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Introduction: Since the 1960’s, the “Golden Hour” has been a phrase well known in trauma circles- the sooner patients reached definitive care, the better their outcomes. In light of the positive endovascular stroke treatment trials we looked to evaluate the time EMS spends at the bedside before transferring a patient. We sought to understand the delays that occur after a diagnosis is made, after a hospital is selected, and after EMS arrives- what happens?Methods: We evaluated trauma, stroke, and cardiac patients who were transferred via helicopter from either the scene or a referring hospital. An air ambulance was requested for all of these patients either by EMS crews at the scene or by physicians in the referring hospital. We measured time to departure as the length of time between the Air crew arriving at the patient and the crew departing with the patient for the definitive care hospital.Results: We evaluated patients in 2015 and 2016 who were transferred via air ambulance for trauma, cardiac, and stroke. There were 749 trauma flights from the scene and 337 interfacility transfers (IFC). For cardiac, there were 38 from the scene and 178 IFC transfers. Finally, for stroke there were 338 from the scene and 301 IFC transfers. Cardiac had the most interesting results with the shortest IFC time at 8 minutes, but the longest IFC time at 22 minutes. Stroke and Trauma were similar at 17 and 16 minutes with no difference between scene and IFC.Conclusions: Acute Stroke patients are delayed in arriving at definitive care. The lack of a national goal for stroke patients is a current impediment leading change. Based on this data though, it is possible to move more efficiently in the transport of critically ill patients.