Airworthiness

All medical equipment carried on board aircraft being operated as air ambulances is subject to TC airworthiness approval. The following guidelines have been developed to assist operators:

Carriage of Incubators and Stretchers
(For temporary installation on aircraft for med-evac purposes.)

This guide for carriage of stretchers and incubators has been written to facilitate their use on large aircraft carrying flight attendants, small aircraft without flight attendants and helicopters without flight attendants. Also taken into consideration was the fact that some flights may be operating solely on a med-evac mission, while others may be operating on regular scheduled services.

Stretcher or Incubator Installation

The stretcher or incubator installation:

  1. Shall not interfere with any operation of any aircraft controls;
  2. Shall not restrict access to, or the use of, regular exits;
  3. Shall not obstruct any emergency exit, or the aisle(s) leading to an emergency exit;
  4. Shall not restrict access to emergency equipment; and
  5. Should be so arranged as to allow ready access by accompanying medical personnel to perform monitoring and therapy functions when needed.

Restraint Systems

All stretcher and incubator restraint systems require Transport Canada (Airworthiness) approval. Each restraint system, including anchorage to the primary aircraft structure, shall be designed for an average occupant weight of 170 pounds and for the maximum load factors corresponding to the specified flight and ground load conditions, including the emergency landing conditions prescribed in the applicable sections of the Airworthiness Manual. (Refer to Section 561, 785, 789 and 1413 of Chapter 523, 525, 527 and 529, as applicable). A safety factor of 1.33 shall be applied to the ultimate inertia forces stated in Section 561.

Application for approvals shall be directed to the Regional Division, Airworthiness.

The attachment of the stretcher or incubator to the aircraft structure shall allow its rapid detachment for evacuation.

Patient Restraint

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.

All patient restraint systems require TC (Airworthiness) approval. Each patient restraint system, including anchorage to the primary aircraft structure, shall be designed for an average occupant weight of 170 pounds and shall protect the patient when subjected to the maximum loads corresponding to the specified flight and ground load conditions, inlcuding the emergency landing conditions prescribed in the applicable sections of the Airworthiness Manual. (Refer to Section 561, 785, 789 and 1413 of Chapter 523, 525, 527 and 529, as applicable. A safety factor of 1.33 shall be applied to the ultimate inertia forces stated in Section 561.)

Application for approvals shall be directed to the regional division of Airworthiness.

Each patient restraint system shall have a quick-release means to allow its rapid detachment in an evacuation.

Some patients may be so injured that the restraint system used will be based on a medical opinion. Medical evacuations, as a rule, involve stabilized patients. An emergency situation involving a patient who is unable to be restrained on a stretcher prior to being stabilized is very rare. However, should this occur, the patient should be transported on a flight whose sole purpose is the medical evacuation.

All medical equipment shall be appropriately restrained in a manner acceptable to TC.

Patient Orientation

The preferred orientation is the patient's head towards the front of the aircraft so that most of the forward loads applied by the patient restraint system are applied on the shoulder area. In an aeroplane, the patient should be placed fore and aft along the longitudinal axis. This is the preferred orientation for helicopters, as well; however, due to the different structural configuration and possible crash scenarios, this may not be feasible if warranted.

Medical Attendant

While not specifically required by regulation, all patients, particularly those confined to a stretcher or babies in incubators, should be accompanied by a medical attendant. Attendants should be assigned a seat which is convenient to their patient.

Incubator oxygen supply and restraint

An incubator may feature a self-contained oxygen supply capable of delivering a controllable flow rate.

An adequate supply of oxygen normally will be provided by the medical authorities. The aircraft oxygen system shall not be used.

If extra oxygen cylinders are to be carried, they shall have protective containers and be capable of being appropriately restrained in a manner acceptable to TC.

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