Stretcher Flights: Choosing Commercial or Dedicated

Stretcher transport decisions should be made in consultation with the treating clinician and, where a commercial airline booking is being considered, the airline's own medical clearance process. This page explains the two broad pathways available and the factors that typically drive the choice between them. Final acceptance on either pathway is subject to clinical review, airline medical clearance where applicable, and aircraft or seat availability.

Stretcher transport generally falls into one of two categories, and the right one depends on the patient's clinical stability, monitoring needs and the urgency of the movement.

• Commercial airline stretcher booking, a stretcher fitted across several rows of a scheduled service, used when the patient is stable enough to travel on a scheduled aircraft with an accompanying medical escort
• Dedicated air ambulance, a purpose-configured aircraft chartered solely for the patient, used when clinical monitoring, equipment or urgency requirements cannot be met on a scheduled service

Commercial stretcher bookings are generally considered when a patient is medically stable, does not require continuous intensive monitoring or life support beyond basic oxygen, and the schedule of available flights meets the required timeframe. The airline's medical department reviews a completed medical information form (commonly referred to by the acronym MEDIF) before approving the booking, independent of any assessment made by Aviall or the referring clinician.

Commercial stretcher transport is usually the lower-cost pathway, because it uses scheduled capacity rather than chartering a full aircraft, but it depends on airline route availability, stretcher-row availability on that specific service, and the airline's own approval process, which can take longer than arranging a dedicated flight.

A dedicated air ambulance is generally the appropriate pathway when the patient requires continuous critical-care monitoring, ventilation, infusion therapy or other equipment that a commercial cabin cannot accommodate, when the required route or timing is not served by a suitable scheduled service, or when the clinical urgency does not allow time for an airline's standard approval process.

• Continuous critical-care monitoring or ventilation support required
• Equipment that cannot be accommodated within a commercial cabin configuration
• Route or timing not covered by a suitable scheduled service with stretcher capability
• Clinical urgency that does not allow time for standard airline medical clearance

Cost differences between the two pathways are significant, and understanding what drives cost on each side helps set realistic expectations for a family or case manager comparing options.

• Commercial stretcher cost is driven mainly by the number of seats blocked for the stretcher fitting, plus escort fares and airline handling fees
• Dedicated air ambulance cost is driven mainly by aircraft type, mission distance, crew composition and positioning legs required to reach the patient
• Both pathways add cost for specialist escort staff, equipment hire and ground ambulance transfers at each end
• Repatriation involving international legs generally adds customs, permit and multi-jurisdiction coordination cost regardless of pathway

Almost all stretcher movements, commercial or dedicated, require a qualified medical escort, typically a nurse or doctor depending on the clinical picture. The escort's role, qualifications and staffing level are determined by the treating clinical team and, for commercial bookings, may also need to meet the specific airline's escort policy. Aviall coordinates escort logistics on both pathways but does not make the clinical determination of what level of escort a given patient requires.