Harnessing innovation for patient-oriented medical interiors

The conversion wish list

AirMed&Rescue also spoke with Rupert Freeman, Acting Manager, Air Operations, at Ambulance Victoria, who confirmed the importance of the right medical interior. “A good medical interior fit-out is a crucial aspect of aeromedical operations. The work we do is challenging enough without having to struggle with poor cabin layout or difficulty accessing equipment,” he stated. “Modern aeromedical layouts will maximize usability, safety and weight savings to ensure the interior of the aircraft assists the operational staff to perform their vital roles.”

Indeed, the work of the air medical crew is complex, high pressure and time sensitive. It is crucial that a medical interior successfully accommodates the needs of the crewmembers. As such, the team is actively involved in the co-design of the medical interior from the start of the process, with close collaboration between a design organization, pilots and clinicians on a bespoke design that aligns with specific requirements.

Modern aeromedical layouts will maximize usability, safety and weight savings to ensure the interior of the aircraft assists the operational staff to perform their vital roles

“The modification of an aircraft is an already complex process by nature. The difficulty exponentially increases when considering the requirements for aeromedical transportation,” Ricardo Simões, Head of Engineering Department, Luxembourg Air Ambulance / European Air Ambulance, told AirMed&Rescue. “For us, as an operator of air rescue helicopters and air ambulance aircraft, this is just the start of the process. The aircraft changes and modifications are defined in the approved scope of work of a design organization. Through their work procedures and areas of expertise, design organizations can support the operator to achieve their desired conversions and modifications.”

Indeed, efficient collaboration remains crucial beyond the conversion design process. “Due to the numerous potential options, an optimal coordination between the involved parties, as well as a clear understanding of the requirements and deliverables, are essential to ensure a successful conversion,” Simões said. He explained the long-term benefits of this: “It is critical to have an accurate recording of choices made in the decision-making process to ensure the delivery of the desirable functions. Allocating significant time and involving multidisciplinary expertise during the conversion process will bring considerable benefits in the long term and for the entire product lifecycle. An efficient integration not only helps the operator to provide quality services to their patients,

but, with appropriate airworthiness instructions and operability requirements, it also directly eases and optimizes the maintainability of the equipment.”

Technological innovation for excellent patient care

An important aspect of a medical interior is the inclusion of advanced technology that will directly benefit the patient, boosting lifesaving capability. David Harding, Chief Aviation Officer at STARS, said that the organization’s medical interior change was completed as part of its fleet renewal transition, which began in 2019 and was completed in 2022. “At STARS it is imperative that we provide the best care possible to patients, and as such it’s important we maintain the latest in technology within our aircraft,” he stated. “We provide ICU-level transport for interfacility missions as well as responses to remote scene calls to provide critical care.”

Sharing some of the specific requirements of the conversion, Harding revealed: “We needed the interior to include a zero-lift, roll-on stretcher with the ability to facilitate airborne intubation, a flexible and easy-to-configure interior with ample storage, proper electrical support for multiple medical devices, crashworthy seating, gaseous oxygen storage and delivery, and cabin heating and cooling to support operations from -40℃ to +40.” Following the completion of the conversion, myriad benefits were felt. “Our crews adapted quickly to the updated interior, and as a result we have improved mission turnaround times, as well as interoperability with ground resources,” Harding said. “Additionally, the flexibility of the interior has significantly reduced downtime when maintenance is required.”

New on the conversion menu

Looking at new medical interior innovations that are benefiting operators, Simões said that advances have continued apace in recent years. “The availability of equipment and material that can be used in the design of a medical interior has increased in the last years with the development of new materials and technologies that are compliant with the strict requirements allowing an installation in an aircraft – for example, the improvements in lightweight composite panels formed or machined with the capability of being produced in ergonomic shapes without losing their resistance, or the availability of flammable resilient materials easy to clean and disinfect for the EMS use,” Simões reflected. “The same level of development can be seen in the medical equipment needed to transport the patient onboard.”

Critical equipment has become lighter, more durable, easier to interface with in complex circumstances, and often combines critical parameters from multiple devices into one

Brannon and Dr Racht shared innovations of note: “As medical technology continues to evolve, critical equipment has become lighter, more durable, easier to interface with in complex circumstances, and often combines critical parameters from multiple devices into one. An increasingly valuable component of medical technology is the provision of decision support tools – information that guides practice real-time based on data input. We always consider the portability and transferability of medical equipment in an aircraft, given the needs for patient movement and handoff.”

They pointed out that in line with technological advances comes the need to remain abreast of developments: “The modernization of equipment necessitates a continuous review of existing equipment and practices.”

Operators have the ability to develop a medical interior that completely aligns with needs, which, in itself, is innovative. Harding said: “We have configured our H145 fleet to be as conducive to our needs as possible.” Providing details of the bespoke elements available to the crew, he stated: “The multiple mounting points for equipment with stretcher, ceiling and wall options available increases flexibility and our ability to incorporate new tools in the future. All our items are clip-in, which allows us to configure the aircraft into any other specialty setup in a matter of minutes and facilitates the incorporation of permanent configuration changes with minimal effort as the clinical needs of our mission sets evolve. Additionally, Wi-Fi capabilities allow us to better communicate and share information with the ground-based physician team.”

Make your selection, please

When it comes to selecting equipment, Simões pointed out that there are plenty of options, and considerations include the necessary range for the operations and the number of passengers required for the operation (patients, medical crews, family members, etc.). “These questions and many other factors play a crucial role in determining the path to follow when selecting the equipment,” he said. Simões underlined that choosing a new medical equipment provider is an important decision and shared further important deliberations: “Considerations on the support provided by the equipment manufacturer and their support of such items (e.g. availability of replacement parts, the capability to allocate changes or to install new equipment, the type of documentation provided to support their product) become vital during the selection process of a new medical equipment provider. Ultimately, the most suitable equipment is the one that aligns the best with your specific operation, enabling you to consistently deliver the best possible service.”

While there are similarities across all patients, there are important differences when considering the needs of specific populations such as neonates, pediatrics, medically complex and infectious-disease patients

Brannon and Dr Racht said that the choice of medical equipment is based on the types of patients that will be managed in that particular airframe. “While there are similarities across all patients, there are important differences when considering the needs of specific populations such as neonates, pediatrics, medically complex (requiring multiple monitors and therapeutic equipment) and infectious-disease patients,” they highlighted.

The sky’s not quite the limit… yet

Exploring limitations with aircraft interior fit-outs, Freeman said that a key challenge is the length of the contracts involved, which can mean that by the time the conversion is complete, it is already outdated to some extent. “An aircraft medical fit-out may be chosen several years before the contract even commences. That same medical interior will likely still be in place, and relatively unchanged, at the end of a 10-year contract,” he said. “A lot can have changed for an operator during the life of the contract, meaning the medical interior may no longer be fit for purpose. It can be an onerous and protracted process to make substantial changes to an aircraft interior and, due to cost and effort, this is avoided. This can result in years of working with suboptimal cabin layouts and conditions.”

Simões underlined that transporting someone with severe physical limitations involves creating a highly specific environment and it’s not enough to look at the equipment in isolation. When asked about the limitations of an aircraft interior fit-out, he said: “The short answer to this question is: the aircraft! Merely concentrating on the equipment installed for this operation without considering how the aircraft’s environment impacts human physiology is insufficient. Both aspects are crucial for a successful transport operation. The act of transporting passengers is ruled by defined guidelines. These guidelines must be put in place through an intensive process of design, but they only consider a person who can walk into the aircraft and not a patient that needs assistance or is moved on a stretcher. With the design of aeromedical equipment, it is not always possible or easy to apply these guidelines to an ambulant patient.”

It takes discipline to keep your configuration and equipment lean and lightweight

Ultimately, a medical interior that assists with smooth team operations is what operators want and need. “Paramedics always like to be prepared for anything and tend to fill cupboards with more than they need – if one of something is good, then five must be better!” said Freeman. “We know that is not the case, and it takes discipline to keep your configuration and equipment lean and lightweight. The medical fit-out should assist with this process and ensure you have easy access to what you want, when you need it most. We want a medical fit-out that works synergistically with the team to assist them to perform at their best in all environments.”

With technology becoming increasingly embedded in every industry, medical interiors will continue to improve. Until then, operators can dream of their ultimate fit-out and one day it may become a reality. “It would be a brilliant achievement to have one platform that fulfills the entire scope of work, from the air rescue helicopters to the long-range air ambulance aircraft, reaching the highest level of equipment provided to both patients, passengers, and crews,” Simões concluded. “Certainly, progress is being made in numerous areas toward achieving this goal. With the continuous advancement of new technologies, we are hopeful that we’ll eventually move closer to realizing this ideal world.”

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