Ebola air medical transport
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Air medical transport (AMT) for patients with Ebola virus disease (EBV) must be coordinated with public health and civil aviation authorities at origin and destination. Infection control policies and procedures should be established before and implemented during all phases of patient transport. A portable isolation unit is recommended to contain infected materials and minimize contamination of the aircraft. Personnel providing care during transport should be trained in clinical management, infection control, and correct use of personal protective equipment (PPE). PPE should be used by all those in the patient care area or who may have contact with patients or their body fluids; infection control guidelines should be followed, and procedures that could increase the risk of exposure to the patient’s body fluids should be avoided.
Air Medical Transport
Air medical transport (AMT) is a unique patient care setting. Unlike ground medical transport, such as in a ground ambulance, the aircraft usually does not stop or re-supply during transport and the mission usually exceeds several hours. During AMT, a patient’s condition can deteriorate, needing additional interventions that could result in an increased risk of exposure for healthcare providers. The recommendations in this guidance are based on standard infection prevention and control practices for Ebola and Marburg hemorrhagic fever, AMT standards, aircraft-specific safety considerations, and established international notification protocols.
Ebola virus is transmitted in healthcare settings by direct contact with infectious blood or body fluids (for example, blood, urine, feces, or vomit); accidental injuries by sharps, such as scalpel blades or needles, that are contaminated with infectious material; and splashes to unprotected mucous membranes of the eyes, nose, or mouth. Infection control measures for patients with Ebola virus disease (EVD) include standard, contact, and droplet precautions. Injection therapy, blood sampling, and other procedures that require the use of needles and other sharp implements should be limited to what is essential for patient care. Procedures likely to generate splashing (such as transferring liquid waste from one container to another) should be performed only when necessary and with careful adherence to correct use of personal protective equipment (PPE). Procedures that might generate aerosols, such as intubation, should be avoided unless necessary for patient care; if it is necessary to perform such a procedure, healthcare providers should wear appropriately fit-tested respirators that provide at least 95% filtering efficiency (such as a NIOSH-certified N-95 or higher-level filtering facepiece respirator).
The decision to transport a patient with EVD should be carefully considered and thoroughly planned in discussion with relevant public health agencies, civil aviation authorities, and personnel from the receiving facility. Factors that should weigh into the decision include whether the patient is clinically stable enough to travel (i.e., whether the patient’s condition could deteriorate during transport), and that personnel providing care during transport are trained in clinical management, infection control, and correct use of PPE.
General Considerations
- Patients with EVD should be transported on a dedicated AMT mission.
- Other patients who do not have laboratory-confirmed EVD should not be onboard.
- Only people directly involved in patient care or operating the aircraft should be onboard. If people other than those caring for the patient and operating the aircraft, such a patient’s family member, need to be on the aircraft, decisions should be made on a case-by-case basis in consultation with public health authorities and, as necessary, aviation authorities.
- Pilots, other necessary crew members, and ground crew should follow routine procedures for AMT missions. Anyone not involved in direct patient care should remain at least 3 feet (1 meter) away from the patient during movement of the patient onto and off the aircraft, and should not enter the designated patient care area.
- If available, a portable isolation unit should be used to contain infectious materials. Use of a portable isolation unit minimizes the need to clean and decontaminate the aircraft after the mission.
- Infection control involves a variety of precautionary measures:
- Eliminate exposure to body fluids.
- Minimize contamination of the aircraft. Disinfect surfaces that are soiled during patient care promptly.
- Use personal protective equipment (PPE) correctly.
- Avoid procedures that require the use of sharps or that could create splashes of infectious material.
- Plan that the crew will need to take breaks in compliance with crew rest requirements.
- Coordinate international transport of patients with EVD with public health and civil aviation authorities at origin and destination.
- In the United States, EVD is a disease for which federal isolation and quarantine are authorized. All transport of patients with EVD destined for a U.S. airport must be reported to CDC before arrival, preferably before travel. U.S. federal regulations require the commander of an aircraft destined for the United States to report any deaths and certain illnesses among travelers to CDC before arrival. Reports from flights operating in U.S. airspace provided to the Federal Aviation Administration Air Traffic Services (ATS) units will be shared with the CDC EOC.
- International movement of patients with EVD might additionally require special approvals by aircraft-servicing or fueling, or patient rest-stop locations, and countries that will be over-flown, if applicable.
- If the AMT experiences an in-flight incident (such as a change to the patient’s condition requiring the flight to divert or be supported by special handling), the pilot should advise the appropriate ATS unit, to facilitate coordination with the responsible public health authorities and the implementation of any needed air traffic management related support. The pilot should also follow applicable company procedures.
Patient Placement
If transport of more than one patient with confirmed EVD is planned, the patients can be isolated together as a group.