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The NHS needs a network of flying doctors to cope with the closure of A&E units, experts say.
Air ambulance chiefs said the extra skills were needed aboard the helicopters as the health service moves towards regional trauma centres.
Much of Europe already uses doctors, but the service in England and Wales tends to rely heavily on paramedics.
Doctors have backed the call, while the government says it will let local managers decide whether to fund it.
Air ambulances have been used since the late 1980s and now answer more than 17,000 calls each year.
But with the NHS moving towards regional centres of excellence which will mean longer journeys for trauma patients, the Association of Air Ambulance Charities is calling for a network of "flying doctors" to help treat patients on arrival.
THE AIR AMBULANCE SERVICE
The first air ambulance service was launched in Cornwall in 1987
The service has now expanded to cover the whole of England and Wales at a cost of over ?50m a year
This is mainly funded through charitable donations, although the NHS does cover the cost of paramedics
It is a model that is pretty standard across Europe and is in the process of being adopted in Scotland.
But only three of the 18 charities responsible for the 26 emergency helicopters in England and Wales use doctors all the time - although a handful of others do use them occasionally.
AAAC chairman David Philpott said: "We find ourselves being called out to extremely serious cases, many road traffic accidents where the injuries can be horrific.
"But it is no longer about transporting them to the nearest A&E.
"What we are doing is stabilising the patients at the scene and getting them to specialist centres that can be a long way away.
"That requires specialist skills and, without doctors on board, patients may be at risk.
"This is not going to happen overnight, but we have to get there."
Essential
Andrew Cameron, chief executive of the London service, which has been using doctors since it started in 1988, added: "When you are talking about brain injuries, spinal damage and knife wounds, a doctor is essential.
"Say someone has been a knifed in the heart, you only have one choice - to open up the chest on the scene."
And Don Mackechnie, from the College of Emergency Medicine, agreed.
"Air ambulances are becoming an important part of the health service and where doctors are being used it is working well so I don't see why it can't be done everywhere."
A Department of Health spokesman said the air ambulance charities needed to work with NHS trusts to agree funding if they wanted doctors on board.
He added: "It is for the NHS locally and the charities to decide on what is appropriate for their own local circumstances."
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