Ebola Patients Air Evacuation in Isolation Bubble

Special Article - Ebola Virus Disease

Austin J Infect Dis. 2016; 3(2): 1024.

Ebola Patients Air Evacuation in Isolation Bubble

Raffin H*

Medic’Air International, Bagnolet, France

*Corresponding author: Hervé Raffin, Medic’Air International, Bagnolet, France

Received: May 17, 2016; Accepted: July 08, 2016; Published: July 11, 2016

Abstract

For the past five years Medic’Air Int’l Doctors have been working to improve an internal process: Biorisk Air Transport (B.A.T.) for any request of evacuation of contagious patient needing isolation. During 2015 & 2016, Medic’ Air performed with success air evacuations of five Ebola patients from West Africa to hospitals in North and Western Europe in a twinjet air ambulance using this process and isolation bubbles.

Keywords: Lassa; Ebola; Marburg; Hemorrhagic fevers; Air ambulance; Medevac; Air transit isolator; Biorisk air transport; Isolation bubble

Introduction

Air evacuation for patients with highly contagious disease is a real challenge to perform with several levels of difficulties: political, logistic, financial and medical.

Medic’Air International realizes medical evacuations, mainly from Africa since more than 25 years. We progressed in this regard now with a well-defined process for evacuation of patients with hemorrhagic fevers: Ebola, Lassa (and Lujo) and Marburg.

Objective

Aware of the endemic presence ofhemorrhagic fevers in Africa, our duty Doctors in charge of each air ambulance flights are trained to be suspicious for any request coming from Africa (all areas), for a pyretic patient, with a clinical status decreasingshortly.

Our first target is to protect our medical teams and pilots from an unknown Lassa or Ebola case with a wrong diagnosis (i.e. malaria) to be repatriated from Africa. We work with epidemiologist physicians from “Doctors without Borders” year after year to establish our final B.A.T. (Biorisk Air Transport) process [1].

1) Previously, in 2010, Medic’Air evacuated a patient with suspected Lassa fever with only individual protective suits and helmet and ribavirinprophylaxis per os for flying medical attendants and pilots.

2) Since 2011, we started to use our first Air Transport Isolators (A.T.I.), with atmosphere in Positive Pressure, and our concept to isolate patient before boarding, in a soft bubble - transparent crystal walls-with filtered air through NBC cartridges. Patient is able to receive oxygen support and venous line from outside and intravenous medication by the attending crew if necessary on flight.

Without confirmation of efficiency, and with a indicated teratogen risk for pregnant woman, we stopped prophylaxis by Ribavirin tablets for our pilots, Doctor and nurse.

In the same time, the level of medical response was increasing in some places in West Africa with local infectious laboratories (i.e. Kenama hospital in Sierra Leone) able to confirm a diagnosis with Elisa test in a short delay.

In 2011, our team performed a successful long range Lassa fever positive case evacuation by air ambulance from Freetown (Sierra Leone) to Linköping in Sweden, with an ATI for an humanitarian physician [2]. During the following months, we worked closely with WHOand “Doctors without Borders” to establish a new process: BAT (Biorisk Air Transport) for highly contagious disease air transport [3].

We have extended our concept to be able to transfer patients with aero transmissible germs and we progressed from internal Positive Pressure bubble to internal Negative Pressure bubble through another manufacturer. So, in case of an accidental tear of the crystal wall, contaminated air is maintained inside the bubble, by the vacuum pump, and with limited risk to spread the pathogens inside the aircraft cabin and time to close the gap.

From summer 2015, with the Ebola epidemic in West Africa, we activated our B.A.T. process to respond to French Health Authorities and European “ECHO” office requests for potential Ebola air evacuations to Europe [4].

During this period summer 2015 to beginning 2016, we evacuate five patients with ATI by Air Ambulance with confirmed Ebola infection or only suspicion in the first days following the exposition. All medical flights were uneventful-except the difficulties to obtain flight clearance over African countries and landing permit in Spain for refueling.

All were humanitarian European workers, Doctor or Nurse, English speaking. Only one was a confirmed case and, after treatment, fully recovered.

Biorisk Air Transport Procedure

Opening a new Ebola case, Medic’Air duty Doctor must shortly - in touch with the local treating physicians and epidemiologists - know (and before our medical team take off from Paris):

The target is to anticipate patient’s degradation and to have conviction that patient will be eligible for the ambulance flight when our team will join him/her.

For any patient’s transport inside an ATI (Bubble) - at this stage of our expertise - we limit long evacuations (more than 4 hours) for non-excreting patients in the first days of the contamination or illness. If the clinical status is decreasing with major symptoms like several diarrheas, polypnea, neurologic defects or hemorrhagic signs before our flying physician takes charge of the patient and the mission has to be aborted immediately.

The B.A.T. procedure includes a nomenclature that lists every stage of the disease evolution of the patient: from asymptomatic to presence of fever, headache, myalgia, nausea, diarrheas, hemorrhage and shock.

Each decision regarding the implementation of the repatriation mission is based on this nomenclature. This procedure entirely follows WHO recommendations whose purpose is to balance between risks and benefits for the patient and the team. At an advanced stage of the disease the contamination risk to the escort team is too high with bad vital prognostics against low probability of recovery for the patient.

Air Transport Isolator - Bubble (ATI) Table 1

In that respect full clinical examination is forbidden to the escort team. Intrusive medical acts which would interrupt the “isolation chain” are forbidden: otolaryngology examination, cardiac or pulmonary auscultation or blood pressure control. Temperature is not monitored, only pulse and oxygen saturation. If venous access is necessary, it must be performed by a local team in the hospital, a venous line is monitored by the escort team on flight medication for hydration or sedation. Oxygen by nasal cannula can also be performed on flight.

Citation: Raffin H. Ebola Patients Air Evacuation in Isolation Bubble. Austin J Infect Dis. 2016; 3(2): 1024.