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Ornge, Ontario’s air ambulance operator, has completed the installation of a new powered stretcher system across its fleet of 11 Leonardo AW139s.
The Powered Aero Loader (known as PAL), produced by Australian company HeliMods, is a push-button operated powered stretcher loader system that allows crews to quickly and easily load and unload road ambulance stretchers into and from helicopter air ambulances.
The system is compatible with the popular Stryker Power Pro XT stretcher system, which is used by the vast majority of road ambulances across Ontario. According to HeliMods, the system allows for the transfer of patients weighing up to 700 pounds (318 kilograms) without the need for any manual lifting, achieved with the push of a button.
“This system allows for a seamless transition from the helicopter to the land system,” Justin Smith, chief flight paramedic at Ornge, told Vertical. “It’s really elevated the ability for us to bring critical care to the patient’s side.”
HeliMods was established by Will Shrapnel in 2002 in Caloundra, Queensland, and specializes in providing customized mission configurations in helicopters — particularly in the AW139.
The contract with Ornge represents the first large-scale commercial delivery of the company’s PAL system, which itself has been in development for a number of years.
“When we looked at developing the system, we took a step back and looked at the patient and the caregiver, and asked ourselves, ‘Where would you start?’ ” said Shrapnel. “You’d start with the best stretcher technology you could find. You’d want to be able to carry all your gear with the patient. You’d want bed transfer to be easy. You’d want power lifting from the ground to a high height.
“I think that’s really the difference of this product compared to others: It’s really putting the stretcher at the core, next to the patient and the paramedic, and saying, ‘Well, I want to start there.’ ”
The system required intensive research and development up front, with HeliMods working with local ambulance services in Australia to create the first-generation proof of concept for the integration. The design, which allows the entire stretcher to be fully cantilevered from the aircraft during loading and unloading, presented some difficult engineering challenges.
“It does require a lot of structural support from the aircraft,” said Shrapnel. “So our team set out to solve the engineering challenge of integrating power loading and lifting technologies into what’s essentially called an aircraft interface, which then connects into the aircraft floor. It does that without tools, so the aircraft can be reconfigured quickly.”
Ornge began exploring options to improve its patient transfer process a number of years ago, and called for proposals in a competitive bid process last year. “We realized that we needed to look outwards to find a better solution for the way we move patients, and the way that our paramedics were able to provide care to our patients,” said Smith.
“There are a number of really great things about this stretcher system, but if you were to summarize it, it really just allows us as paramedics to have a piece of equipment that acts more of an extension of our work and works with us, and not necessarily something that we’re having to fight with during the course of our duties,” Smith continued. “It really is an extension of our care.”
HeliMods was awarded the contract in October 2018, with a tight schedule requiring delivery of the first systems in April 2019. The company worked closely with Ornge ahead of that delivery to customize the system to the organization’s exact requirements.
“Will and his team were absolutely outstanding as far as taking our direction and working together collaboratively to come up with a system that is, I think, one of the best I’ve ever seen, quite frankly,” said Smith. “The end product is something that I think Will, his team, and us are all very proud of.”
One of the key customizations was the design of the bridge — the mounting attached to the stretcher that houses various pieces of medical equipment, such as the cardiac monitor, infusion pumps, and mechanical ventilator. The design of the previous bridge often required the various tubes, lines, and pieces of equipment required to treat a patient to be deconstructed and reconstructed during a transfer — a time-consuming and laborious process.
“You can imagine over the course of a shift having to remove and replace equipment on and off an equipment-carrying bridge,” said Smith. “Over time, that leads to musculoskeletal injuries, repetitive strain injuries, and just overall fatigue during the course of a shift. We don’t have to do that anymore. We’ve now got a system whereby all of our equipment stays on the equipment bridge for the duration of the transport.”
Inside the aircraft, the stretcher sits a little higher than the previous system, giving paramedics improved access to the patient during flight.
The PAL system also allows Ornge to transport bariatric (heavier) patients more effectively.
“There were times in the past where we would have to come back to base and essentially reconfigure our helicopter to be able to go service those [bariatric] calls,” said Smith. “We no longer have to do that, as this new system really allows us to service them in a way that is appropriate.”
The PAL system is “slightly heavier” than the previous stretcher system, said Smith, but he highlighted the efficiency it provides as being worth the extra weight.
Ornge has installed the new system throughout its fleet over several months, to ensure a smooth integration.
“We wanted to make sure that we didn’t impact our provision of care in our daily operation when transitioning over to the system,” said Smith. “One of the nice things about this system is that the learning curve — for paramedics, for pilots and anybody who’s going to interface with this — is not steep at all. It’s very easy to learn.”
The final aircraft to receive the new system entered operation with it at the end of August. Throughout the Ornge fleet, the organization has already completed close to 1,000 transfers with the PAL stretcher system, and feedback from crews has been “outstanding,” said Smith.
The PAL system has been certified by the regulatory authorities in Australia, the U.S. and Canada, and is also certified in the H145 in the U.S. HeliMods is also planning to certify it in the AW169, and potentially the Bell 429.