An air ambulance medical interior directly impacts patients, crews and operations. The key focus, of course, is patients – their safety is paramount and, therefore, strongly influences design considerations. Customized interiors are increasingly possible and necessary, as a one-size-fits-all approach doesn’t fly, and flexibility is important: the ability to modify a layout as needed can save on cost and time. Furthermore, space and how it can be maximized is an essential requirement, giving the clinical crew an optimized space to access the patient and accommodate the required equipment. “When the use of limited available cabin space is optimized, it is possible to treat even more complicated medical cases such as extracorporeal membrane oxygenation (ECMO) patients and patients needing isolation units,” said Thomas Redder, Vice President of International Sales for Spectrum Aeromed.

Reflecting on the latest developments in aircraft medical interior design, James Helsham, Aerospace Engineer for HeliMods, said that balancing the requirements of the platform and aviator with the requirements of the patients, paramedics and doctors is the key driver. “Elevating the requirements of patients and crew, and letting their needs drive innovative developments in emergency medical services (EMS) interior design results in higher levels of safety and capability, and improved patient outcomes while minimizing compromises that crew working in air medical environments commonly face when compared with those working within ground-based environments,” he stated. “Two examples of compromise that continue to remain prevalent across air medical operations include the use of manual stretchers that are not interoperable with ground-based EMS operations, and fragmented and poor communication with the broader retrieval network when on task.”

Two innovations at HeliMods are the Powered Aero Loader and Connected Cabin. “The HeliMods patented Powered Aero Loader product range allows the market leading Stryker PowerPRO XT ground ambulance stretcher to be incorporated into fixed-wing and rotary-wing medical interiors, without the need for the paramedics to do any manual lifting, at the push of a button. This innovative technology, which was developed over several years, enables seamless interoperability between road, fixed-wing and rotary-wing assets without the need to patient transfer or manually lift. The technology is proven to increase the careers of paramedics through reducing injuries relating to lifting and significantly reduce the time it takes to load and unload patients,” Helsham highlighted. “The HeliMods Connected Cabin is a new and innovative solution that connects devices, aircraft and ground-based services together, enabling more efficient coordination of emergency response assets, while also sharing critical patient information between crew in the air with doctors and triage response teams on the ground allowing for a faster and more focused emergency response and, ultimately, improved patient outcomes.”

Aircraft are receiving certification for multiple approved floor plans that can be changed quickly

Switching it up

Adam Doyle, Paint and Interior Sales Manager at Elliott Aviation, said that there is increased standardization of fleets. “Aircraft are receiving certification for multiple approved floor plans that can be changed quickly. Those operating dual role aircraft are capable of switching between executive and medical configurations in less than an hour, maximizing the aircraft’s availability to perform multiple roles. Layouts are being designed with safety, ease of access and effective use of medical equipment. All of this continues to evolve with the use of latest composites and coverings providing enhanced disease resistance and durability while making the cabins feel warmer and more welcoming unlike the truly sterile environments that they are.”

A spokesperson from Bucher spoke of the increasing popularity of modularly expandable equipment: “This allows operators to acquire a basic set of equipment and then supplement or upgrade it at a later time. Equipment that can be flexibly adapted and used in various helicopter types is also highly sought after in the industry. Often, customers are looking for solutions that are as lightweight and cost-effective as possible, while more complex rescue missions require a more refined and compact equipment setup aimed at providing optimal mission support. An example of this is the disaster management mission. However, customer concerns about robustness can sometimes be more important than the need for a light weight, especially given the tough conditions that helicopter emergency medical services (HEMS) crews face”.

Lightweight and connected

In regions where major hospitals are not available, these innovations help to treat the patient within the ‘golden hour’,

Considering how innovations in this arena are facilitating diagnostic and other capabilities in the prehospital stage of care, there is an ongoing goal to make medical aircraft interior equipment even lighter and more flexible. “Medical devices and solutions are becoming smaller and lighter, facilitating improved and quicker treatment of the patient. Especially in regions where major hospitals are not available, these innovations help to treat the patient within the ‘golden hour’,” said Redder.

The spokesperson from Bucher provided an insight into their current developments: “Our main recent focus has been on developing fully removable equipment for multi-use helicopters – such as the AC67 flex for H135s and the AC70 flex for H145s – which can be installed on lease rotorcraft without permanent changes.” They continued: “This equipment also serves as backup for civil emergencies in police and military aircraft.”

Helsham said that innovations in device and aerial platform technology are allowing a greater diversity of devices to be brought into EMS platforms in a safe and certified manner: “This includes a broader variety of specialty medical devices and patient transport devices – such as powered stretcher systems.”

State-of-the art communications are crucial for information sharing between air ambulances and hospitals, and developments here are, ultimately, lifesaving. “Quite often data connection and inflight communication systems are now installed to assist preparation for arrival at the receiving hospital,” said Redder.

Doyle agreed: “Data sharing with the use of communication systems are providing accurate and quick information transfer between crews in the air and final destination specialists so treatment can begin immediately and continue seamlessly upon arrival to a given facility.”

Helsham provided an insight into developments in this area. “Innovations in distributed communication technologies are allowing far greater levels of connectivity between remote EMS platforms and hospitals including facilitating two-way transfer of information,” he said. “Products such as Connected Cabin can allow for data transfer to the hospital to ensure the hospital is appropriately prepared for the needs of the patient. This is aided through audio and visual technologies which can be incorporated into the HeliMods Connected Cabin suite. Similarly, the expertise of the destination hospital can be brought into the prehospital stage of care through the same types of products that enable communication, both audibly and visually. Innovations in display and augmented vision technologies are allowing paramedics and doctors to visualize and better contextualize patient information. The connectivity of the assets that carry the patient to the hospital and the destination hospital will become more closely linked and the benefits of this data transfer will grow.”

The expertise of the destination hospital can be brought into the prehospital stage of care through the same types of products that enable communication, both audibly and visually

Cost considerations

When it comes to gaps in terms of further opportunities for medical device development and/or medical interior design, Doyle said that an ongoing point of contention is funding: “Funding has always held tension within this sector. It is typically available up front but not planned for over the duration of a given term of operation.” He added: “Consulting with multiple modification centers and their experts can provide real savings both up front with cabin layout design/workability and requests from medical staff. Lead times for raw materials and equipment availability continue to frustrate this community.”

The spokesperson from Bucher agreed that costs are a prevalent issue: “The forefront is always focused on the advantage that a new implementation or innovation would bring to the operators, ie to their fleets. Such an implementation is always associated with high costs, especially in the realm of design and consistent appearance, where the cost–benefit perspective must always be taken into account. However, fundamentally, the desires of the customers are always considered.”

Despite innovations that are enhancing air ambulance medical interior design and elevating patient care, there remain challenges at play in the search and rescue helicopter industry. “This includes the constant balancing act between the weight of the helicopter and the required comfort for both the crew and the patients,” said the spokesperson. “An ongoing limitation involves striking the right balance between the complexity of rescue missions and the weight of the necessary equipment. This revolves around

We need to be open to customized customer solutions depending on their specific needs with no one-size-fits-all approach

optimizing operational efficiency and flexibility. Customers consistently wish for the newest and best equipment with them, for every possible contingency. However, due to the many limiting factors in aviation and the direct impact of weight on the operational costs of aircraft, these wishes cannot always be met. Therefore, we need to be open to customized customer solutions depending on their specific needs with no one-size-fits-all approach.”

Taking care to the next level with tech

Looking ahead to the future of aircraft medical interior design, Doyle said that this arena will become even more dependent upon multirole availability for both dedicated medical transport and dual role operators. “Cabin layouts and design will be even more heavily engineered than ever before. Dedicated medical aircraft will have additional therapy considerations during transport, which will require floorplan changes at a moment’s notice. Those in the dual role operation will have to pivot to and fro between executive and medical configurations,” he stated. “These will not be your typical commercial level business class appointments throughout the cabin; they will have the same high level fit and finish found in private aviation travel, no matter the operator’s stance. This will no longer look like a hospital delivery room from the 2000s, it will be transformed in appearance and comfort to a boutique hotel.”

Helsham said that the future will continue to have more connected systems and communication between devices, aircraft and ground facilities. “This will become even more prevalent as emerging assets enter the air medical industry such as electric vertical takeoff and landing (eVTOL) and uncrewed aerial systems (UAS) aircraft,” he said. “An increased and broadening level of patient care will be provided as more sophisticated medical devices are able to be incorporated into the aircraft environment. Increased levels of data and automation will drive more efficient and effective coordination of operations leveraging data-driven decision making, reduce response times, and improve patient outcomes and working environments for air medical crew. Increasing focus on safety and community service levels will drive requirements for engineering organizations to develop more advanced solutions that can be integrated with advanced air platforms and also support technological change over the life of the service.”

Tracking and communication through a specific solution could enable the rescue team to transmit the patient’s electrocardiogram data to the hospital in real time, even while the patient is still in the helicopter

The spokesperson from Bucher said that increasingly advanced communications will continue to benefit patients. “I believe the goal will be to offer primary rescue to patients at the earliest possible stage and to prepare hospital colleagues for the patient’s condition as soon as possible,” they stated. “This could be achieved, for example, through flight data monitoring. Tracking and communication through a specific solution could enable the rescue team to transmit the patient’s electrocardiogram data to the hospital in real time, even while the patient is still in the helicopter. Additionally, it’s likely that we will see more work with modern technology in the future like telemedicine and remote diagnostics.”