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Physically demanding water and over land winch rescues are critical tasks for helicopter paramedics. To assess the physiological demands of winch rescue, 14 intensive care flight paramedics (12 male, 2 female, mean (±SD) age 44.3 (±5.4) years, experience 7.1 (±5.2) years) completed land and water-based task simulations. For the land task, VO 2  was 41.7 (±4.5) mL kg −1  min −1 , or 86 (±11) % of VO 2peak . Task duration was 7.0 (±3.6) min, or 53 (±27) % of maximal acceptable work duration (MAWD) (13.2 (±9.0) min). For the water task, VO 2  was 36.7 (±4.4) mL kg −1  min −1 , (81 (±12) % of VO 2peak ). Water task duration was 10.2 (±1.1) min, or 47.6 (±4.8) % of calculated MAWD (21.0 (±15.6) min). These results demonstrate that helicopter rescue paramedics work at very high physiological workloads for moderate durations, and these demands should be considered when developing selection tests and when deploying to rescues, to ensure staff are capable of task performance. Practitioner summary:  Paramedics performed helicopter winch rescue task simulations in water and over land. Paramedics worked at 81% of VO 2peak  for 10.2 min and 86% of VO 2peak  for 7 min for swim and land tasks respectively. Rescue organisations should consider these demands when selecting and credentialing staff and when deploying to incidents. Abbreviations:  HEMS: helicopter emergency medical service; ICFP: intensive care flight paramedic; MAWD: maximal acceptable work duration; PES: physical employment standards; SAR: search and rescue

The physiological demands of helicopter winch rescue in water and over land