A HEMS pilot is a trauma helicopter pilot who specialises in flying helicopters for emergency medical services. A helicopter pilot is someone who transports people or goods by helicopter professionally. Helicopter pilots often find work in various sectors, such as medical transport, search and rescue, tourism, or with public services such as the police or fire service. According to a pilot in 2013, a Private Pilot Licence, PPL(H) for short, only allows recreational flying, and passengers may come along if everyone, including the pilot, pays an equal share of the costs. Accepting money or services is then not allowed. A Commercial Pilot Licence, CPL(H) for short, allows you to fly for pay for a company under that company's regulations.12

Work as a SAR or HEMS pilot is often idealised, while most of the work takes place at night, in bad weather or in difficult conditions. It is dangerous and mentally demanding, with decisions to be made about the patient, the crew and an expensive aircraft. As one pilot notes, "The patient is not my client; the medical crew is my client and I am there to serve them". One helicopter pilot recommends learning to fly helicopters if you do not want to fly long haul, because the days can be long but you never sit in the aircraft for hours on end. HEMS (EMS) work in particular is experienced as varied. However, in 2018, a helicopter pilot with more than twenty years of experience described the career path as a flat line, where you do roughly the same work throughout your career, the aircraft gets a bit bigger and the salary a bit better. A helicopter pilot with 14 years of experience remarked in 2011 that a helicopter career has an almost flat curve, starting in a two-seater and possibly ending in a twelve-seater, with a lot of repetitive work. This pilot noted that the view from an S76 is exactly the same as from an R22, which underlines the repetitive nature of the work.3456

According to a pilot in 2009, a working day as an offshore helicopter pilot is usually not a standard 08:00 to 17:00 day, but can vary from, for example, 06:00 to 15:00 or 12:00 to 21:00, set out in specific rules. Rosters differ by company and include patterns such as 5 days on and 2 off, 4 on and 2 off, and 3 on and 2 off, because flying continues at weekends. A corporate helicopter pilot who started in 2009 described no fixed working day, noting that there is sometimes nothing to do and sometimes seven hours of flying, but they are always on standby and able to be airborne within half an hour, rarely able to plan anything.7

Many HEMS jobs in the US have a low flying rate, sometimes one flight a day or fewer, because regulation is lacking and there are more HEMS helicopters in an area than needed. In Europe this is more often managed by the government. US HEMS pilots are a mix of ex-military and civil pilots, where military pilots have NVG experience and civil pilots often have more flight hours. The Bristow SAR unit in the Gulf of Mexico, which operates as a subscription service for offshore companies, uses pilots who are called out on average 3 to 4 times per 14-day shift. According to a pilot in 2025, these pilots fly at least one training flight with three offshore landings with night vision goggles. These pilots fly S92A, AW139 (both with winch and rescue swimmer) and S76 (medevac only) helicopters.3

To fly helicopters professionally, you need at least a CPL(H) and a Class 1 medical. From the age of 65, a pilot may no longer fly in commercial air transport. In 2026, ANWB Medical Air Assistance (MAA) lists as minimum requirements, among others, 1,000 hours as captain (PIC), of which at least 500 on helicopters and 500 hours on turbine helicopters. For an Airbus H135 T3, a widely used type for SAR and HEMS, insurers set the experience requirements, which means thousands of hours. A minimum requirement in a helicopter pilot job advert, such as 750 hours, is often not enough to be competitive, because candidates with 1,000, 1,250 or 3,500 hours apply. Besides total flight experience and experience on type, specialist helicopter jobs such as search and rescue also require experience in that specific sector. According to a pilot in 2009, a multi-engine helicopter type rating requires ATPL(H) theory, or at least 70 hours PIC on helicopters if you have neither ATPL(H) theory nor a CPL(H)/IR.378

There is no specific training course for this role. Experience for a HEMS pilot is built up through other routes, because a specific course is not feasible for a training provider given the high hours requirement. An EASA Private Pilot Licence (Helicopter), PPL(H) for short, requires a minimum of 45 flight hours in a helicopter, of which 25 hours of dual instruction and 10 hours of supervised solo flight. The Commercial Pilot Licence (CPL(H)) course, which follows the PPL(H), has a cost indication of EUR 32,000. For the commercial helicopter licence (CPL(H)), at least 155 flight hours in helicopters are required before the course starts, including 50 hours as pilot in command (PIC) and 10 hours of cross-country flight. The European Helicopter Center (EHC) in Norway offers an integrated course for the commercial helicopter licence (CPL(H)) with ATPL VFR theory, an EC135 type rating and MCC VFR for over EUR 100,000, excluding extra costs such as skill tests. This course includes training on R44 and EC135 helicopters.23910

In 2024, an experienced pilot estimated, cautiously, that a civil helicopter pilot needs 10 to 12 years to get into HEMS or SAR. Pilots describe these jobs as end points with little turnover. A HEMS pilot reported in 2016 that he came in through the civil route rather than the military, took lessons himself, flew all over the world, landed on oil rigs at night in bad weather and was then hired on the trauma helicopter. According to a pilot in 2010, ANWB HEMS pilots are mainly ex-military. Most pilots on the Lifeliner trauma helicopter are ex-air force, with former SAR pilots in particular very well suited to the work. A military pilot gains almost all the experience relevant to the trauma helicopter during their work, such as flying with night vision goggles and landing in tight spots, whereas offshore pilots usually lack that experience. Military pilot selection is very strict, but according to an experienced helicopter pilot in 2011, failing it says nothing about suitability as a civil pilot, as almost any normal person can become a pilot. A helicopter pilot reported in 2011 that he was rejected in the selection of an offshore helicopter company because of his vocational-level diploma, but after completing a higher secondary diploma he later got a job with the same company. According to a pilot in 2018, employers also hire older starters, and this pilot himself started at around 27. A pilot who ended up in a SAR unit via US flight schools after a career outside aviation sums up the road by saying you just start, and then twenty-five years later you are a pilot in a SAR unit. Direct entry from training is an exception for a job on the ANWB trauma helicopter. A pilot reported in 2012 that for a job on the ANWB trauma helicopter, where the CPL(H) was obtained does not matter, as long as the HEMS hours requirement and multi-engine experience are met.35689111213

At the end of 2024, there were European HEMS co-pilot vacancies with varying requirements. One vacancy asked for ATPL/CPL(H) and IR with no minimum hours, with a preference for an EC135 type rating and MCC. ADAC Luftrettung asked for at least 500 hours and good German (C2 or language proficiency level 4). Often a type rating plus hours on type is the stumbling block. At the end of 2024, an aspiring helicopter pilot saw vacancies for instructors (CFI) in the US often starting at 250 hours, and offshore co-pilot roles in Norway with IR and 1,000 hours. In the United Kingdom, requirements for offshore co-pilots were relatively low around 2024 (CPL(H), IR and 250 hours), with some pilots moving to offshore almost straight after their CPL(H). Employers look at total hours, hours on type, turbine experience, night hours and IR. At ANWB MAA, a pilot who met the minimum requirements in 2016 could email an open application with a CV to officemaa@anwb-maa.nl, and vacancies are listed on their website.3911