Fixed-wing aircraft can serve a wide variety of missions, from urgent to routine, over great distances. Since airplanes land only at airports, they cannot make scene flights, and they need ground ambulance connections at both ends of the flight to transport the patient between the hospital and airport. Because of this need, fixed-wing flights generally take longer to arrange and are not used for truly emergent patients.
In the United States, more fixed-wing than rotor-wing aircraft are used for air medical transport. Rotor craft are usually dedicated as air medical transport units, while planes are often multifunctional, used for charter flights or business. Unfortunately, this may sometimes lead to inadequate equipping and staffing of airplanes when used for air medical work. Medical fixed-wing craft need to have an adequate cargo-type door to allow access to a patient on a stretcher. Removeable medical equipment modules have been developed for airplanes to ensure the presence of adequate medical equipment when required.
Fixed-wing transports are less expensive per mile and usually more practical than helicopters at distances over 150 mi. On average, helicopter transport costs about three to four times more than fixed-wing transport per patient-loaded mile.1 This estimate is rough because of the large number of variables involved in determining charges: distance, aircraft type and speed, crew configuration, and the nature of the patient's condition.
Airplanes vary in size and speed. Jet aircraft typically cruise at 400 to 500 mph, turboprop airplanes at 200 to 300 mph, and piston-driven airplanes at 120 to 150 mph. The appropriate aircraft to use for any one mission depends on many factors: distance, the nature of the airport at the patient's pick-up point, the condition of the patient, the amount of equipment, and the crew required in transport. The more critically ill the patient, the more equipment and crew may be needed and the larger the aircraft required. The choice of aircraft must also take into account the comfort of the crew and the patient for a trip of that distance. The cabins of fixed-wing aircraft are more spacious than those of rotor-wing craft. A larger plane that is able to be pressurized can fly above 10,000 ft, which means the plane can go faster, farther, and more comfortably.
Since airplanes can fly above bad weather and are less susceptible to icing conditions, fixed-wing craft can often fly when helicopters cannot. Fixed-wing planes can also fly under more difficult visibility circumstances than rotor craft because of on-board instrumentation and ground control from an airport.
All fixed-wing services must comply with FAA rules for airplanes. Standards have been developed for air medical fixed-wing aircraft by the Association of Air Medical Services and CAAMS, just as they have been developed for helicopters.26 These standards deal with aircraft configuration, medical equipment requirements, medical crew configuration and training, and medical director qualifications.
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