The decision to transport by air or ground requires careful consideration by multiple personnel to ensure patient and team safety. Safety must always be the overriding factor in initial transport mode determination. Advantages and disadvantages of each mode of transport must be evaluated on a case-by-case basis. Selection of the most efficient and, most importantly, safe transport mode for any child requires coordination of multiple personnel, including ground and air dispatch, pilot, team members and composition, and the MCO. Patient acuity, vehicle/helicopter availability, weather, site limitations, patient locality, distance from the receiving medical center, and capabilities of the team caring for the patient at the outlying facility must be considered. Taking all these factors into account leads to a team-oriented, informed decision ensuring a safe and efficient transport for a critically ill or injured child.