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Modes Of Transport

How do we transfer patients?

In this article, Dr Anthony O'Dwyer gives us an overview of some key vehicles used in transfer medicine.
Ambulance boat in Venice with paramedics sitting in the front of the boat writing notes
© Dr Anthony O’Dwyer, North Central London Adult Critical Care Transfer Service (NCL-ACTS)

Transferring patients can be done in many different ways in many different environments, each with their own challenges. Worldwide there are many interesting solutions, which we’ll learn more about as we progress through the weeks. In this article we’ll look at some examples of what transfer trucks, ambulances, helicopters and planes can look like and go on to explore the unique concepts these modalities are based on.

On The Road…

Almost any vehicle can be adapted to become a mode of transport to provide medical care for patients and thus become an ambulance
  • Below we show you some of the more common and some of the more unusual ways to transfer patients.

Road Ambulances

  • Many services are using standard front line ambulances or ambulance vans for transfers. In this case the whole equipment has to be loaded for every transfer in bags and attached to the stretcher as you can see in this picture.
  • Road ambulances can be classified in a variety of different ways across the world, but typically classes are based on their design, complexity, emergency & care capabilities and weight. For example, in Europe these are classified into A, B, C, whereas in North America it is Types I through IV.
Click here if you would like to explore this classification in more detail.
  • Here is an example of a Type B ambulance which is used for patient transfer:
London Ambulance used for adult critical care transfers

Mobile Intensive Care Units (Type 1 or Type C ambulances)

  • These are typically specialised trucks based on the chassis of heavy duty vehicles like lorries. The Mobile Intensive Care Units are capable of providing advanced life support.
  • Typically they offer more space to work and enable more advanced interventions for care during patient transfer. They are frequently fully equipped with inbuilt cupboards and drawers for safe storage of equipment, with space for a table to document and advanced communication tools.
  • These trucks can also be further adapted, for example to cater for bariatric patients with an increased gross vehicle weight rating.

Fast Response Cars

  • Ambulance vans are used in services using fast response cars to bring the transfer team and the whole equipment to the sending hospital. This can give more flexibility for services operating in larger areas.

Off-Road Transfers

  • Some parts of the world are less accessible, like remote areas in the Arctic regions or some rural areas in Africa. The focus on the ambulances used in these environments is more on the off-road capabilities than on the comfort for the teams and patients.
  • Good transfer preparation and packaging of the patient is especially important in this circumstances.
Tanzanian adapted 4-wheel truck
Off-road capable ambulance in Australia

Alternative Solutions…

Bicycle Ambulances

  • Bicycles can be adapted for patient transfer with the addition of a bicycle ambulance trailer, and this is a solution to improve access to healthcare.
These ambulances are essentially ‘stretchers on wheels’ and can be used when no other transport is available.

Motorbikes

Motorbike to transfer patients from health centres to hospitals in rural Tanzania

Ambulance Buses

  • In some major incidents, mass casualty or natural disaster situations, a bus ambulance can be used to take sitting wounded, or ill patients between or to hospital.
  • As you can see above, during the COVID pandemic London Ambulance Services used standard buses to transfer patients.

On The Rails…

  • Train ambulances show how even trains can be adapted to provide high speed mobile patient care.
  • In 2020, France adapted one of its high-speed TGV trains into a mobile hospital to facilitate transfer of Covid-19 patients and decompress smaller more overwhelmed hospitals.
  • Below is a rescue and transfer train for critically unwell patients in Germany.

Picture shows transfer and retrieval team in a train tunnel loading a patient into the side door of a train ambulance

Rescue/Transport Train German Bahn

On The Sea…

Boat Ambulances

  • The image at the top of the article shows an ambulance boat in the lagoon of Venice, Italy, on a cloudy day in winter.
  • Boat ambulances are useful for cities with major waterways, like Venice. They are also used to transfer patients from other boats, oil rigs, and nearby islands for medical treatment, and important in remote areas with limited access or places which are impassable during certain seasons.

In The Air…

  • Patients can be transferred by air in one of two ways:
  1. Rotary-Wing Ambulances – i.e. helicopters which may be primary HEMS or secondary retrieval
  2. Fixed-Wing Ambulances – i.e. planes which could be dedicated retrieval jets or commercial airliners

Primary HEMS Helicopters

  • The advantage of using a HEMS helicopter is the fast availability and the flexible use.
  • However, the disadvantage is the very limited space in some of the helicopters like in the EC135 shown in this picture.
  • Long transfers means the resource is bound for extended times and the HEMS is not available for urgent primary missions.
German air ambulance in action

Secondary Retrieval Helicopters

  • There are much larger helicopters which are frequently used for secondary retrievals all over the world. They can carry a higher payload and can accommodate more staff and equipment, like ECMO patients.
Kent Surrey & Sussex Air Ambulance

Long Distance Retrieval Jets

  • Dedicated jets are often used if transfer distances are greater than the range of a helicopter.
Long distance retrieval jet in action in New Zealand

Commercial Airliners

  • Patients can be transported on airliners. This has the huge advantage of being able to cover long distances without refuelling stops, with stretchers fixed on top of seats or instead of seats.
© Lufthansa
  • Lufthansa has a clever solution called the “Patient Transport Compartment (PTC),” which we learn more about in Week 3 step 3.19, alongside a detailed look into aeromedical transfers.

Now that we’ve seen the huge array of modes of transportation, we can have a think about why we might need to transfer patients around the world. Move to the next step and tell us your thoughts!

© Dr Anthony O’Dwyer, North Central London Adult Critical Care Transfer Service (NCL-ACTS)
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A Journey Through Transfer Medicine

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