Air Ambulance Operation

Information and guidance for operation of a Fixed Wing Air Ambulance

Air ambulance operations are considered public transport flights. They are distinct from Helicopter Emergency Medical Services (HEMS), where additional risks are defined and the relevant requirements applied.



Stretcher Fit

The approval of a stretcher installation will generally constitute a Major Modification. Alterations to previously approved existing modifications may be classed as a Minor Modification.

Medical Equipment

An approval is not required for the carriage of Dangerous Goods in flight for the purpose of providing medical aid to a patient.

Flight Time Limitations

CAP 371- "Avoidance of Fatigue in Air Crews" specifies limits on Flight Duty Periods (FDPs) for these operations, and the circumstances under which they can be increased.

Operations Manual

In addition to the standard Operations Manual, the following should be considered or included where appropriate:

  • At least one medical attendant should accompany a stretcher patient at all times.


  • Generally, two-able bodied persons are given the responsibility of removing a patient from the aircraft in an emergency situation.


  • Stretcher cases must only be removed from the aircraft after all passengers not associated with the patient have been evacuated.


  • If aircraft fuelling takes place with a stretcher patient on board, an exit must be designated through which the stretcher can e carried in the event of an emergency evacuation.


  • The aircraft operator must ensure that, in the event of an emergency evacuation, a jetway or steps are placed at the designated exit for stretcher patients.


  • When stretcher cases are on-board an aircraft, an airport fire appliance must be in attendance during a fuelling operation.


  • Fuelling with a stretcher patient on-board is not permitted with AVGAS (Aviation Gasoline)


  • Some air ambulance flight have a medical requirement to fly as low as possible- the Operations Manual should provide guidance on how this is to be interpreted.


  • The Operations Manual should address considerations associated with urgent flight.



Further Information

Modifications and Repairs

Memorandum of Understanding between the CAA and the Care Quality Commission (CQC)