A HEMS helicopter cabin is one of the most tightly engineered spaces in medicine. Monitor, ventilator, drug pack, stretcher rail and two working clinicians all have to fit inside a cabin built to stay light enough to fly. That confined space to operate and maneuver means crews have to assess a patient quickly, and a harder call on whether safe transport is feasible.

Based in Weßling, near Munich, ADAC HEMS Academy runs medical and flight training for HEMS crews. Its training covers light twin-engine helicopters built to reach patients ground crews can’t reach. HEMS crews train in mountain side extraction, night vision navigation, and mechanical CPR integration. 

Bariatric patients are where that training model gets tested hardest, and where most simulation programmes fall short. As the Academy puts it:

"R42 gives us the opportunity to include a patient group in our simulation training that is otherwise quite difficult to represent realistically. Especially in our environment, where space, weight, patient handling and transportability can have a significant impact on decision-making.
— Philipp Lex, Head of Medical Training, ADAC HEMS Academy GmbH, Weßling, Germany

R42 describes a patient that makes that threshold real inside the cabin. Crews load it, position it and work around it under the same space and lifting constraints a real bariatric transfer imposes: how the patient is packaged, how many hands a lift takes, whether the stretcher clears the door they are aiming for. Inside ADAC HEMS Academy's helicopter simulator, that turns the aircraft’s payload and performance limits from numbers on a spec sheet into a decision the crew has to make with a patient in front of them.

The same manikin carries into the Academy's advanced resuscitation training. In ACLS scenarios, crews run R42 alongside corpuls' mechanical CPR device, managing compressions, the device and the transport decision as one task. As the Academy describes it: 

"We often combine R42 with the mechanical CPR device from corpuls. This adds another layer of complexity and realism when teams have to manage resuscitation and transport of a bariatric patient."
— Philipp Lex, Head of Medical Training, ADAC HEMS Academy GmbH, Weßling, Germany

ADAC HEMS Academy trains crews for two of the helicopters most widely used in European air rescue. R42 puts the patient group that tests those airframes' limits hardest inside that training, at a scale that reflects many of the handling and transport challenges presented by bariatric patients.