Today I chat with Doctor Howard Roby, CSM. Howard is a specialist in Anaesthesia and Intensive care and after gaining aeromedical retrieval skill in Australia joined the RAAF reserve as part of the Military Critical Care Air Transport Service (MCAT). Howard recounts some of the critically ill patients he retrieved over the subsequent 15 years he worked on call for MCAT, from military traumatic injuries out of the Middle East to civilian casualties from the White Island Volcano eruption in NZ. We also discuss the innovation in clinical equipment and training that has led to better patient outcomes in war and austere environments.