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Introduction:Hurricane Ian impacted Southwest Florida in September 2022 leaving massive destruction. Notably, the barrier islands were isolated by destroyed bridges and docks. Delivery of Search and Rescue, Medical Care, and other aid required a joint Civilian-Military Air Operation to provide essential services.Method:This presentation will detail the just-in-time development and operation of a massive joint civilian-military air operation in order to provide essential disaster response services.Results:Components of the joint air operation included: the establishment of a regional air asset request centercreation of a command structure for air mission taskingthe use of an airborne military air traffic control asset for forward controlsetting up a helibase at an international airportcreation of multiple helispots in remote damaged areas with forward control assetsthe coordination with numerous private, NGO, municipal, county, state, federal, and military agenciesheavy, medium, and light lift helicopter operationsboth civilian and military dedicated medevachoist and water rescue operationsaccommodating a US presidential visit during operationsTogether these operations supported the transportation needs of Search and Rescue, Medical, Command, Planning, and Logistics Operations for XXX days until the establishment of reliable ground transportation.Conclusion:This presentation will not only provide insight into the planning and operation of the joint air operation but will also share the impacts on the medical care from the physicians who were directly involved in the medical care delivered on the barrier islands of Florida.