The role of pre-hospital care is still to be stressed especially in case of head injuries. We compared two groups of head injuries (total 50 patients, 38 politrauma) transported by traditional ambulance (28 patients) or by EMS helicopter (22). The two populations had similar values of the considered indices (TS, ISS, GCS, TRISS). They significantly were different only for the "free therapy time". Patients transported by ambulance showed an higher incidence (p less than 0.01) of acute complications (like hemorrhage and hypovolemic shock) despite the same gravity score indices. The index applied for the follow-up valuation, does not show any difference in the two groups. This may be due to the unreliability of the used scores if they are applied without any correlation with the quality of care during the transport.