Since the beginning of NETS activities, it was clear that highly specialized personnel and appropriate equipment were essential. The limited market for transport equipment has resulted in homemade, customized and nonstandardized systems, eventually leading to equipment failure [
5,
6]. Despite the enormous progress in planning ambulance for intensive care, and despite the reported usefulness to have available dedicated ambulance to neonatal transport service, to date specific rules describing the ideal ambulance for neonatal transport are still lacking [
7‐
9]. Planning our project, we decided to avoid the installation of cabinets, usually assigned to contain various accessories for adult use, such as, for example, immobilizer and seat belts, vacuum splints, emergency seats, cervical collars, vacuum mattress, or other devices that are totally worthless during neonatal transport, as well as, cabinets possibly earmarked to contain essential features of equipment used in neonatal transport, such as glove and catheter box, intubation set material, or central catheters, that are usually stored into the transport bag, thus being immediately available and easily transportable. This choice allowed us to design a health compartment with a highly reduced number of kinematic mechanisms, protrusions or sharp corners, thus improving passive safety and increasing the usable space. The health compartment is equipped with waterproof floor with a perimeter edge of 50 mm, easily washable with water jet. In our project we do not consider mechanical characteristics of the vehicle; we underline that adjustable suspension to provide and assure comfortable ride is a fundamental tool, as well as, all safety equipments usually equipping modern vehicles. We believe that a strong point of our study is that we did not simply modify the EU type C ambulance for using it in neonatal transport activities, but, indeed, we designed the completely new EU type D ambulance previously not reported by EU documents. Adding to the EU type C ambulance equipment list the pipeline for nitric oxide use, the active controlled cooling device, the phototherapy lamp, the shock adsorbing stretcher support, and, obviously, a fully equipped neonatal transport module, definitively characterized the project (Table). The presence on board of a shock absorbing stretcher support, associated with an air-foam mattress and gel pillow, is very important for improving the safety and comfort of the transported patient reducing the effects of vibrations and impact during long transfers or transport on rough terrain [
10]. Vans suitable to be arranged for ambulance use actually present on the market have all similar interior dimension that are approx one/third of the recommended standard of 25 square meters for NICU, thus making very important an accurate use of the available space. The possibility to move the stretcher support laterally to the right up to 20 cm and the presence of rotating seats allow the NETS team to work snugly and secure. Even though the longitudinal position of the stretcher support, our project established that the personnel can be seated facing the direction of travel, thus reducing motion sickness. Rotating seats and the 20 cm lateral movement of the incubator when fixed to the stretcher support allow one team member to sit at the head of the transported newborn to provide constant clinical monitoring and management of the airway while the second member can have continuous viewing of the monitor and easy access to additional equipment. A parent may be accommodate in the driver compartment, properly secured. The front video-camera can record the entire trip allowing NETS Direction to have available all the needed documentation to be used in case of accident possibly resulting in litigations, monitoring driver performance, and, at the same time, to provide to the NETS team in the back partially blinded health compartment to have on dedicated television a continuous view of the road and traffic, making personnel ready to take on drive emergency. We wish for equipping all neonatal transport ambulances with a dedicated black-box trip recorder to improve the safety level. The sterilizing nebulizer system is important to obtain a clear ambulance in short time. Although these plants are not exclusively for neonatal transport ambulance, the larger space obtained inside the health compartment removing useless devices and cabinets makes easily their assembly. The Resin Transfer Molding (RTM) allowed us to design a health compartment with a highly reduced number of kinematic mechanisms, protrusions or sharp corners, thus improving passive safety and increasing the usable space. Finally, the only cabinets we established to include are for, as reported above, neonatal defibrillator, cooling device, gas analyzer, and a refrigerator for drugs and, in a separated box, for another specific need of neonatal transport, i.e., the transport of the patient’s placenta. Radio, GPS, and WiFi antenna allow communications whether transporting, tracking patient’s vital sign, and secure transmission of photographs, medical images and electrocardiograms, when needed.