Transferring patients with Ebola by land and air: the British military experience

Abstract

The Ebola epidemic of 2014/2015 led to a multinational response to control the disease outbreak. Assurance for British aid workers included provision of a robust treatment pathway including repatriation back to the UK. This pathway involved the use of both land and air assets to ensure that patients were transferred quickly, and safely, to a high-level isolation unit in the UK. Following a road move in Sierra Leone, an air transportable isolator (ATI) was used to transport patients for the flight and onward transfer to the Royal Free Hospital. There are several unique factors related to managing a patient with Ebola virus disease during prolonged evacuation, including the provision of care inside an ATI. These points are considered here along with an outline of the evacuation pathway.

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

“…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.…”

“…Four studies mentioned the importance of effective communication and coordination among partners, but none discussed details of communication plans. 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.…”

“…Ewington et al 6 and Thoms et al 2 detailed the space layout within the C17 aircraft that both evacuations used, including placement and securing of the isolation unit. Thoms et al 2 detailed "aircraft containment zones" for patient areas within the aircraft where HCWs and crew could move within the aircraft and procedures and level of PPE that HCWs and crew would need for each zone.…”

“…The 2013 to 2016 Ebola virus disease (EVD) epidemic prompted multiple AE HLCTs; at least 10 nations conducted AE HLCTs for at least 33 patients with EVD within the country and internationally. [4][5][6][7] The AE-HLCTs were conducted by single-patient isolation transports. Since that epidemic, multiple groups have developed AE HLCT systems enabling simultaneous isolation and care of multiple patients; these include the US Department of State Containerized Bio-Containment System and the US Department of Defense (DoD) Transport Isolation System.…”