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The coronavirus disease 2019 pandemic has profoundly affected the Lombardy healthcare system. Although air transport of critical patients played a crucial role, there are still gaps in understanding how the pandemic impacted helicopter emergency medical services (HEMS). A retrospective observational analysis was performed using data from the regional emergency-urgency online portal. The investigation focused on patients airlifted by helicopter to the Lombardy emergency departments from January 1, 2019, to December 31, 2021. A total of 12,953 admissions to the emergency departments have been recorded (5,733 in 2019, 3,550 in 2020, and 3,670 in 2021). The monthly average of events changed significantly over the 3 years (2019 [477.7], 2020 [295.8], and 2021 [305.8]) (P < .001). Additionally, there was a notable increase in the percentage of severe cases with red triage codes in 2020 (28.9%) and 2021 (33.5%) compared with 2019 (19.9%). Moreover, the number of hospitalized patients increased in 2020 (39.9%) and 2021 (37.2%) compared with 2019 (27.7%). The HEMS documented a noteworthy decrease in mission numbers and an increase in patient clinical severity during the pandemic. Consequently, the HEMS might be allocated for specific roles in national pandemic plans during the alert phase activation, such as secondary transport between hospital facilities., Competing Interests: Declaration of competing interest The author(s) have no relevant disclosures. There was no grant funding or financial support for this manuscript., (Copyright © 2024 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)