Peter Donaldson checks out the latest innovations in the constantly evolving HEMS space.
Patients and medical crews are the design focus of all good Helicopter Emergency Medical Service (HEMS) interiors. These life-saving airborne spaces must be capable of supporting basic medical gear and specialised devices that doctors and paramedics require.
At their most complex, HEMS interiors are flying Intensive Care Units (ICUs), but their layouts and equipment fits are shaped by patient needs, operating concepts, climate, geography, population distribution, and the aircraft’s space and weight limits.
Balancing these factors draws on expertise from aviation, medicine, and engineering.
We quizzed four leading practitioners – Aerolite, Bucher, Gama Aviation and United Rotorcraft – about how they how they innovate to meet operators’ changing needs and the rapid development of medical technologies.
Aerolite designs lightweight, ergonomic interiors that support advanced critical care equipment, partnering with operators to offer solutions for all medical missions.
Gama Aviation offers a full-service capability, including identifying commercial off-the-shelf (COTS) equipment, design, production, and turnkey HEMS programmes where they also fly the aircraft and run operations.
Bucher, which is active in the automotive, railway, and aviation sectors, provides catering, cabin, and EMS systems, including quick-change helicopter interiors.
United Rotorcraft is a mission system designer and integrator for airborne law enforcement, search and rescue, aerial firefighting, corporate aviation and HEMS.
Design philosophy and clinical integration
In creating an aircraft medical fit, interior specialists typically take responsibility for cabin layout, ergonomics, equipment mounting, integration, compatibility, and certification (including crashworthiness and safety).
Operators define medical procedures and Aerolite “provides the aviation set-up for the best possible service to the patient,” as Stefan Spichtig, the company’s Head of Customer Relations, explains.
Rolf Kraus, Bucher’s Director of Sales and Programmes MIC, notes that HEMS crews face growing demands. The cabin must be a real treatment space with thoughtful device placement, power distribution, room for crew movement, and flexibility for mid-mission changes.
A DRF crew works on a patient in an EC145 T2 with a Bucher interior designed around the medical workflow. Image Bucher
Bucher’s infrastructure supports flexible device positioning, structured electrical systems, and accessible service panels.
“We think about the workflow first and design around it,” says Kraus. “The choice and clinical configuration of specific devices, and deeper avionics integration, is typically a conversation between the operator and their equipment suppliers. What we make sure of is that our interiors are ready for that conversation and don’t create obstacles.”
Joe Tolaro, Sales Manager at United Rotorcraft, stresses the importance of designing around in-flight medical workflow, with early engagement of operators and clinical teams to prioritise access, visibility and efficiency.
“Human factors are central,” he says. “Ensuring clinicians can work effectively and safely, even in high-stress scenarios.”
The new skidded ‘Evo’ version of the AW169 offers more than 300 kg of extra payload and a cabin with extra internal volume thanks to repositioned fuel tanks. Image: Gama Aviation
When telemedicine and real-time data sharing extend integration beyond the cabin, responsibility shifts toward avionics partners and operators.
“We design the cabin to support those capabilities, but system-level connectivity and device integration are typically outside our scope. Success depends on tight collaboration – cabin designers, avionics integrators, and operators each own different parts, but the end goal is shared.”
Duncan Daines, Group Head of Engagement at Gama Aviation, notes that local conditions affect HEMS capability needs.
In Italy, high-altitude mountain operations make weight critical, so the focus is rapid scene-to-hospital transport.
In New Zealand, long distances between population centres and definitive care centres make fuel capacity key.
The UK’s blended model includes one-way operations – the aircraft drops off the medical team, who then travel with the stabilised patient by other means – and full airborne ICU missions.
Aerolite’s Spichtig notes that every operator has different mission profiles, medical workflows, and operational priorities, so the company’s policy is to conduct frequent deep reviews with Chief Medical Officers.
He says: “We believe that only by sitting next to them on a daily basis can we capture their needs and become a trusted partner. This cooperation helps us build ‘ready to fly’ interiors, anticipating operators’ needs that show up mainly in the most critical missions.”
Stefan Spichtig, Head of Customer Relations, Aerolite
Putting patients first
At Gama Aviation, customisation is driven by three overarching factors, according to Daines.
These include demographics such as the distribution of bariatric patients, and trauma from farming accidents in rural parts of the UK, for example.
Geography and urbanisation must also be taken into account, with urbanisation demanding compact aircraft footprints, while remote areas call for endurance and self-sufficiency.
Differences in operational philosophy are equally impactful, with the question of whether definitive patient care is delivered on scene or once the patient has been taken to hospital serving to shape different types of interior.
“HEMS interior design is global, but never one-size-fits-all,” says United Rotorcraft’s Tolaro.
“Differences in clinical models, crew structure and mission priorities drive deeper customisation than layout alone.
“Physician-led systems often require support for advanced in-flight interventions, while paramedic-led models tend to prioritise speed and efficient access. Crew size and roles shape seating, reach, and workflow.”
Daines emphasises Gama Aviation’s patient-first approach to interior customisation, illustrated by its work with Dorset and Somerset Air Ambulance (an AW169 operator).
Now entering production, this work improves patient “packaging” to streamline loading/unloading while improving medical access and accommodating more equipment.
Daines says: “We started by looking at the process map with Dr Phil Hyde and Paul Owens, particularly the number of interventions and where the ‘red hazards’ were – areas where manual handling can cause line detachment or critical patient effects.”
Collaborating with the clinical team, they identified 26 such hazards and reduced them to 15 via three innovations.
First, an all-purpose “bridge” accommodates a Ferno scoop plus equipment (medical gases, monitors, syringe drivers, etc) for a total load of 25 to 30 kilograms, carried to/from the aircraft in one go.
Second, the bridge works with a new composite aviation stretcher, with or without the Ferno scoop.
Third, a detachable height-adjustable trolley lets crew move bridge and patient with minimal lifting; its legs fold automatically as it enters the cabin.
At the hospital helipad, it can remain stowed or be used to transport the patient – useful if no porters/stretchers are available – thereby avoiding delays.
Looking ahead, Daines sees a trend toward equipment for advanced interventions such as Extra-Corporeal Membrane Oxygenation (ECMO) and Intra-Aortic Balloon Pumps (IABP), requiring more volume, weight and clinical specialists, potentially increasing the importance of flex-fit and quick-change interiors.
Space, weight and balance
Maximising clinical space and accommodating more equipment without compromising weight, balance and hover margins (especially in hot/high environments) is a perennial challenge.
United Rotorcraft approaches the question of additional equipment not as simple add-ons but as system-level trade-offs.
Tolaro says; “When evaluating increased oxygen capacity, the first step is to look at mission profile – typical transport duration, clinical needs and utilisation rates. In many cases, the goal is not to maximise capacity but to right-size it.”
Solutions combine lighter-weight materials or composite systems, optimised equipment placement for centre-of-gravity management, and modular configurations that scale capability by mission.
“Improving cabin efficiency often creates margin without sacrificing functionality,” says Tolaro. “Adjustments in one area ripple across the entire aircraft system.”
A larger aircraft is one answer, and OEMs sometimes rework types to make them lighter and more spacious.
Leonardo’s 5.1-tonne AW169 Evo, for example, exchanges retractable wheeled undercarriage for fixed skid gear, increasing the maximum take-off weight by over 300 kilograms and relocating fuel tanks to free cabin space.
Gaining momentum
According to Klein, 2025 was a turning point for the type’s commercial momentum, which has created a high-quality problem for Airbus in terms of meeting demand and keeping backlogs under control.
Until late last year, the H160 final assembly was on a line shared with the H175, but now the super-medium will share a final assembly line (FAL) with the Tiger attack helicopter, while the existing line is dedicated to the H160.
This will mean an annual production rate in the regional of 35 to 40 aircraft is achievable, though further expansion of that line will be needed to attain the eventual goal of 60 a year (40 civil and 20 H160Ms), which is what will be needed to meet the expected demand.
Another programme designed to improve production rates is the generation factory programme at Marignane, which aims to cut lead time for main gear box production by half.
Clearly there are some elements that are outside Airbus’s supply control, but the company is looking to further reduce supply chain demand by progressive expansion of TBO intervals on major components like MGBs.
Klein says: “We were able to get the MGB time between overhauls (TBO) to 3,000 hours [and] examinations of fleet leader MGBs revealed exactly what we expected. That gave us the confidence to extend the TBO, and, as the fleet matures, we are expecting to progressively extend the TBO to 6,000 hours.”
I thought about Klein’s words as we began our approach to NHV’s Ostend headquarters, as the sun began to arc towards the horizon, and thought more about the prospects for medium helicopters in offshore operations in the North Sea, which now filled the horizon.
In recent years, much of the discussion has centred on the heavy versus super-medium debate, while scant attention has been given to the role of mediums in the space. Something of an oversight, I reckon.
It is, however, something that may frame the equipment choice discussion in the coming years – especially if, as Airbus and NHV confidently expect, the H160 delivers in that most demanding of offshore energy environments, the North Sea.
Tackling crew fatigue
Medical crew fatigue risks patient care, so interior developers work to eliminate it at source.
Bucher’s Kraus notes that fatigue builds through small, repeated issues: awkward reach, poor lighting, fittings requiring two hands and concentration.
“We try to design those friction points out,” he says. “Seating positions allow work without uncomfortable postures for long periods. Devices are placed where hands naturally go, not where easiest to mount. Quick-release fittings reduce reconfiguration effort, which matters more than it sounds on a fourth mission of the night.”
Proper lighting is also key, with Kraus noting that Bucher has invested in LED lighting with night vision mode.
He says: “Getting the right light in the right place for clinical work, without blinding the pilot or killing night adaptation when the door opens, takes real thought.”
Stefan Spichtig echoes this, noting that Aerolite optimises equipment reach zones, creates intuitive workflows, includes improved seats with swivel tracking adapters, reduces clutter, and installs adaptive dimmable lighting.
“Seating positions allow work without uncomfortable postures for long periods. Devices are placed where hands naturally go, not where easiest to mount. Quick-release fittings reduce reconfiguration effort, which matters more than it sounds on a fourth mission of the night.”
Rolf Kraus, Director of Sales and Programs MIC, Bucher Leichtbau
He says: “The goal is to create a familiar environment where operators feel able to provide the best performance possible, to reduce fatigue and improve safety during long missions, and where possible to add comfortable options.”
Gama Aviation’s Daines says design starts with “patient effect”, then optimises the clinician-patient interface.
The company’s interiors minimise manual handling via trolleys and rolling systems, with surfaces designed to avoid awkward loads, catch points, and finger traps.
Electromagnetic interference
HEMS aircraft present a complex electromagnetic interference (EMI) environment due to the number and variety of portable electronic devices.
All four companies take similar approaches: shielded wiring, proper grounding, cable segregation, and close coordination with avionics specialists and authorities.
Spichtig says Aerolite integrates EASA and FAA compliance early in the design process and verifies it with a test campaign for each aircraft before release.
Kraus notes that routing and shielding are planned with EMI in mind from the start, with a centralised, structured electrical system providing a more controlled environment than ad hoc additions.
At the same time, Bucher follows evolving regulations closely.
“The whole industry is still working through how certified installed equipment and operator-supplied portable devices should coexist,” says Kraus. “The right answer will come from ongoing dialogue between manufacturers, operators and regulators.”
Many portable medical devices – ultrasound, monitors – are now wireless and, like phones and tablets, undergo Transmitting Portable Electronic Devices (TPED) testing.
United Rotorcraft’s Tolaro says: “Effective EMI integration depends on early collaboration and disciplined design to maintain safety, compliance, and reliability without limiting clinical capability.”
Quick-change durability
Quick-change interiors let operators transition between HEMS, VIP, utility or troop configurations on the same platform, with Tolaro noting that frequent swaps subject attachments, locks, electrical interfaces and floor fittings to wear and tear.
“Repeatability is critical,” he says. “Systems must maintain structural integrity, proper fit, and reliable engagement every time. If tolerances drift or interfaces degrade, it impacts safety and usability. Simplicity is key; overly complex mechanisms create maintenance issues and increase improper installation risk.”
A Kent Surrey Sussex AW169 with a Gama Aviation interior. Note the medical oxygen system in the stretcher platform and transverse ceiling rails. Image: Gama Aviation
Spichtig says that Aerolite develops lightweight, robust locking systems, reliable interfaces, easy inspections and simple installation procedures for long-term reliability,” adding: “Where operators have to focus on patients, Aerolite focuses on the environmental tools.”
Bucher’s Kraus says: “Any mechanical interface in aviation has a service life; disciplined inspection and maintenance are key. The system is reliable; keeping it that way is a shared responsibility.”
Even dedicated air ambulances benefit from quick-change capability, Daines says, for example in repositioning the stretcher to the centreline for bariatric patients, without tools.
Gama Aviation developed this approach for the King Air, but the concept applies to helicopters with large cabins.
More specialised equipment such as ECMO, IABP, X-ray and incubators could in future be installed, including plug-and-play on rails with integral connectivity.
Kraus says this configurability will soon be essential for keeping up with evolving cabin technology without complete replacement every few years.
“Our modular systems allow swapping, repositioning or upgrading components without touching the certified set-up. Operators can respond to new equipment, mission profiles or clinical protocols without starting from scratch.”
Certification requirements
Certification looms large for aircraft modifications, increasingly so with growing complexity and integration.
Managing complexity while maintaining certification timelines and operational practicality is the biggest STC challenge, says Spichtig, adding: “Success depends on close cooperation between operators, suppliers, and authorities.”
Tolaro explains that modifications now span structures, electrical systems, avionics, crashworthiness and EMI.
An Airbus H145 operated by Gama Aviation pictured in the process of transferring a patient to ground transport. Image: Gama Aviation
He says: “A major challenge is integrating modern medical systems into complex electrical architectures. As cabins become more connected, managing power demand, quality, and redundancy without impacting avionics is critical.
“Certification expectations have increased, with greater focus on system-level validation, interaction between components, and detailed documentation.
“The biggest hurdle is integration at scale – aligning engineering, certification, and operator requirements is essential.”
However, Daines identifies regulator bandwidth as the single biggest hurdle. Authorities are stretched, and their pace doesn’t match commercial timelines, with there being no discernible difference in responsiveness between EASA and the FAA.
“It’s more of a programme management issue,” he says. “Ensuring we’ve given engineers enough time for the certification process.”
Future tech
Asked to identify one area of technology influencing HEMS interior design over the next five years, the companies highlighted connected patient care and telemedicine.
Spichtig emphasises that patient care is central to Aerolite’s development of modular cabin architectures with scalable power, data integration and flexible equipment configurations.
He says: “We aim to provide the best service with the latest technology without forgetting our values and experience.”
Tolaro at United Rotorcraft’s view is that aircraft are becoming extensions of the hospital – integrating monitoring, diagnostics and telemedicine into a single ecosystem that serves to drive cabin design, from power and data architecture to EMI management and human-machine interaction.
Rather than a single technology, Gama Aviation’s Daines identifies a systemic shift: aircraft being integrated with uncrewed “support” assets to deliver specialist equipment to the scene, thereby freeing up cabin space and weight in the helicopter.
He asks: “Conceptually, why burden a single system with all the capability when it could be federated to a broader distributed network approach?”
This article “Balancing acts” was published in the Volume 20 Issue 4 of RotorHub International. To read more articles like this, apply for your complimentary subscription today.
