Patient transport in Bangladesh: matching stretchers, trolleys and wheelchairs to how your hospital moves
Casualty and imaging trolleys, scoop and foldable stretchers, hydraulic height adjustment, castors and braking, and how to audit a hospital's real patient movements before deciding what the transport fleet should contain.
Most hospitals buy patient transport by the line item: ten trolleys, twenty wheelchairs, four stretchers, lowest compliant bid. A year later casualty is using an imaging trolley because it is the only one with a brake that holds, the porters have adopted two particular trolleys because those are the ones that steer, and three wheelchairs are in a store room with flat tyres. The fleet was bought as a quantity when it should have been bought as a set of jobs.
Audit the movements before writing the tender
Spend a week counting. This is not a research project, it is a clipboard at each of the places where patients change location. Five questions produce a specification that no brochure will.
Casualty to resuscitation, and casualty to imaging. How many per day, how many are supine, how many need spinal precautions, and how far away the X-ray room actually is.
Ward to theatre and theatre to recovery. Whether the patient travels on the ward bed or transfers to a trolley, and where the queue forms.
Ward to imaging. The distance, the lifts, the thresholds and ramps on the route, and whether the patient can sit up.
OPD and discharge movement. Mostly seated, mostly short, mostly attendant pushed. This is wheelchair work and it is usually the highest volume in the hospital.
Ambulance handover. Whether your trolleys load into the ambulances that actually arrive at your gate, and who does the lifting.
Two numbers come out of this: peak simultaneous demand at each point, and the physical route each device has to travel. Both change the specification more than any feature list.
Four jobs, four different devices
Job
Equipment
What decides the choice
Casualty reception and resuscitation
Casualty trolley with hydraulic height, Trendelenburg and a firm surface
Height range for CPR and for lateral transfer, IV pole and cylinder mounting, a brake reachable from either end
Imaging transfer
Transport trolley with a radiolucent backrest section or cassette provision
Whether the patient can be imaged without a second transfer, plus how it steers over the actual route
Inter-ward and theatre transfer
General transport trolley, or the patient's own bed
Corridor width, lift depth, and whether transferring the patient twice is worse than pushing a bed
Weight of the device, single person loading, and whether it locks into the ambulance floor
Seated movement, OPD and discharge
Attendant propelled and self propelled wheelchairs
Volume, folded storage, and who is pushing
Casualty and imaging trolleys
The most useful feature on a casualty trolley is hydraulic height adjustment with a pedal reachable from both sides. Lateral transfers are safe when the two surfaces are level, and a trolley that cannot be brought level with the bed guarantees a bad lift every time. The range matters at both ends: low enough for a patient to sit on and swing their legs across, high enough for a clinician to work at without stooping. A trolley adjusting through roughly 550 to 860 mm covers both, which is why that band is common on transport trolleys rather than accidental.
For imaging, the useful trolley is the one that removes a transfer. A radiolucent backrest section lets a chest film be taken without moving the patient onto the table, which matters most for exactly the patients you least want to move. Check the backrest angle range, and check whether a cassette can be placed from the side rather than by lifting the patient off the surface.
A central fifth wheel is worth asking for on any trolley that travels long corridors. It gives directional stability, so the trolley tracks straight instead of crabbing, and it lets one porter steer a loaded trolley without fighting it. Trolleys without one are noticeably harder work over distance, and that is how a hospital ends up using two of its ten trolleys.
Stretchers are not trolleys
These get merged in tenders and the confusion is expensive, because a stretcher bought as a trolley substitute does neither job.
Scoop stretchers split lengthwise and are assembled around a patient lying on the ground, so the patient is not rolled. That is the entire purpose: suspected spinal injury and trauma, where log rolling is undesirable. It is a rescue and transfer device, and no patient stays on one.
Foldable stretchers are lightweight aluminium alloy frames with a fabric surface, for evacuation, camps and any route a wheeled device cannot take: stairs, a narrow lane, a flooded compound. They fold into a cupboard, which is exactly why they are forgotten until the day they are needed.
Ambulance stretcher trolleys are the wheeled device that loads into the vehicle. They need to be light enough for the loading method your crews actually use, and the fastening has to match the ambulance floor. This is the one that goes wrong: a trolley that will not lock into the vehicle is scrap metal with a mattress on it.
Check the rated load rather than assuming it. The foldable and scoop stretchers we supply are rated to 159 kg, which is lower than a hospital transport trolley, and that figure is a design limit rather than a suggestion. If your casualty department regularly receives patients above it, that is a specification decision to make now and not an improvisation to make at three in the morning.
Castors and brakes decide whether the fleet gets used
Castors are specified last and complained about first. They are also the cheapest part of the trolley to get right and the most annoying to retrofit.
Diameter against threshold. Small castors stop dead at lift thresholds, expansion joints and the lip where terrazzo meets tile. Walk the route and look at the floor. A 15 mm step will jar a patient on a small castor and will not on a larger one.
Central locking beats four separate brakes. One pedal that locks all four castors, operable from either end, gets used. Four individual levers do not, and a trolley that rolls during a transfer is how staff and patients get hurt.
Directional lock. A pedal that fixes one castor straight ahead turns a wandering trolley into one that tracks. Ask for it as a separate feature from the brake, because suppliers quote it as though it were the same thing.
Bearings and tyre material. Wet floors, chlorine mopping and the grit that walks in during monsoon destroy cheap bearings. Sealed bearings and non marking tyres cost more once and save an annual replacement.
Noise. A trolley that rattles down a ward at two in the morning is a clinical problem, and it never appears in a specification.
Wheelchairs: highest volume, least attention
Wheelchairs move more patients per day than every trolley in the building combined, and they are usually specified in a single line. Three distinctions decide whether the fleet survives.
Attendant propelled or self propelled. Transit chairs with small rear wheels are lighter, narrower and cheaper, and the patient cannot move themselves. Self propelled chairs with large rear wheels give independence and take more corridor width. A general hospital fleet is mostly attendant propelled; a rehabilitation unit is not.
Solid or pneumatic tyres. Pneumatic tyres ride better over rough ground. Solid tyres never go flat. For a hospital pool that lives indoors and receives no maintenance attention, solid tyres are the right answer, because a punctured wheelchair is a wheelchair nobody repairs.
Seat width and folded width. Specify seat width against your actual patients, then check the folded width against the store you intend to keep them in. A fleet that will not fold flat gets parked in corridors, and corridors are where wheelchairs get damaged.
Electric wheelchairs belong to individual patients rather than to a hospital pool, with few exceptions. If you are specifying one, the numbers that matter are seat width, driving range, climbing capability against the ramps at the patient's own home, and charging time. In a household with load-shedding, being able to charge overnight and hold enough range for a day is a practical constraint rather than a footnote, and a chair rated for a 13 degree climb will handle the sort of ramp found at a Dhaka apartment entrance while a lower rated one will not.
Rated load, stated honestly
Rated load on transport equipment covers the patient and everything travelling with them: oxygen cylinder, monitor, infusion pump, and the attendant leaning on the side rail during a transfer. Specify with a margin over your heaviest realistic patient, and ask whether the manufacturer's figure is a safe working load or a static test figure, because they are not the same number. On a hydraulic trolley, also ask at what load the ram still raises smoothly, which is usually lower than the rated maximum.
The maintenance nobody budgets for
Number every device and keep a register. A fleet that is not numbered cannot be maintained, because nothing can be traced.
Monthly: check that brakes hold on a slope, that castors spin freely and are clear of thread and hair, that side rails latch, and that no mattress cover is split.
Quarterly: run the hydraulics through the full height range and look for weeping at the ram, check IV pole and cylinder holders are secure, and inspect the welds at the handle ends, which take the most strain.
Annually: replace worn castors as a set rather than one at a time, and replace any mattress cover with a split, because a split cover cannot be cleaned and the foam underneath is already contaminated.
Order castors, brake pedals, mattress covers and hydraulic seals as spares with the original purchase. These are the parts that fail, and a three month wait for a castor takes a trolley out of service for a quarter.