Offloading patients from aircraft requires careful coordination, communication, and attention to safety. While aircraft types and procedures differ slightly, the following always apply:

•  The flight crew oversees the offloading process.

• If the patient is intubated, someone MUST be in control of the tube during movement to prevent extubation.

• Be alert for I.V. lines, chest tubes, and other patient care devices that may be pinched or severed during offload.

• If using a Flight Stretcher, the pram mattress should be removed. Placing a sled on top of the mattress causes instability and damage to the mattress.

Fixed wing offloading operations fall into two general categories-with a ramp, and without a ramp.

THE FOLLOWING APPLY TO ALL WITH RAMP OFFLOADS:

• There should be equal people on both sides of the patient to prevent uneven lifting and tipping.

• The EMT shall ensure that the brakes on the pram are engaged, and at least one wheel is braced with a foot to prevent the pram from moving away from the ramp.

• Coordinate movement actions with the flight crew.

• Be aware that the patient’s feet may impact the oxygen tank at the foot-end of the pram. Adjust accordingly

WITH RAMP- FEET FIRST:

This is the most common type of offload you will encounter and is most common with turbo prop aircraft.

The flight stretcher with patient will be moved from inside the aircraft onto the ramp by the flight crew. The ramp will be lowered to facilitate offloading.

Place the head-end of the pram as close as possible to the end of the ramp. The level of the pram should be slightly lower than the end of the ramp, as the ramp will sag when loaded.

In coordination with the flight crew, the flight stretcher will slide down the ramp and onto the pram.

Be aware of your hand placement to prevent a crush injury. Hands should always be placed on the side of the flight stretcher, and not near the corners or leading or trailing edge.

Once the flight stretcher is firmly on the pram, secure it as described below.

WITH RAMP- SHEET SLIDE:

Some programs may elect to move the patient off the flight stretcher to the pram for increased comfort. In this case the mattress shall remain on the pram.

Once the flight stretcher has been moved onto the ramp and is locked into place, move the head-end of the pram as close as possible to the flight stretcher with the head slightly elevated to meet the level of the flight stretcher.

In coordination with the flight crew, flight stretcher seatbelts will be removed from the patient.

Make sure that monitor wires, IV lines, etc have enough slack to facilitate the move.

The sheet/Life Blanket/Mega Mover will be used to slide the patient onto the pram.

The pram seatbelts, including shoulder straps, shall be used to secure the patient to the pram.

WITH RAMP- ISOLETTE:

Due to the configuration of some isoletts, they must be unloaded with the pram backward to allow the patient access and care equipment to be accessible from the bench seat.

This operation presents a significant risk of hand injury. Hands should always be placed on the side of the sled, and not near the corners or leading or trailing edge.

The oxygen bottle must be removed or repositioned down for the isolette to clear.

Move the foot-end of the pram to the end of the ramp.

In coordination with the flight crew, move the isolette onto the pram and secure as described below.

Once the isolette is secured to the pram, lower the height so that the isolette is level.

WITHOUT RAMP:

Some teams may not use a ramp in the offloading process. This type of offload poses an elevated risk of injury to providers and patients. In these cases, the following shall apply:

• Have a clear plan with the flight crew prior to executing any movements.

• Ensure that you have enough people to facilitate the move.

The teams that do not use a ramp often elect to remove the patient from the flight stretcher. This usually involves placing the flight stretcher on the ground next to the pram (fully lowered) and moving the patient to the pram with a sheet lift. Alternatively, they may elect to place the flight stretcher on the pram mattress, then remove the flight stretcher from underneath the patient. Both methods are dangerous and pose an elevated risk of injury to provider and patient.

SECURING THE FLIGHT STRETCHER/ISOLETTE:

Regardless of the brand of flight stretcher, it must be secured to the pram.

The pram seat belts alone are insufficient.

Cam-Straps shall be used to secure the flight stretcher/isolette to the frame of the pram at four points.

The Cam-Straps shall be placed on the side of the flight stretcher/pram with one toward the head-end and one toward the foot-end. Using the straps anywhere else can cause instability and/or interfere with the pram functionality.