The aim of prehospital treatment of head injuries and severe multiple injuries is to prevent additional cerebral damage. When accidents occur in remote mountain areas, time is lost covering the distance to the nearest cabin or village where the rescue team can be called by telephone. Rapid transport of a trained physician to the patient can save precious time and allows prompt control of respiration and circulation at the scene of the accident. In a series of 57 rescue operations between 1980 and 1990, we used a helicopter staffed by an emergency physician and equipped with a winch. The hospital mortality rate was 12 percent (7 out of 57 patients). At 6 months after the accident, a normal neurological state was registered in 44 of the 55 survivors (88 per cent), whereas mild neurological deficiencies were noted in six patients (12 per cent). No persistent coma or vegetative state was seen. This experience suggests that fast rescue by a helicopter equipped with a winch and with an experienced emergency physician on board in an effective way of preventing secondary cerebral damage after accidents in remote mountain areas.