Most observational studies have shown that preterm infants who were transported postnatally had a higher incidence of severe brain hemorrhages (grades 2–4). This underscores the potential role of transport as a critical risk factor during the first days of life – particularly for unstable and immature neonates.

Regardless of the mode of transport (ground or air), neonatal transport exposes infants to high levels of noise, vibration, and acceleration. Helicopter or fixed-wing aircraft transports offer the advantage of reducing the time needed for a specialized team to arrive and the overall transport duration, but may also involve increased noise and acceleration stress. In addition, a drop in cabin pressure can worsen respiratory status; a small observational study showed reduced cerebral oxygenation in some neonates.

Various mattresses have been tested for incubator transport, with gel mattresses transmitting the least vibration. However, due to limited literature, no definitive recommendation can be made. Gel mattresses may also pose a higher risk of injury in the event of an accident due to their weight.

Since noise and vibration can induce stress in neonates during transport—affecting heart rate—it is recommended to reduce noise exposure and ensure the use of hearing protection for newborns and preterm infants.

A retrospective view shows that vehicle and stretcher systems have improved significantly over the past 50 years – modern systems transmit significantly less vibration than older ones. However, the transport environment remains highly stressful, particularly due to acceleration, braking, and take-off/landing maneuvers.

Manufacturers have attempted to adapt incubators to reduce noise, light, and temperature fluctuations – but the reduction of vibrations during transport remains an unsolved challenge.

In the United States, over 68,000 transports to specialized NICUs take place each year – and about 5,000 in Canada. Approximately 15% of births occur in hospitals without appropriate neonatal facilities. Transport to centers with intensive care capabilities is therefore often life-saving – but also represents a physiologically and logistically highly demanding phase.

Vibrations can destabilize vital signs and make monitoring and treatment more difficult – especially in emergency situations.

Bailey et al. (2019) tested various mattress configurations for ground transport, including:

• Gel pads with foam backing
• Foam layers placed below the isolette tray
• Foam padding of the tray rails

The guideline explicitly states: “Transport should be as gentle as possible and pain-free.” This applies especially in the case of unstable pelvic or spinal injuries, in order to avoid secondary damage. The recommendation was reviewed in 2022 and holds GPP status (Good Practice Point).

The S3 guideline (AWMF 187-023) recommends: “Any extremity that is even suspected of being injured should be immobilized before major movement or transport.” This helps prevent pain, secondary injuries, and neurological deterioration. The recommendation carries a grade B ⇑ with a consensus strength of 94%.

According to the guideline: “Pain and the associated emotional stress can further raise blood pressure and contribute to the progression of the aortic dissection.” This implies the need for calm, low-vibration positioning to help keep patients stable and reduce the risk of dissection worsening.

The study shows that many of the vibrations occurring during ambulance transport fall within frequency ranges that are particularly sensitive for the head, abdomen, and spine. This can trigger physiological stress and compromise patient safety. The authors emphasize that improved stretcher designs with appropriate damping can significantly reduce transmitted vibration levels.

International guidelines, such as those from the European Society of Cardiology and the CHEST Journal, highlight the importance of preclinical stabilization in pulmonary embolism:
oxygen administration, anticoagulation, possible thrombolysis, and close monitoring of hemodynamic parameters.

Although low-vibration or immobilizing positioning is not explicitly recommended, it may be beneficial for unstable patients to avoid further cardiac stress or adverse reactions.

Claramonte et al. (2024) documented significant physiological stress markers in a study involving 27 paramedics following real emergency operations. In addition to elevated blood pressure and heart rate, there was a clear increase in salivary amylase—a reliable marker for acute psychosomatic stress.

Source: Claramonte et al. (2024) – PubMed

Schmidt et al. (2023) conducted a nationwide online survey involving more than 900 emergency medical personnel in Germany. The results indicate persistent mental strain, especially due to complex cases, responsibility for unstable patients, physical strain from vibration, and time pressure during transport.

Source: Schmidt et al. (2023), Notfall + Rettungsmedizin

While multiple studies have shown that neonatal transport is associated with increased risks of complications and mortality, the direct causal link between mechanical stress (e.g. vibrations, acceleration, noise) and clinical outcomes remains insufficiently understood.

Still, evidence suggests that acute stress—triggered, for example, by unstable positioning—can worsen the course of vulnerable conditions, especially in unstable patients. Reports from emergency personnel and physicians reinforce this assessment.

Muniqo Performante is the first to enable continuous measurement of mechanical stress on patients throughout the entire emergency care pathway. This lays the foundation for medical evidence that can establish a causal link and support targeted improvements in patient transport.