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In rotary-wing operations, the greatest predictable inertial load on a secured stretcher typically occurs along the aircraft’s longitudinal axis during rapid deceleration events such as landing flares, rejected takeoffs/aborts, or sudden power reductions. Proper stretcher orientation and locking systems are engineered so the strongest tie-down points oppose forward motion, protecting the patient and crew from becoming projectiles. While vertical shear exists during liftoff and climb, those forces are generally distributed through the litter locks and floor hardpoints and are less likely to cause catastrophic restraint failure than sudden longitudinal deceleration. Lateral forces during pedal turns are momentary and comparatively lower in magnitude than an abrupt forward stop. Vibrational resonance can degrade monitoring quality and patient comfort but is not the primary hazard addressed by litter orientation and restraint strategy. Therefore, aligning the stretcher so restraint systems counter forward deceleration best addresses the dominant risk profile in helicopter cabin dynamics and complies with air medical transport safety practices emphasizing forward load limits and restraint integrity.