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Air Transport Of Large Patients


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#1 Rob Mauch

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Posted 19 June 2013 - 05:18 PM

How do folks deal with large patients? We all have the weight limits that our stretchers and aircraft can accomidate. But what about the actual girth of the patient? How do you share this kind of limitation with your referring medical facilities?

I know I have encountered flight requests that were acceptedbecause the patient weight met our guidelines. But we get there and find the patient spilling over the edges of a hospital bed. Then the referring staff is frustrated because they "told" us the weight when the request was made.

Any help or suggestions would be greatly appreciated!!

Rob
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#2 old school

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Posted 19 June 2013 - 09:08 PM

Our dispatch gave both a weight limit and width limit. I don't remember what they were, for sure. I think 300# and 36".
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#3 ForeverLearning

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Posted 20 June 2013 - 12:13 AM

Perhaps asking for height along with weight would give you rough idea if they will be spilling over. If they are 5 foot 3 and 300lb vs 6 foot 1 and 300lbs.
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#4 old school

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Posted 20 June 2013 - 12:38 AM

Perhaps asking for height along with weight would give you rough idea if they will be spilling over. If they are 5 foot 3 and 300lb vs 6 foot 1 and 300lbs.


Well that's where the width or girth comes in. I think our dispatch asked for a width if the patient was over 250.
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#5 onearmwonder

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Posted 02 July 2013 - 03:49 PM

Well actually companies usually don't post or share weight limits of their sled systems. They aren't required by the FAA. The weight limit is actually determined by what it is attached to in the aircraft and how it is attached. This is what I was told by engineering reps of Life Port and Spectrum. They will not give you numbers. Old School is right, I think the best guide is to take the patients weight, girth, and how wide the patient is at their widest point. Couple that with how much room you have to work around in your aircraft and however does your patient hang off the stretcher. Will this patient stay on your stretcher in extreme turbulence? Will they affect your egress from the aircraft? And then what is your comfort level? It will be a case by case basis. I personally have made my comfort level at 350lbs in our Astar and that's if they fit, and 400lbs in our King Air 200 with the cargo door. My company obviously has higher number thresholds, but I really don't care. My comfort is my comfort. I had to pick numbers since I wasn't comfortable with my services numbers. I based my numbers off personal experience and with buffers. Purely anecdotal for me. Remember it's not our fault that our patients are sick or hurt, but it will be our own fault if we screw the situation up or ourselves.

Matt
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#6 Macgyver

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Posted 03 July 2013 - 07:18 AM

Lifeport refuses to state a maximum weight for the Aerosled - because the FAA doesn't require them to do so for passengers. So as far as they will commit to paper for you, a 999# pt is fine as long as the weight/balance of the AC is still within the envelope.

TOTAL BS

The version of the Aerosled that is used to mount isolettes has a limit of 350# with the isolette and accessories attached. That is the max weight that is allowed by the STC required for cargo (the baby is not included as it is a passenger) for the Aerosled system. Using basic logic however, if the cargo sled is limited to 350# it will be for 1 of 2 reasons (weight and balance considerations being out of consideration here). Either the frame will deform unacceptably above that weight and make the mounting of the cargo (isolette) questionable, or the latching system that retains the Aerosled on the Base is limited (by virtue of g-force testing in various directions) to that weight before it fails to pass.

The patient litter uses the same frame and latching system. SO..... 350# is the MAX you should consider carrying, STC or not, and that includes the patient, the sled, the "arch" and any medical equipment such as pumps and monitors etc. So realistically (and for simple math) 300#. From my experience, the sled frame starts to deflect (bend) at about 220# but it is not a permanant deformation - likely caused by the center of mass of the load (pt) being in the middle of the two base feet as oppossed to distributed along the length of the stretcher as is the case with an isolette sled.

So what else can be deduced? If the 4 latch pins are rated to 350# max load for shear strength/G-forces, each pin and it's mounting system should be good for 87.5# give or take. So add a third "foot" and mounts to the base (will require a new STC) and you should be able to adequately secure 525#. The third foot in the middle of the stretcher will also help the deformation problem with bariatric loads. It will however not work with some aircraft as the stretcher uses that gap to make cornering possible with the loading ramp. Another possible solution is a 4 foot system, with the feet mounted at the foremost/rearmost possible locations (all the various slots in the base of the sled itself) as well as the two positions closest together. Not quite evenly distrubted so some deformation might occur but now G-wise good for 700#. Again an STC ammendment and testing will be needed to keep the FAA happy.

At this point it is worth mentioning that the mounts between the base unit and the aircraft also need to be verified for any weights above 350# (W&B as well as mounting) as they are STC'd for the base unit (as supplied) with the sled and load on top. Increase the sled's capacity and you need to make sure that the floor tracks won't rip out or the securing fastners won't fail. So NOT something your friendly rule bending mechanical type can do by himself. All in all you are looking at about 6 months, lots of paperwork, and several tens of thousands of $ to get a custom STC for your bariatric program using the existing Lifeport system you already have.

LP also sells bariatric Aerosleds and likely has done some testing or similar instalations already so may be able to streamline the process/cost if you spec a new system rated for a XXX# load (sled and pt) but you will likely have to demand that they STC and rate it as if cargo was strapped to the sled not a person (bags of lead shot for instance) or you'll likely get the runaround about no pax weight limit... But really, 300# through a standard Kng Air door is a good place to be. If you have a B200C (with a cargo door that is 54" wide - like the one in my avatar pic) and can get a loading sstem (ramp that will allow the modified sled to corner and a lifting system to get those heavy loads in without needing an engine company assist) and are setting up a dedicated bariatric system, then it is a matter of time. $$$ and what you spec.

FYI I have flown a 648# ICU IFT on mutiple pressors and a vent using an orange Ferno basket stretcher (with the pt strapped inside) secured with cargo loops and herc straps to the port side of the aircraft - went from the cabin wall to the side of the LP base unit. We had to remove the 2 seats aft of the spar and secure them to the lifeport stretcher, and shift as much weight forward as possible with the 2 of us sitting in the L/R aft facing seats fwd of the spar to (barely) stay within the CG for the aircraft. Needed 8 FF at each airport to hand load the 700#+ total weight in/out....

Since then I have seen Beech 1900's used (same cargo door) as well as PC-12's and Metroliner III (DON'T!!!!! - wing loading is excessive already!) do bariatric runs as well. But generally, the standard stretchers from Medpac, Lifeport, Spectrum and Egan ALL are not rated for bariatrics and are to small in any event (for NORMAL pt's the Aerosled is small - AFAIK was designed for the 29th century FAA "standard" patient, 172# and 5'10). Not sure about Aerolite however.

Somewhere else on FlightWeb there is another thread about the Lifeport ARCH and it's limitations.....

Found it: http://www.flightweb...l=&fromsearch=1
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Ken BHSc, RN, REMT-P

#7 MSDeltaFlt

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Posted 04 July 2013 - 06:50 PM

When it comes to large pts it is more of a girth and CG issue than actual weight. Because when you realize how you load a 350# and up pt into the AC very few ceew members have the strength to carry the AC cot at the head and toe only. What they normally do is load from both sides and the head. Which means you don't have slide out the sled all the way depending on your airframe. Just slide the cot onto the sled. Now if you can't lock the cot or the doors then you can't fly, obviously. Or if the CG is off and you're at max gross. If those are all in check then you can. I have no problem meeting at the local airport.
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Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain