The second Lebanon war started as a limited operation and progressed to a large-scale campaign. Most of the fighting took place in mountainous villages and small towns inhabited with civilians. The Israeli Defense Forces (IDF) Airborne rescue and evacuation unit is charged with air evacuation of soldiers and civilians in times of peace, limited conflict, and war. Objective: We describe this unit's activities in the second Lebanon war, analyzing injury, treatment, and evacuation characteristics Methods: Data were collected from flight medical reports, debriefings of aero-medical team members (usually immediately upon return from mission), ground units medical reports and debriefings, and hospital records. Results: 725 IDF soldiers were injured and 117 killed either in Lebanon or near the Israeli-Lebanese border during the war. A total of 338 (46%) were evacuated in 95 airlifts (averaging 4.5 evacuees per airlift) from the lighting zones or the border. Air evacuation used dedicated helicopters with advanced care capacities, and most victims were evacuated straight from the battlefield, as the fighting was ensuing. Many wounded first received advanced medical care upon the arrival of the aero-medical teams. Conclusions: In military operations within civilian populated areas with threats to ground transport, air evacuation can sometimes be the only readily available option. Providing timely ground advanced medical care proved difficult in many instances. Thus, for many, the rescue helicopter was the first point of access to such care. Aero-medical aircrafts and personnel faced threats from gunfire and missiles, causing both delays in evacuation and a high average number of evacuees per airlift. This article proposes ways of coping with situations in which similar rescue and evacuation problems are likely.