Table 1

 Protocols for use of inhaled nitric oxide (iNO) during air transfers

iNO cylindersMust be clearly marked with necessary hazard labels
Must not be changed during a flight or its delivery system dismantled
iNO may only be carried when there is a real medical likelihood of being required
If iNO is not required, the cylinder should not be taken on the return sector
NO/NO2 detectorsBoth NO and NO2 detectors must be carried on every flight with iNO
They must be fully functional and tested before departure
In the event of an alarm the medical crew must immediately alert the flight crew of a gas leak. In such an event the flight crew will initiate an adverse event
Adverse eventsThe aircrew will divert to an airport closest to a hospital with iNO facilities
Once the aircraft has landed, the doors will be opened allowing residual gases to be vented from the aircraft
Arrangements will be made for the mandatory medical examination of the air crew
Continuation of the flight is at the discretion of the air crew and dependent on any symptoms experienced by the crew
If there is a clinical issue about deterioration of the infant and the need for an urgent onward journey, a request should be made for the services of a Search and Rescue (SAR) asset
If a SAR asset is used, it has to be on the basis that no other option for transport is available and the condition is life or death