Air ambulances provide fast, effective medevac services in all manner of medical emergencies, but few aspects of patient transportation have caused as much debate, or raised as much concern, as the transportation of babies in incubators.

Land ambulances are well-equipped to transport infants in incubators but are subject to the constraints of road traffic and inaccessibility to remote locations. Air ambulances can offer quicker, more direct patient transportation which, when dealing with seriously ill neonates, can mean the difference between life and death.

Air ambulances have not traditionally been fitted to accommodate incubators that will also travel in land ambulances. This poses a problem when air ambulance transportation would be the best option, but is impossible because they cannot accommodate the incubator.

Paraid, a UK-based supplier of emergency medical products, has an existing transport incubator system (TIS), which was in use throughout Scotland by the National Transport Service for the Newborn. New European regulations stipulate that the maximum weight for transport of the TIS, including the trolley, vital sign monitors and patient must not exceed 140kg. Some transport incubator systems weigh up to 265kg, excluding the trolley and monitors. Paraid recognised the need for a lightweight TIS that could be

easily and safely transported by air ambulance, while adhering to all CAA regulations.

Air ambulances can offer quick, direct patient transportation which, when dealing with seriously ill neonates, can mean the difference between life and death

The problem is essentially a design issue. The Scottish Ambulance Service contracted Bond Air Services to head up a project team to address this issue and to design, manufacture and certify a TIS that met all the land and aviation requirements. Paraid engineers, clinicians and Gama Aviation were key project team members and have taken this problem in hand and designed a system to safely transport neonates in incubators.

Initially, the design team needed to identify and solve each of the problems and potential issues associated with the transportation of the TIS. The air ambulances need to be able to load and unload the incubator safely and easily, as well as carry it securely in flight.

The design had to meet the exacting requirements of a crash landing scenario without endangering the crew, medical attendants or patient.

Medical support equipment, auxiliary incubator power supply and medical gas supply must also be carried on board and access to the neonate must be maintained throughout the flight.

Further concerns were raised when the process of moving the incubator between land and air ambulances was considered. Health and safety regulations and employer’s duty of care to employees have to be adhered to throughout this process. Aside from this, it is vitally important that the transfer can be made quickly and safely to optimise the patients’ level of care and expedite the journey.

To solve these problems, the design team fitted a series of wheels running in tracks along the underside of the incubator frame to produce a smooth transfer into the aircraft. A four degree angle on the helicopter floor to be mimicked by a corresponding angle produced on a tilt feature on the trolley’s interface plate. These modifications were suitable for the EC135 helicopter air ambulance, but the team also had to design the system for the Beech King Air 200 fixed-wing aircraft. A pair of low support and locking feet were designed to fit into the low friction channel that extends between the outside door and the fuselage of the King Air, allowing the smooth travel of the incubator around a 90 degree turn and on to a LifePort plus medical support plinth.

To meet CAA regulations, the team had to ensure that the TIS would remain securely in the aircraft, even in the event of an accident. The floor locks of the system were designed to adjust to both land and air ambulances to provide secure transport and the locking system of the LifePort includes a release mechanism for the trolley.

The Paraid trolley is designed to be flexible and to fit into any of the Ambulance Service’s fleet so the Scottish Ambulance Service can conventionally transport the incubator when it is not suitable to utilise either of its air assets. It also solves the problem of interchangeability of the incubator between both forms of transport.

To meet CAA regulations, the team had to ensure that the transport incubator system would remain securely in the aircraft, even in the event of an accident

Further considerations came as a result of the specific needs of the neonate. Inhaled Nitric Oxide posed a potential hazard to flight and medical crews in the pressurised aircraft, and a dangerous substances assessment was carried out. Successful tests were also carried out to ensure that the none of the electronic equipment associated with the incubator interfered with the electronic configurations of the aircraft.

The design team identified that access to the patient throughout the flight was vital and had to ensure that, while the Perspex canopy must remain on the incubator to allow this access, the incubator must not become a projectile if the aircraft made an unstable or heavy landing.

To maintain the integrity of the canopy, two steel bands with aircraft rated overlatches secured it to the incubator’s base frame, which was itself secured with a sled-like frame.

Employers, including air ambulance operators and emergency services, have responsibilities to their staff, and must ensure that their safety is not compromised when transporting incubators by air. Staff must be trained so that they feel confident and comfortable providing medical care during air ambulance flights.

There are many factors that must be taken into account when air transportation of a neonate in an incubator is considered. Distance, availability of air ambulances, weather conditions and the condition of the patient are the practical concerns that must govern the decision to transport the TIS by air. All preparations must be made before the flight, to ensure that the infant arrives at its destination safely and quickly.

The system holds both EASA and CAA certification and represents an innovative design that meets to

the immediate needs of transporting critically ill neonates that is already attracting national and international interest.