Loading a patient, regardless of condition, should be as easy and smooth as possible for helicopter emergency medical services (HEMS) crews. Patients requiring HEMS transport often present with complex medical conditions, may have experienced traumatic injuries — or both.
HEMS missions must also accommodate specialized patient populations, including infant, bariatric, and geriatric patients. No matter the circumstances, every patient requires fast, high-quality care, which depends on loading systems and stretcher designs that account for every operational detail.
“Air ambulance missions today involve complex clinical scenarios — from trauma and bariatric transport to neonatal and ECMO [extracorporeal membrane oxygenation] support — often conducted in tight rotorcraft cabins under extreme time pressure,” explains Rolf Kraus, director of sales and programs at Bucher Leichtbau. “Operators need interiors and equipment that maximize patient safety, support clinician workflow, and maintain aircraft performance.”
Bucher, therefore, focuses on engineering for weight efficiency, ergonomic workflows, and rapid adaptability, enabling operators to switch between intensive-care HEMS missions, multi-patient configurations, or parapublic and utility roles in minutes. Its OneTouchChange system allows components to be repositioned across walls, floors, or ceiling rails in moments.
To support mixed-acuity patients, Spectrum Aeromed offers different stretcher sizes, a variety of restraint systems, and adjustable strap configurations.
“Operators consistently emphasize three design priorities: minimizing system weight, safely supporting heavier bariatric patients, and ensuring clean integration of medical devices,” explained Tammy Enright, vice president of marketing and business management at Spectrum Aeromed. “By tailoring layouts to each cabin, we balance patient access, crew ergonomics, and aircraft payload limitations while maintaining a safe working environment in tight spaces.”
Air Ambulance Technology (AAT), depending on customer requirements, offers several stretcher types, including lightweight, foldable, comfort, and bariatric models, as well as stretchers with an undercarriage.
“We try to be as lightweight and easy to handle as possible, and be certified to all applicable load cases in an aircraft, with patient limitations in accordance with EASA requirements,” said Istvan Luis Zakarias, technical sales engineer.
Zakarias noted that heavier patients can create challenges for medical crews during loading, and increases pressure on available cabin space. In response, AAT has developed its Grand Stretcher for bariatric patients weighing up to 150 kilograms (330 pounds), featuring reinforced construction and added protection for the aircraft floor.
Integration with other medical equipment
As HeliMods founder Will Shrapnel noted, today’s HEMS sector is seeing increased requirements for stretcher carrying capacity and associated loading systems to support a broader range of medical missions.
These include high-acuity and complex transfers where additional equipment must be transported alongside the patient. This equipment can range from ventilators, infusion pumps, and various monitoring systems to oxygen cylinders, IV poles, and ECMO devices.
In response, HeliMods has developed a range of stretcher bridges that allow clinicians to safely transport medical equipment with the patient across multiple stretcher types, without the use of tools.
“This includes the ability to connect and position medical equipment in multiple locations and orientations on the stretcher bridge to suit the specific transfer being conducted,” Shrapnel said.
Spectrum Aeromed’s current stretcher platforms use purpose-built mounts and attachment rails that allow monitors, pumps, and IV equipment to be secured directly to the stretcher or stretcher bridge. This keeps critical tools close to the patient and reduces cabin clutter, Enright said, noting that many operators mount syringe pumps or ventilators directly to side rails for seamless access during flight.
AAT also offers stretchers and rail systems that can be highly customized to meet specific requirements. The company has additionally developed a bridge that can be installed on specialized stretcher configurations.
Bucher stretcher systems are installed in cabins alongside rails, brackets, and panels designed to secure IV poles and other medical equipment. Quick-change interfaces and modular attachment points allow stretchers and mission modules to be rapidly reconfigured without tools or specialist technicians.
The evolution of loading
Powered loading systems, as the name suggests, reduce or eliminate the need for crews to manually lift the full weight of the patient and stretcher.
“By removing these strenuous lifts, crews experience a safer working environment and more predictable transfer workflows,” Enright said. “Faster, smoother loading also supports high-acuity patient care, where time and controlled movement matter most.”
Spectrum Aeromed loading systems are engineered to minimize lifts and simplify the transition from gurney to aircraft.
“We use dedicated interface plates and hard-locking mechanisms that secure the stretcher directly to compatible ground units, eliminating the need for belts or improvisation,” Enright said. “Matching heights and connection points enables a clean ‘roll-on and lock’ process, reducing patient movement during handoff.”
Kraus added that both rear and side loading are supported by Bucher’s systems, ensuring smooth ground-to-air handovers while maintaining patient stability, even in challenging operational environments.
HeliMods offers several automated stretcher loading systems, such as its Powered Aero Loader (PAL), featuring push-button operation.
“Push-button stretcher loading represents the gold standard for safe and efficient patient handling during ambulance transfers,” Shrapnel said. “Our powered stretcher loading systems are simple and intuitive to use and greatly reduce the risk of manual-handling injuries that have historically been prevalent within the HEMS industry. We commonly hear frontline responders comment on how much easier it is to perform their role with the assistance of powered loading — and that their careers have been significantly extended as a result.”
Aerolite has developed a wheeled stretcher system that enables no-lift loading and unloading. The system features a certified pack rack (bridge) and a certified backrest for taxi, takeoff, and landing, while the stretcher can also be detached from the wheeled gurney for operational flexibility.
“This current system is designed and certified for the Airbus H145 EMS interior, with approximately 100 units in service,” said Hans Bretscher, vice president and general manager of Aerolite. “We are also developing a powered-loading variant and adapting the system for additional airframes, including the upcoming H140.”
Cabin layout considerations
When loading a patient, stretcher and loading system design must account for access to the patient’s head, the ability to perform concurrent CPR, and the potential need for multi-patient configurations.
Enright noted that cabin layout is one of the most critical topics in discussions with HEMS-focused customers. Access to the patient or patients, the ability to perform CPR, and options for multi-patient or escort seating all depend on aircraft size and mission requirements. Spectrum Aeromed designs interiors to ensure crews have the reach, clearance, and equipment placement required for each patient profile.
In this area of HEMS care, Bucher offers flex kits that provide reconfigurable cabin layouts with rapid installation. Designed for dedicated HEMS fleets, the kits offer multi-mission versatility. For helicopter intensive care air medical services (HICAMS) missions — involving three medical crew and one patient — the system supports configurations tailored for specialized parapublic, military, or critical transport applications.
Beyond the helicopter cabin, HeliMods has developed a range of solutions that allow the same stretcher — such as the Stryker Power-Pro XT — and its associated medical equipment to move seamlessly along the entire transport chain. This includes missions requiring a combination of fixed-wing, rotary-wing, and ground transport.
“This allows ambulance and retrieval services maximum flexibility in the assets they use to perform specific transports without having to move the patient off the stretcher between different legs of the journey,” Shrapnel said.
Future trends
Spectrum Aeromed observes that new clinical tools and treatment methods — such as ECMO systems, liquid oxygen (LOX) solutions, and organ transport — continue to evolve. In response, the company is developing corresponding mounting and integration features.
“Ongoing dialogue with clinical directors helps ensure our stretcher and loading solutions remain aligned with emerging requirements and future mission needs,” Enright said.
HeliMods is also seeing increasing HEMS complexity, with deeper integration of medical devices into stretcher systems.
“As medical device technology improves, there are more options for carrying specialty equipment,” Shrapnel explained. “Combined with powered loading systems, this is making highly complex transports more feasible for a wider range of air ambulance services.”
As the scope of HEMS missions continues to expand and new loading and unloading systems emerge, the use of advanced materials is also increasing. Bucher, for example, continues to refine its interior and stretcher designs with a focus on lighter composite materials, improved modularity, and enhanced device interoperability.