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AIM To highlight the role of secondary aeromedical services and required knowledge of Critical Care Flight Nurses (CCFN), in facilitating the safe inter-hospital transfer of patients with acute Spinal Cord Impairment (SCI) from a Major Trauma Centre (MTC) to a specialist SCI centre. METHOD literature search. RESULTS There is significant demand for secondary aeromedical services in order for patients with acute SCI to be transferred to a SCI centre within 24 hours of injury. CCFN play an important role in triaging patients, coordinating patient care, arranging logistics of transport as well as providing direct clinical care inflight. CCFN must have knowledge regarding the pathophysiology of acute SCI, altitude physiology and interventions to manage stressors of flight in the aeromedical environment. Specific clinical challenges encountered by CCFN include the prevention of hypobaric hypoxic hypoxia and achieving appropriate immobilisation of the spine. CONCLUSION Mitigating the increased risk associated with transporting critically unwell patients with SCI in the aeromedical environment, relies on aeromedical clinicians with education and training within the clinical specialty of aeromedical retrieval. The availability of secondary aeromedical services to undertake urgent inter-hospital retrieval of patients with acute SCI, will be promoted by continued development of Retrieval Nurse Practitioner (RNP) roles. IMPACT STATEMENT Secondary aeromedical services and CCFN are essential in providing and facilitating access to timely and appropriate care that will promote a reduction in long term morbidity for patients with acute SCI. PLAIN LANGUAGE SUMMARY This discussion focuses on the important role of secondary aeromedical services and CCFN during the inter-hospital transfer of patients with acute SCI. A significant number of patients with acute SCI are initially transferred from the scene of their injury to a MTC for stabilisation. Reduced patient morbidity has been associated with subsequent secondary transfer to a specialist SCI centre within 24 hours of injury, in order to facilitate early surgical decompression of the spine. Consequently, patients with acute SCI rely on secondary aeromedical services having aircraft and specialised clinicians available for urgent patient retrievals. Aeromedical clinicians such as CCFN, are required to co-ordinate and undertake both timely and safe retrievals, that will ensure that patients with acute SCI are not compromised by stressors of flight in the aeromedical environment. The pathophysiology of patients with acute SCI is complex, and patients with acute SCI are particularly prone to exacerbation of hypoxia at altitude and risk of secondary spine injury due to movement of an unstable spine during transport. Managing these aspects of care poses significant challenges for CCFN, both in relation to clinical considerations as well as due to the need for further evidence based research specific to patient transport. In addition, advanced nursing roles such as RNP, provide opportunities for CCFN to increase their scope of practice and aeromedical services to increase the availability of their services, both of which will improve patient outcomes and reduce long term morbidity.