In the case of acute myocardial infarction (AMI), prompt and appropriate initial treatment is essential for increasing the rate of survival and early reperfusion is a main determinant factor for long-term prognosis. The survival of a patient with refractory ventricular fibrillation was made possible by cooperative emergency medical care including air medical transport, despite long distance to the hospital. The patient was a 60-year-old man. Under a diagnosis of AMI, a helicopter emergency medical service (HEMS) with medical staff on board was requested. Although ventricular fibrillation (VF) occurred at the scene, quick and appropriate advanced cardiovascular life support (ACLS) was provided by the attending doctor, leading to the return of heartbeat. Since the patient still exhibited serious bradycardia and cardiac failure, he was airlifted while undergoing transcutaneous pacing. Upon arrival at the hospital, the patient underwent emergency percutaneous coronary intervention (PCI). During the PCI, VF recurred and chest compressions and a total of 17 defibrillations were performed. The PCI was continued with percutaneous cardiopulmonary support (PCPS). The patient survived without sequelae. Smoother cooperation between pre-hospital medical procedures and post-hospital emergency care is considered to be essential for the survival of patients such as this case.