Aeromedical Transfer of Patients with Viral Hemorrhagic Fever.

Edward D Nicol,Michael Jacobs,Joanna D’Arcy,Emma Vincent,Andrew Green,David Mulvaney,Belinda Mollan,Ian Mollan,Stephen Mepham,Jonathan Naylor,Philip Gillen,Matthew Adam

doi:10.3201/eid2501.180662

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.

Highlights

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
End-to-end maximal patient containment from overseas to the receiving hospital and subsequent discharge is achieved through the Transport Isolator (T-ATI) (Figure 1), which is designed to interface with the Trexler isolator
Separate T-ATIs are owned by the Ministry of Defence (MOD) and the Department of Health, and both capabilities are operated by a dedicated MOD team that includes the medical operations directorate, the Royal Air Force (RAF) Aeromedical Evacuation Coordination Cell (AECC), and the Deployable Air Isolator Team (DAIT)

Summary

Aeromedical Transfer of Patients with Viral Hemorrhagic Fever

In the United Kingdom, 2 high-level isolation units (HLIU) are primarily responsible for the care of patients with viral hemorrhagic fevers (VHFs): the Royal Free Hospital, London, and the Royal Victoria Infirmary, Newcastle. The United Kingdom uses a larger closed T-ATI system for the transfer of infected patients (Figure 1), a design that provides patient comfort and medical care while maintaining containment for the duration of the transfer mission. These systems have been used on Lockheed Martin C-130 and Boeing C-17 Globemaster (Figures 3,4) aircraft, enabling rapid delivery of the T-ATI and clinical team to both standard and austere landing strips at great distance from the United Kingdom

Late neurologic complications

Transfer of Patients with Viral Hemorrhagic Fever

Discussion

Limitations and challenges

Three military HCW exposed to Ebola were returned from the

Thank You EID Reviewers