- 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 ground ambulances only (emergency and ICU configurations); air-ambulance requests route through 112 to the Health Command and Control Centre (SKKM).
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.
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.
Warning: Citizens cannot directly call an 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 which transport mode is dispatched. [1]
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]
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 Türkiye no citizen dispatches an air ambulance directly. The process is a hierarchical decision chain [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.
As we explained in the difference between private ambulance and 112, Nova Ambulans — a private-sector ground operator — has no air-ambulance dispatch authority. Once the SKKM has decided on air transfer, Nova may be tasked with the landing-site-to-hospital leg, or with the entire long-distance ICU ground transfer when an air ambulance is not appropriate.
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 possible, 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 (drive time is the practical limit) |
| 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].
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.
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 ↗
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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.