European concepts for the domestic transport of highly infectious patients

Abstract

Highly infectious diseases involve clinical syndromes ranging from single to multiorgan infections and pose a constant threat to the public. In the absence of a definite treatment for most causative agents, patients benefit from maximum supportive care as clinical conditions may deteriorate in the short term. Hence, following initial case identification and isolation, rapid transportation to a specialized treatment unit must be considered in order to minimize the risk of secondary infections, but this is limited by available infrastructure, accessible care en route and the patient's clinical condition. Despite the development of consensus curricula for the clinical management of highly infectious patients, medical transportation lacks a common European approach. This article describes, as examples, three current European concepts for the domestic relocation of highly infectious patients by ground vehicles and aircraft with respect to national legislation and geography.

Evaluation of Ambulance Decontamination Using Gaseous Chlorine Dioxide

“…Paraformaldehyde fumigation is used to decontaminate Swedish highly infectious patient transport ambulances, and Italy uses manual surface cleaning protocols to decontaminate transport vehicles. 26 Currently, ambulance decontamination protocols from the three high-level patient isolation units in the United States (Maryland, Georgia, Nebraska) have not been published, and no reports of specialized transportation vehicles exist for these units. High-level isolation facilities use a variety of specialized patient transportation methods, including standard ambulances draped with plastic or absorbent sheeting, specialized high-efficiency par-ticulate air (HEPA)-equipped container vehicles with detachable patient care compartments, fixed-wing aircraft transport of HEPA-equipped ambulances, and the use of patient isolation pods.…”

“…High-level isolation facilities use a variety of specialized patient transportation methods, including standard ambulances draped with plastic or absorbent sheeting, specialized high-efficiency par-ticulate air (HEPA)-equipped container vehicles with detachable patient care compartments, fixed-wing aircraft transport of HEPA-equipped ambulances, and the use of patient isolation pods. 26 Despite the effort in developing adequate transport isolation, these units still recognize the need for decontamination after patient transport. To date, a limited number of high-level isolation units employ ambulance fumigation protocols utilizing paraformaldehyde gas, and other units carry out manual surface decontamination in full personal protective equipment.…”

“…26 A combination of fumigation and surface cleaning is utilized in Germany based on the biological organism requiring decontamination. Paraformaldehyde fumigation is used to decontaminate Swedish highly infectious patient transport ambulances, and Italy uses manual surface cleaning protocols to decontaminate transport vehicles.…”

Transportation capacity for patients with highly infectious diseases in Europe: a survey in 16 nations

“…Basic recommendations for transporting HID patients were agreed on in the EUNID consensus but the absence of EU-wide legally binding regulations led to a broad range of individual concepts adapted to local prerequisites [1]. Overall, the different solutions implemented depend greatly on national legislation, the availability of vehicles and funds, geography, population density and public health threats or challenges faced in the past in the affected country [17].…”

“…In contrast, experience gained from VHFs imported to Europe highlighted the fact that suspected cases are often not directly referred to isolation facilities but are encountered in standard hospitals not equipped to provide mid-or long-term care under strict infection control regimens [2,16]. Hence, patients may need to be relocated to the closest isolation facility available if the clinical conditions allow transportation, although risks for personnel and patients en route must be considered [17].…”