Examines the sustainability paradox of helicopter operations from the perspectives of offshore energy transport and helicopter emergency medical services (HEMS). Helicopters are indispensable for critical missions due to their vertical take-off and landing capability, low-altitude flight profile, hovering capacity and operational flexibility. However, when these operational advantages are evaluated together with high energy consumption, carbon emissions, noise impacts and public acceptance concerns, a paradoxical sustainability structure emerges. The study adopts a systematic literature review approach. Studies published between 2010 and 2025 were screened in Web of Science, Scopus and TR Dizin in line with the PRISMA 2020 flow logic. The search strategy was structured around keywords such as helicopter operations, rotorcraft, sustainability, carbon emissions, energy intensity, noise, offshore, HEMS, emergency medical services, urban air mobility and electric vertical take-off and landing aircraft. A total of 41 studies were included in the thematic analysis and classified under environmental, operational and social dimensions. The findings show that environmental sustainability targets in helicopter operations are constantly shaped by operational requirements. Life-saving urgency in HEMS operations and safety-critical conditions in offshore missions define the practical limits of sustainability-oriented interventions. The chapter concludes that technological transformation, operational optimization and public acceptance policies should be addressed together to improve the sustainability performance of helicopter operations.