, Van, Diyarbakır and Sivas.
Operational limits are explicit:
- Flight duration: Continuous 2 hours 30 minutes maximum.
- Operational radius: 400 km from each base without refuelling.
- Service hours: Sunrise to sunset. Night flights are not routine in the current system. [2]
- Launch time: Under §3.6 of the Circular, helicopters "shall launch within 7 (seven) minutes of mission order, weather permitting" [1].
The Republic of Türkiye is preparing a domestic boost to this fleet in 2026. In the Anadolu Agency report dated 28 September 2025, Director General of Emergency Health Services Assoc. Prof. Dr. Eray Çınar stated: "In 2026 we will strengthen our fleet with three Gökbey helicopter ambulances that have completed civilian certification" [5]. Compared to current helicopters Gökbey offers longer range and better meteorological tolerance.
Academic evidence supports the investment. According to Enomoto et al.'s 2024 systematic review and meta-analysis, helicopter emergency medical service (HEMS) in pediatric trauma patients significantly reduces mortality compared to ground emergency medical service (GEMS); helicopter emergency medical service (HEMS) was associated with lower mortality (odds ratio 0.66, 95% CI 0.59 to 0.74) [7]. More recently, Fritz et al. (2025) showed that for severe traumatic brain injury (Glasgow Coma Score, GCS < 9), helicopter emergency medical service (HEMS) scene response saves one life per 19 transports (number needed to treat, NNT = 19; 95% CI 15–28) [8].
Aircraft Ambulances: Ankara Esenboğa Hub and 24-Hour Service
The Ministry's fixed-wing fleet has a different profile. The Directorate General of Emergency Health Services states that "aircraft ambulances differ from helicopter ambulances which operate sunrise-to-sunset by providing 24-hour service capability" [3]. Fleet details:
- Total aircraft: 3 fixed-wing ambulances.
- Stretcher configuration: 1 aircraft with 4 stretchers, 1 with 2, 1 with 1. [3]
- Base: Ankara Esenboğa Airport. [1]
- Coverage: "Service is provided both domestically and internationally." [3]
- Launch time: Under §3.7, aircraft launch within 60 minutes of mission order. [1]
High speed, long range, high ceiling and adjustable cabin pressure together enable international medical transfers on these aircraft. While the helicopter's 400 km operational radius defines domestic dispatch, the aircraft ambulance is the backbone of repatriation operations from abroad. [3]
This public fleet is not the only party that can arrange aircraft-ambulance transport. Private-sector medical jets — airworthiness-certified by the Directorate General of Civil Aviation (SHGM) — can be chartered for non-emergency planned and international cases; in this channel the transfer decision belongs not to a public advising physician but to the private operator the patient's side engages. Nova Ambulans handles the coordination of this private channel — see the section "How Nova Ambulans Steps In for Air and Multimodal Transport" below.
Air Ambulance Indications: What the Ministry Says
Section 7.3.1 ("General Criteria") and 7.3.2 ("Anatomical and Physiological Findings") of the Circular set out a two-layer indication list. Presence of any one or more of the following is sufficient to task an air ambulance [1].
General Criteria (Geography, Distance, Operations)
These apply regardless of clinical picture [1]:
- Time threshold: Ground ambulance travel time to scene exceeds 30 minutes.
- Geographic obstacle: Terrain or weather makes road access difficult or impossible.
- Clinical urgency: Time spent on road transport to an appropriate health facility threatens patient survival or risks permanent disability.
- Geographic isolation: Patient transport required from islands or over sea. (Directly applicable to the Istanbul Princes' Islands; for after-call standby see our waiting-for-the-ambulance guide for relatives.)
- Newborn / ICU: Preterm/newborn patients requiring NICU transport, or critical patients with no ICU bed in their province.
- Organ transplant: Transport of organs, transplant recipients or transplant teams.
- Multi-casualty: Transport of multiple patients/casualties at once.
- Disaster: Disasters or extraordinary situations.
Anatomical and Physiological Findings
When the clinical picture crosses any of the following thresholds, air ambulance becomes a candidate [1]:
| Parameter | Adult threshold | Pediatric threshold |
|---|---|---|
| Glasgow Coma Score (GCS) | <10 | <12 |
| Systolic blood pressure | <90 mmHg | Below age-appropriate value |
| Respiratory rate | <10 or >30 / minute | Outside age-appropriate range |
| Trauma score | <12 | <8 |
Section 7.3.2 also lists these clinical states as indications [1]:
- Unconscious or progressively deteriorating consciousness.
- Respiratory arrest or apnea.
- Open injury to chest, abdomen, head, neck or groin.
- Fractures predicting progressive shock (≥2 long-bone or pelvic fractures).
- Limb amputation; spinal injury with neurological findings.
- Burns over >20% of body surface area (2nd–3rd degree) or affecting face / neck / hands / feet / genitals; inhalational or chemical burns.
- Drowning and multi-trauma.
- Vascular events requiring fibrinolytic therapy — particularly stroke patients requiring clot-busting therapy within hours.
- Acute coronary syndrome — particularly heart attack patients needing rapid transfer to a center capable of percutaneous coronary intervention (PCI).
Per Bekgöz's analysis in the Turkish emergency medicine community publication, helicopter emergency medical service (HEMS) provides clear benefit "for patients located more than 16 km from a trauma center where initial care has not been administered", with diminished benefit at shorter distances where ground EMS has provided initial care [9].
When Air Ambulance Is NOT Appropriate (Contraindications)
Section 7.4 of the Circular lists these absolute contraindications [1]:
- Untreated pressure-sensitive pathologies: Pneumothorax, pneumomediastinum, pneumocranium, gas gangrene, ileus. Acilci.net reinforces this: even at 2,000 m altitude, pressure drop expands pneumothorax volume; at 5,500 m the risk becomes serious [9].
- No landing area: Calls from locations with no suitable landing site or where security forbids access.
- Contamination: Radioactively or chemically contaminated patients who have not been decontaminated.
- Behavioural risk: Psychiatric patients with disturbance or potential for violence.
For these patients the right choice is ground ambulance (an ICU ground ambulance if clinically indicated) — and in the pneumothorax case, only after a chest tube has been inserted.
Call and Decision Process: Who Does What?
In the public emergency system no citizen dispatches an air ambulance directly. The hierarchical decision chain below applies only to emergency calls — that is, to the Ministry of Health's public fleet [1]:
- Citizen calls 112. Even cross-province calls land first at 112.
- SKKM advising physician evaluates. The duty advising physician at the Health Command and Control Centre (SKKM) — the Komuta Kontrol Merkezi (KKM) — reviews the information against §7.3.1 and §7.3.2. This physician holds the authority to decide whether air ambulance is indicated.
- Within area of responsibility: If air is indicated, a "mission can be assigned" instruction is issued to the air ambulance; the SKKM chief physician's approval is then secured, after which the "intervene" instruction is issued and the timestamp recorded.
- Out of area: If the helicopter must operate beyond its 400 km radius, the Komuta Kontrol Merkezi (KKM) applies to the Ministry Air Ambulance Operations Centre.
- Aircraft ambulance: Aircraft tasking is performed directly by the duty advising physician at the Air Ambulance Operations Centre.
This hierarchy binds only the public emergency system. As we explained in the difference between private ambulance and 112, Nova Ambulans has no authority to dispatch the public helicopter or aircraft fleet, and we never substitute ourselves for 112 in a genuine emergency. For planned transfers and international transport, however, the picture is different: in those cases which aircraft is used and how the operation runs is decided directly with the private operator. Here Nova Ambulans takes on three distinct roles: (1) the landing-site-to-hospital leg for a patient moved by public air ambulance, (2) long-distance ICU ground transfer when an air ambulance is not appropriate or unnecessary, and (3) end-to-end coordination of air-ambulance, scheduled-flight escort and multimodal transport for planned/international cases — detailed in the next section.
How Nova Ambulans Steps In for Air and Multimodal Transport
For planned intercity transfers, repatriations from abroad, and cases that chain several transport modes, Nova Ambulans plans and runs the whole transfer. Alongside operating its own ICU and emergency ground ambulances, it coordinates air and multimodal logistics end to end. The full scope of this service is on our international patient transfer page.
Air Ambulance (Medical Jet) Coordination
Arranging an aircraft ambulance is not the Ministry of Health's exclusive prerogative. ICU-equipped private medical jets with managed cabin pressure can be chartered for planned cases that are ventilator-dependent, require haemodynamic monitoring, or need long-range (international) transport. Nova Ambulans sources these jets through accredited air-medical partners; our 24/7 operations centre manages flight planning, airline/airport slot coordination, airline medical clearance forms (MEDIF/MEDA), customs permits for medical equipment, and bed reservation with the destination hospital. A physician or experienced paramedic stays at the patient's side throughout the flight.
For stable patients there is a more cost-effective option: medical escort on a scheduled flight. The patient travels on a commercial flight accompanied by a physician/paramedic, with a stretcher or supplemental oxygen arranged where needed. Airline medical clearance and any extra-seat/stretcher arrangements for this option are also coordinated by us.
Helicopter: We Don't Operate One, But We Organise It
Nova Ambulans does not operate a helicopter ambulance. But when a helicopter transfer is genuinely required in a planned case, we don't leave the process unaddressed: we route the need to our accredited air-medical evacuation partners, or organise the operation by sourcing a suitable medevac aircraft in the destination region or country. The ground segments (landing-site-to-hospital, home-to-airport) are then completed by our own ICU ground ambulances.
Cross-Border Road ICU Transport
Not every international transfer requires an aircraft. For patients who are clinically stable, not fit to fly, or for whom air costs are unjustified, Nova Ambulans performs cross-border road ICU transport in two directions, in its own ICU-equipped ground ambulance. Westward it covers the whole of Europe: because most of the European Union lies within the Schengen Area, internal borders generally have no systematic checks once you are inside it, which eases multi-country transit (e.g. an uninterrupted road run from Türkiye to Germany). Eastward and southward it reaches neighbouring countries such as Georgia, Azerbaijan, Iraq and Syria. With a ventilator, multiple infusion pumps and a physician/paramedic escort, and with border crossings and transit documentation planned in advance, the patient is moved door to door. This channel is also a safe alternative for patients affected by pressure changes (e.g. after a treated pneumothorax) or who cannot obtain flight clearance.
Multimodal (Combined) Transport: Example Scenarios
Most cases are solved not by a single vehicle but by chaining modes. Planning the whole chain from one operations centre prevents the handover gaps and time losses that fragmented transport creates. A few typical combinations:
- City + scheduled flight: Transport from Konya to Istanbul by medical jet or ICU ground ambulance, then onward from Istanbul to the final international destination with medical escort on a scheduled flight.
- Air + ground: Bringing a patient abroad back to Türkiye by medical jet, then delivering them from the airport to the target hospital by ICU ground ambulance (or vice versa).
- Ground + ground: Bringing a diaspora patient in Europe to their hometown hospital in Türkiye by road ICU transport.
Which combination fits best is decided by weighing the patient's clinical condition, distance, cost and urgency together. Nova Ambulans's 24/7 coordination unit runs the simultaneous communication with airline, airport, consulate, insurer and destination hospital from a single point.
When Is Ground Ambulance the Right Choice?
Air is not the default. Three categories favour ground.
In-City Emergencies — The Istanbul Case
In dense urban centres like Istanbul, emergency ground ambulances reach the scene quickly; the bottleneck is on-scene intervention, not transit. See our Istanbul ambulance response time 2025 report. The landing footprint, air-traffic coordination and total time often make helicopters slower than ground inside city limits.
Stable Planned Intercity Transport
For clinically stable patients with normal haemodynamics and no ventilator dependence, ICU-equipped ground ambulance is the correct choice. See our intercity patient transport guide. It is far cheaper than air and not weather-dependent.
Patients With Any Section 7.4 Contraindication
If any of the contraindications above apply (e.g. untreated pneumothorax), the answer is determined: stabilise first, then transport by ground. Air is not on the menu [1].
Cost, Access and Comfort Comparison
| Dimension | Air ambulance (public) | Air ambulance (private) | ICU ground ambulance |
|---|---|---|---|
| Cost | Covered by Ministry when indication met | High (hourly/km tariff) | Reasonable distance- and equipment-based tariff |
| Access | SKKM decision + approval required | Direct booking with a private operator (Nova Ambulans coordinates); SHGM-regulated | Direct call; verify licensure |
| Hours | Helicopter sunrise–sunset; aircraft 24-hour | Operator-dependent | 24-hour |
| Distance | Helicopter ≈400 km radius; aircraft international | Operator-dependent; often international | Domestic unlimited; cross-border road transfer to Europe and neighbouring countries |
| Clinical capability | ICU-level | ICU-level | Physician-led ICU-level |
| Weather sensitivity | High | High | Low (except snow/fog) |
Frequently Asked Questions
Does the citizen pay for an air ambulance call?
The Ministry of Health's helicopter and aircraft fleet is free for Turkish citizens when the indication is approved. Private-sector air ambulance (medical jet charter) is market-priced.
For Istanbul-to-Antalya transfers, air or ground?
Clinical status decides. Stable, non-ventilated, haemodynamically normal patients are best served by an ICU-equipped ground ambulance. If a time-critical condition like acute coronary syndrome or stroke is present, the SKKM evaluates air ambulance.
Can a helicopter land at a hospital without a helipad?
No. Section 7.1.2.4 of the Circular states that when the destination hospital has no helipad, "the nearest landing/take-off zone shall be identified and the flight crew informed"; the Komuta Kontrol Merkezi (KKM) then arranges sufficient ground ambulances for the final leg [1]. The last link between the air ambulance and the hospital is always a ground ambulance.
Can air ambulance be called at night?
Helicopter ambulances are sunrise-to-sunset. Aircraft ambulances cover night hours (Esenboğa-based, 24-hour) [3]. According to Anadolu Agency, in 2026 Gökbey "may have night-vision capability evaluated and added after delivery" [5].
Are air and ground ambulance used together?
Often yes. The air ambulance takes the patient from the scene to the closest landing site near the hospital; a ground ambulance completes the landing-site-to-hospital leg. This is the integration model defined in §7.1.2.4 of the Circular [1]. In planned and international cases, air and ground modes are combined into much longer chains; Nova Ambulans handles this multimodal coordination.
Can Nova Ambulans arrange an air ambulance or international transfer?
Yes. Although Nova Ambulans operates its own ground ambulances, for non-emergency planned and international transfers it coordinates air and multimodal logistics end to end: air-ambulance (medical jet) charter for critical patients, medical escort on scheduled flights for stable patients, and cross-border road ICU transport to Europe and neighbouring countries. We do not operate helicopters, but when one is genuinely needed we arrange it through accredited air-medical evacuation partners or by sourcing a medevac aircraft in the destination country. Airline medical clearance (MEDIF/MEDA), customs, visa and destination-hospital coordination are handled by our 24/7 operations centre. In a genuine emergency, always call 112 first.
Related Posts
- Istanbul Ambulance Response Time: 2025 Data — in-city response times.
- How Intercity Patient Transport Works — planning long-distance ground transfer.
- When Is an ICU Ambulance Required? — ground ICU indications.
- Red vs Blue Stripe Ambulance Difference — Türkiye's four ground ambulance classes.
- How to Verify a Licensed Private Ambulance — operator verification steps.
- International Patient Transfer Service — air ambulance, scheduled-flight escort and cross-border road transport coordination.
Intercity Ambulance Transfer Service
Safe and fast intercity patient transport across Turkey. ICU support included.
Average response time: 15 seconds
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- Principles for the Operation of Ambulance Aircraft (Circular B.10.0.TSH.0.16.08)T.C. Ministry of Health, Directorate General of Basic Health Services ↗
- Helicopter AmbulanceT.C. Ministry of Health, Directorate General of Emergency Health Services ↗
- Regulation on Ambulances and Emergency Health Vehicles and Ambulance Services (RG-8/1/2025-32776)Resmî Gazete ↗
- Domestic helicopter Gökbey to join the air ambulance fleet in 2026Anadolu Agency ↗
- Ambulance Helicopters ProjectT.C. Ministry of Transport and Infrastructure — Directorate General of Civil Aviation ↗
- Association between helicopter medical services for pediatric trauma patients and mortality: Systematic review and meta-analysisThe American Journal of Emergency Medicine (Elsevier) ↗
- Helicopter EMS for scene response to head-injured patients: systematic review & meta-analysisBMC Emergency Medicine ↗
- Helicopter Ambulance SystemAcilci.Net — community publication, Turkish Society of Emergency Medicine ↗
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This content is informational only and does not replace professional medical evaluation. In emergencies, call 112 or +90 216 339 00 39.
