Aeromedical Transfer of Patients with Viral Hemorrhagic Fever

Abstract

For >40 years, the British Royal Air Force has maintained an aeromedical evacuation facility, the Deployable Air Isolator Team (DAIT), to transport patients with possible or confirmed highly infectious diseases to the United Kingdom. Since 2012, the DAIT, a joint Department of Health and Ministry of Defence asset, has successfully transferred 1 case-patient with Crimean-Congo hemorrhagic fever, 5 case-patients with Ebola virus disease, and 5 case-patients with high-risk Ebola virus exposure. Currently, no UK-published guidelines exist on how to transfer such patients. Here we describe the DAIT procedures from collection at point of illness or exposure to delivery into a dedicated specialist center. We provide illustrations of the challenges faced and, where appropriate, the enhancements made to the process over time.

Review of Literature for Air Medical Evacuation High-Level Containment Transport

“…The reviewed articles understated the considerable collaborations involved in AE HLCT decision making because most only vaguely mentioned frequent discussions and multiagency requests must occur before transport. [17][18][19] Nicol et al 19 did indicate that the decision to evacuate patients is a "complex process that considers the clinical, public health, and political contexts." Although no article identified a decision-making rubric for deploying AE HLCT assets, several discussed factors involved in the decision-making process (eg, recommendations by domestic and international agencies).…”

“…Patient stability and survivability were noted as principal factors in the decision to conduct an AE HLCT; a patient moved before the onset of severe disease manifestations is preferable and, at times, a requirement for transport because of limited isolation units. 5,6,17,[19][20][21] AE HLCT places additional stressors associated with altitude on the patient that impact their physical condition (eg, hypoxia and claustrophobia). 2,6,19,21,22 Articles identified a lack of local facilities with resources and capabilities as a reason for domestic or international evacuation.…”

“…5,6,17,[19][20][21] AE HLCT places additional stressors associated with altitude on the patient that impact their physical condition (eg, hypoxia and claustrophobia). 2,6,19,21,22 Articles identified a lack of local facilities with resources and capabilities as a reason for domestic or international evacuation. 2,6,22 Volunteers supporting humanitarian endeavors overseas are often assured that they will be repatriated should they become ill, as was the case during the 2013 to 2016 EVD epidemic when at least 24 EVD-infected HCWs/volunteers were evacuated to their home countries.…”

“…The regulations and legal limitations associated with the AE HLCT were not fully explored in any reviewed article. Two articles mentioned the need to adhere to organizational policies, 2,6 1 noted a requirement to obtain consent from governments for transports 5 and one stated AE HLCT teams routinely seek diplomatic clearance when flying over other nations, 19 but none discussed applicable federal or international regulations. Withers and Christopher 9,10 discussed the…”

“…5,6,17,20 Seven articles did identify organizations that would be contacted to initiate a transport, albeit at a high level. 5,10,16,17,19,20,22 Thoms et al 2 detailed crew predeparture briefings. The article by Christopher and Eitzen 17 was the only one to detail communication plans with the patient in-flight, namely, 2-way radios between team members and patients.…”