Aircraft Certification Staff Instruction (ACSI)

ACSI No.: 32
Issue No.:  1
Issue Date:  1983-04-15
FILE NO. A2204-79-32
REF. FILE NO. 5012-S11

Aircraft Certification Staff Instruction (ACSI)



The stretcher installation in an aircraft should allow the transfer of patients without endangering their lives due to any emergency conditions that may arise during the flight, interfering with the use of the aircraft by other passengers under normal or emergency conditions, or reducing the effectiveness of the safety measures provided.

Since any stretcher installation will be part of the Cabin Installation, the guidelines are drawn from those FAR requirements applicable to Cabin Installations.


To formalize guidelines for stretcher installation in aircraft.


The following is based on FAR 25 requirements and is only applicable to Transport Category aircraft. Similar guidelines can be drawn for rotorcraft or small aircraft based on their respective regulations.


  1. General
    1. A person using the stretcher should not suffer serious injury in an emergency landing as a result of the inertia forces specified in FAR 25 (Ref. 25.785 (a) ).
    2. The stretcher installation should be designed for an occupant weight of 170 Lbs., considering the maximum load factors, inertia forces and reactions between the occupant, stretcher and restraint at teach relevant flight and ground load condition (including emergency landing conditions). (Ref. 25.785. (i) ).
  2. Location of Installation
    1. The stretcher installation shall not interfere with the operation of any aircraft controls.
    2. The stretcher installation shall not restrict access to or use of regular exists.
    3. The stretcher installation shall not obstruct passageways or aisles leading to any emergency exit. (Ref. 25.813 (a)).
    4. The stretcher installation shall not obscure any passenger's view of any required exit sign and should not obscure the view of the "seat belt" and "no smoking" signs unless an auxiliary sign or other approved means for proper modification to the passengers is provided.
    5. The installation shall be so arranged as to allow ready access to the patient by accompanying medical personnel to perform monitoring and therapy functions when needed.
  3. Stretcher Supporting Structure
    1. The stretcher restraint must be designed to prevent unwanted movements during turbulence or in an emergency landing. (Ref. 25.785 (c) ).
    2. The attachments of the stretcher to the aircraft structure or seats must allow its rapid detachment for evacuation in crash landings. (Ref. 25.803).
    3. Each projecting object of the stretcher installation that may injure the person occupying it, or persons moving about the airplane in normal flight must be padded. (Ref.785 (e) ).
    4. The structural analysis and testing of the stretcher supporting structures may be determined by:
      1. Assuming that the critical load in forward, sideward, downward and rearward directions (as determined from the prescribed flight, ground and emergency landing conditions) acts separately, and
      2. Using selected combinations of loads if the required strength in each specified direction is substantiated. (Ref. 25.785 (i) (l) ).
  4. Patient Restraint
    1. The patient restraint shall be designed to prevent unwanted movements of the person using it during turbulence or in an emergency landing, and to apply the restraining loads over a large area of the body, Vests or X-shaped belts could be acceptable. A preferred orientation is that the patient's head will be forward so that most of the forward loads are applied on his shoulder area. Some patients may be so injured that the restraint used will be based on medical opinion.
    2. The patient-stretcher restraint must be provided with quick disconnect means to allow its rapid detachment for emergency evacuation.
  5. Stretcher

    Road ambulance stretchers may be used when transferring patients by aircraft. There are no technical specifications for stretchers used or intended for use in civil aircraft at this time. Road ambulance stretchers used in aircraft installations would not require approval and would not be considered as aircraft parts (as related to maintenance and quality control) unless they are permanently installed on an aircraft.
  6. Operating Limitations and Placards
    1. The installation must be covered by an approved revision or supplement to the Aircraft Flight Manual or operating limitations, weight and balance records, and equipment list changes as necessitated by the installation of the stretcher. On an aircraft which does not require a Flight Manual, a placard which references the appropriate instructions must be provided.


      1. References

        In addition to FAR 25, the following documents were reviewed when preparing these guidelines and should be used by operators:
        1. AC 43-13-2A, Chap. 12 - Litter, Berth, and Cargo Tiedown Device Installation.
        2. AC 67-1 - Medical Information for Air Ambulance Operators.
      2. Operational Requirements
        1. The operator must develop an emergency evacuation procedure and ensure that all crew members are familiar with it.
        2. The stretcher should be boarded before all other passengers.
        3. The patient must be accompanied by a qualified attendant who should be assigned the seat which is most convenient to attend the patient.
        4. A patient should be accepted for carriage without a qualified attendant only when the saving of life is involved.
        5. At least one attendant must remain on board as long as the patient is on board.
  7. Dissemination of Guidelines

    Regions are encouraged to make these guidelines known to Air Carriers and other fleet operators.



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