From Runway to ICU: The Role of Air Transport in HCID Patient Care

Hello and welcome to Transmission Interrupted.

My name is Jill Morgan.

I'm a nurse here at Emory University Hospital in Atlanta, Georgia.

For those of you not yet familiar with NETEC, our mission is to set the gold

standard for special pathogen preparedness and response across health systems in

the U.S., with the goals of driving best practices, closing knowledge gaps,

and developing innovative resources.

NETEC works alongside and in cooperation with the CDC and is

funded by ASPR, the Administration for Strategic Preparedness and Response.

Today I get to talk with some old friends and really dive into, what is a

mystery topic for a lot of folks, which is air transport of high-consequence

infectious disease patients.

So many of you'all may remember, famously the Phoenix Air Group was

the company that did a lot of these transports of patients, returning

travelers, returning workers, from West Africa during the Ebola outbreak.

Their mission has continued and they are just a tremendous group of professionals.

So today I'm so excited to introduce y'all to some folks

that I've known for quite a while.

We have with us Vance Ferebee.

Vance is the former medical division director and the chief flight

nurse for the Phoenix Air Group.

He served as the director from 2007, right up until 2025.

And he was the co-lead on the team that developed this Airborne

Biological Containment System or ABCS.

Which was utilized for patient transport during the West Africa Ebola

outbreak, and then he also led that team that developed and implemented

these follow on transport units.

The containerized biological containment system, CBCS, that

was utilized early in COVID.

Really they end up transporting like over a hundred patients from Japan and

California and Africa, back home to here in the United States and across

Europe during the early COVID days.

So really happy to have Vance here.

I also have Wade Miles, and Wade is the operations and training manager

for the Emory Office of Critical Event Preparedness and Response, or CEPAR, and

has been with Grady EMS and he's been responsible for developing and managing

and delivering all sorts of EMS education.

He works with the CEPAR team to develop and coordinate drills and exercises,

for Emory University, and he serves as the training manager for the section

of pre-hospital and disaster medicine.

Also, Wade is the deputy Director for Emory EMS and is a current member of

the National EMS Advisory Council, and is a co-lead for NETEC's EMS workgroup.

So grateful to have Wade here.

I also have Ben Tysor, and Ben is the Captain and Paramedic of,

Emergency Medical Services Quality Assurance at Omaha Fire and Rescue.

And he's been in Omaha for over 20 years in their fire

and emergency medical services.

He's a member of the Omaha Fire and Rescue High-Consequence

Infectious Disease Transport Team.

And he was part of many of the transports that occurred to the Nebraska Unit at UNMC

during the, 2014 - 2015 Ebola outbreak.

So a lot of great experience here.

And then rejoining us is Dr. Alex Isakov.

He is the founding and executive director of the Office of

Critical Event Preparedness and Response, CEPAR here at Emory.

He's also a professor of emergency medicine at Emory University and he

directs CEPAR's initiatives to enhance disaster resilience at Emory and in

the broader community across Atlanta.

And obviously looking forward to things like the World Cup here.

He's also the director of Emory's Section of Pre-Hospital and Disaster

Medicine and leads Emory's EMS.

Alex serves as co-lead for NETEC's EMS workgroup.

So thanks guys.

I hope I didn't blunder those too badly.

You are such illustrious guests.

I'm grateful for your time today, so welcome.

We're gonna dive into just what it looks like.

Vance, let's start with just some basics.

What does it look like to land somewhere in a foreign country and have to pick

up somebody with an infectious disease?

What kind of report do you get?

What do you know about what's gonna happen on the ground?

And then I'd love to hear about what kind of care you can actually deliver

in the back of a aircraft of some kind.

And, as I mentioned earlier, I just wanna preface this by saying, we're really

gonna talk about fixed wing transport.

We're not gonna talk about what might happen locally with your air

medical transport with helicopters.

Vance, help us understand your world, the world you help create actually.

Thanks for having me, Jill.

Back in 2014, obviously it was a pretty exciting time and there was

more that we didn't know than what we actually did know, especially

with our first couple of transports.

And, those first two transports were to Liberia.

As you know, the infrastructure in Liberia at that time, during

the bull outbreak was very sad.

The hospitals were overrun.

A lot of staff were getting sick and were passing away.

And, we were originally tasked to pick up two missionary

workers that had gotten sick.

And the word went out from their leadership that they wanted to have

them brought back to the states.

And, they went through a lot of effort to try to find some

means of bringing them back.

Commercial air carriers were not available.

Private aircraft were not available.

Everybody was of course very afraid of Ebola.

The news coming out was pretty much over the top about what

the disease looked like.

Just as background.

with Phoenix Air, infectious disease transport was not something that we

really intended to get into, but what happened in the past was the CDC, back

in 2007, had a need that was unrecognized to bring back some of their staff if

they were overseas, in very remote locations, say a bat cave in Vietnam,

and they came across some novel airborne disease and how could they get them back?

And they were receiving some anxiety from their staff because back then

the policy was treat in place.

People couldn't be transported.

And just to make their own staff feel better and to try to develop a program,

CDC got with Phoenix Air, because we're local, and then also the DOD.

And what came out of all that is what we call the ABCS, the Airborne

Biological Containment System.

And of course, our slang word for it is a tent.

And it was something that by the time it was developed, those initial concerns

in Southeast and Southwest Asia, had moved on and, it was just left,

owned by the CDC and we kept it in a warehouse until obviously 2014 and then

we ended up using it and off we went.

The real challenges initially were, aside from those in our medical staff

utilizing the aircraft and the ABCS device, was really our leadership.

No one wanted to have the Ebola patients brought back to the United States and none

of the government agencies were ready.

They spent a lot of time trying to make that happen on very short notice.

And what came out of all that was we came under contract with the State

Department and we needed a federal partner that could coordinate all the various

agencies and also be the gatekeeper.

At that time we had one aircraft and we could only move one

patient every three days.

That became a real issue initially, but fortunately more aircraft came online and

more ABCS units were built and were ready.

But that was the initial challenge.

To get back to your question though, it was very exciting landing in Liberia.

It's nighttime.

Of course we flew there and we immediately went into crew rest, because our first

patient was very sick and had received half of a dose of ZMapp, which was

the first time I believe it had been administered to an actual patient.

We came out of crew rest and then met them at the airport.

It was very interesting.

All of the plans that we had made about how we would initially make contact

with a patient and how we would receive the patient in the aircraft immediately

just turned into not what we expected.

Everything went wrong.

That began our continuous learning every time that we did a flight.

Everything that we thought we knew, we didn't know, and our policies we thought

were appropriate, needed to be revised.

It was a, an ongoing, exciting time for all of those trips.

I think you're being overly modest here, Vance.

I mean, when you say things went wrong,

things weren't what you expected, but one of the strengths of you and

this whole aspect of our industry and healthcare, is your ability to adjust.

Your ability to assess a situation and pivot as needed.

And so I don't doubt that while things may not have been the way you

thought they were going to be, that y'all did, obviously a great job and

a safe job of loading these folks up.

What does care look like?

You pick somebody up who's very sick, they've got something like

Ebola, you're putting them into some sort of, as you said, tent.

And what, as a nurse, what are you able to do or what care could you do?

In one of these aircraft?

Great question.

On the one hand, it's very limited.

And on the other hand, there's a lot you can do.

The big limiting factor, of course, is it's a very tight space and

you're in full PPE and you're scared, you're perspiring heavily.

It's very hot outside.

Your working light is very poor, and you're dealing with Ebola.

We don't have a photo to look at, but the tent is a disposable,

plastic tent that's suspended from an aluminum frame that is assembled

in the back of the aircraft.

It has two chambers.

There's the patient compartment and then there's an antechamber.

Think of that as the warm zone.

And then there's the cabin, which is the cold zone.

It was designed to really deliver ICU level care.

And the plan with the design was how could we replicate a hospital ICU-capable

negative pressure isolation room.

We had two rooms, negative pressure.

We had double HEPA filters for the air coming in and double HEPA

filters for the air going out.

We had an air handling unit that would be pulling the air through it.

The pressure was actually on a negative pressure gradient.

The negative pressure in the patient compartment was more negative than

that in the antechamber, which was negative compared to the cabin.

The patient compartment is only eight feet long and we have a six foot stretcher

in there, and when the negative pressure is in effect, the walls of the tent

are pulled in, so it's very tight.

And of course, our protocol is to try to avoid having any of your PPE come

in contact with the walls of the tent.

The great part was the initial design had all of our medical equipment outside

the tent, attached to the tent frame.

So, monitors, suction, IV pumps, ventilators, et cetera, and then all of

the various tubing and cables went through a sleeve into the patient compartment so

we could maintain our negative pressure.

The real advantage to that system is that it allowed us to have

full body access to the patient.

So just like in the hospital, the patient is in normal clothes.

We're in PPE.

We have full access to do assessment and also any

interventions that were necessary.

So it, it was pretty good.

The real challenge is doffing in the antechamber.

And that's a very, very small area.

And then to compound, the concern is that at that time we did not utilize a PAPR.

Oh.

we could not use a PAPR.

Our PPE consisted of the normal items, but we also had a face mask

and goggles and a face shield.

And the reason that we couldn't use a PAPR is that there was

no way to decon the PAPR.

Because the antechamber was very, very small, and it just had a red bag for the

discarded PPE, so we didn't have that.

Later on when the CAPR system became available, and everything was inside

your PPE, then that was utilized.

But the fact that we didn't have a PAPR really increased the discomfort level,

because you didn't have some airflow.

It was very snug and it just takes a lot of practice.

And how many people make up your crew in the back, and

how long is everybody back there?

How long are these transport?

We utilize a three man crew.

Three person crew.

it's usually a physician, but not always.

Usually a minimum of a nurse and a paramedic and a physician.

Or it could be two nurses and a paramedic.

It could be three nurses depending on what was available.

We eventually had three aircraft flying at the same time.

And so we really started reaching deep into our staffing and so the

crew composition varied, but it was always a three person crew.

For loading and unloading, we have two crew members that it takes to get the

patient in and out of the aircraft.

And then the T.O. is partially dressed out in the T.O. fashion, but not completely.

They're not involved in patient care.

They're interacting with the sending and receiving units and relaying

that information back to the crew.

It was very interesting.

The trips from West Africa were usually about 14 hours long.

We would have to make one fuel stop.

If we were going back to the U.S., and then we'd enter through Bangor,

Maine or Dulles, and then we would go to one of the three RESPTCs

that were available at that time.

Going to Europe was similar.

About a third of our patients went to Europe they were NGOs.

We would rotate once the patient was in there and settled we were able to monitor

by vision, which was not great, and then we eventually had a video camera in

there to keep an eye on the patients and then we would just go in periodically.

So all of our monitoring was remote.

If a patient needed something, we would go in there.

We used a walkie-talkie at that time to try to communicate, but that was

problematic because sometimes they were too weak to use a walkie-talkie.

Sometimes they just didn't know how to use it and sometimes

English was not a first language.

Oh, yeah,

So we had the communication challenges there.

Sometimes we just needed to go in there and just sit with the patient because

they were scared, agitated, confused, but we would swap out periodically.

But it was difficult to stay in there as, as long as 45 minutes just

because of the discomfort of the PPE.

Yeah, I can imagine that.

I would go anywhere as long as I have my PAPR, but without it I feel like

I'm gonna explode pretty quickly.

I wanna explain a couple terms.

You mentioned T.O., which is our trained observer, and they're

like a safety officer for us.

They watch us and intervene, or direct us to do things like perform

hand hygiene or to clean something.

And then RESPTC.

We have now, 13 RESPTCs, or Regional Emerging Special Pathogens Treatment

Centers, across the country, and now grateful to be supplementing that

with about 50 Level 2 facilities.

And, we'll have the opportunity to talk about Level 2 facilities and

the new National Special Pathogen System of Care on an upcoming podcast.

You mentioned the ground crew and delivering patients.

And so I wanna reach out to Ben and Wade and Alex and talk about

the ground transport side of this.

Phoenix Air is landing there.

They might, as Vance said, have to stop for both fuel, passport control

coming into the U.S., and then make it to one of the facilities that's

going to be caring for these folks.

That means that they have to communicate with and hand off a

patient out of a plastic tent and into the back of an ambulance.

So I'd love to hear a little bit more from you guys, and maybe Wade and Alex

to start with because I know y'all got the first patient and then pretty

quickly after that, Ben, y'all in Nebraska got the first of your patients.

So, what was it like to receive a patient from Phoenix Air?

Is this something y'all had done before, or had practiced

before, or was this really a learning on the fly kind of thing?

I'll start, Jill.

then I'm gonna turn it over to Wade for, details and, a picturesque

description of what went down.

Vance talks about procedures from 2014, and I know that's

what we're talking about today.

What our friend and colleague Vance didn't share is that we'd really been working

together between Phoenix Air Group and Grady EMS since 2002, 2003 timeframe.

There was need to develop a capability for transport of a patient, suspected

or confirmed, to have an HCID, even pre-SARS because of Emory University

Hospital's role in having a serious communicable diseases unit and Its

relationship with CDC and the possibility that a laboratorian or a field worker

might get exposed to a special pathogen.

The really good news running up to 2014 is that we already had a good

working relationship with Phoenix Air Group, with Vance in particular,

with others at Phoenix Air.

And so that really paid off when it was time to collaborate, to

safely get a patient to Emory University Hospital in 2014.

We knew each other.

We'd done exercises together.

We even worked to bring other patients to Emory that were suspected to have

a serious communicable disease prior to 2014, but proved not to have one.

And that was invaluable for seamless operations, the

interface between ground and air.

the ease of communications between the clinical team on the Gulfstream

III and the Grady EMS ground team.

That really helped.

But now I'm gonna turn it over to Wade, because Jill, I promised to

not talk that much here and so I'm gonna it over to Wade and let him

talk about our mission that day.

Thanks, Alex.

Yeah.

Thanks Alex.

it was a very, scary time, but it was also a very exciting time for our team.

As Alex said, we had already developed the policies, procedures.

As you know, Jill, every year we would do a full scale

exercise with Emory and the CDC.

And it seems every year we would always select a patient that had

Ebola, So it was like a, this is just another exercise for us.

Couple things that we did learn, that we didn't really, think about

until it happened was unloading the patient from the Gulfstream.

Patient number one was fairly easy, was able to walk.

Patient number two proved to be challenging.

Unable to walk, we couldn't get assistance to take the stretcher off

the plane through the cargo door.

We had to improvise and use a stair chair.

So that's one of the lessons that we'd learned.

Like I said, it was a very exciting time for us.

It was like we had finally made it to the Super Bowl.

It is interesting.

I wanna highlight something and to me it feels like a theme of

an awful lot of stuff I've been hearing y'all talk about lately.

One of those things is the importance of relationships.

Knowing who to talk to, not having this be a cold call.

That you want to, when the rubber meets the road here, you want to be

able to reach out to people that you already have a relationship with.

That's so important and I think, as a message, right, we want people

to think about what transport is gonna look like in their region.

if you're not familiar with your regional CONOPS, you need to get

familiar with regional CONOPS.

You need to understand who and what is going to happen, and who can help you.

You know, it also fascinates me that you mentioned exercises.

Vance mentioned that they had basically developed this tent, if

you will, and then it sat in storage.

Isn't that what many people feel like they're doing every day when we talk

about Ebola or Marburg or anything else?

They're readying for something that may never happen and they

hope will never happen perhaps.

And yet for y'all, this is stuff that you got ready for and then were

called upon to do and had to step up.

And I think that's just this is the reality that other people

maybe fear, maybe dread, and maybe eagerly anticipate, right?

There's everybody on the spectrum.

Ben, in Nebraska, you hadn't had the opportunity to perhaps practice with

Phoenix Air, but y'all have, quite a history of preparedness out there.

What was it like for you getting your first patient and

patients, from an airfield.

You're exactly right.

Thanks for having me, Jill.

Unlike our friends at Emory in Atlanta, we had not done any preparation as

far as transporting high-consequence infectious disease patients, despite

Nebraska having a biocontainment unit ready for almost 10 years at that point.

In fact, when the fire chief asked me if I'd be willing to transport a patient

with Ebola from this outbreak in Africa, and I agreed to do it, I had to go Google

what exactly Ebola even was, because that's how unfamiliar I was with it.

So I really questioned my decision to say yes.

But we rely heavily on the hospital, the Nebraska Medicine University of

Nebraska Medical Center to provide that guidance and talk about having friends

and phone-a-friends, our colleagues there were able to reach out to our

friends in Atlanta and New York that had done it before and that had prepared.

And they were able to secure, photos of this aircraft that we're

gonna be interacting with, coming up with different ways to get

this patient off, to Wade's point.

Based on their suggestion, we had a stair chair ready.

We had a means to get an isopod off the side of the aircraft through

the cargo door if we needed to.

Fortunately the first two patients ended up being able to walk down the stairs

with some simple assistance by the crew.

But that was definitely, an interesting exposure for us to the first infectious

disease patient we, ever had.

I think this speaks to the importance of having a plan, but

being able to evaluate the situation and pivot your plan as needed.

But then what does the actual transport look like?

Are you guys going lights and sirens and big escorts?

Are you trying to go, as they would say these day, or somebody would say these

days on the DL? Like you're trying to keep it on the down low and not so noticeable?

What's the strategy for that?

The first transport that we had was actually off of an Air Force

base, is where the aircraft landed.

The media was well aware that it was happening.

The media was lined up outside, ready for us.

Due to some threat assessments there was also a heavy law

enforcement presence for us.

So while we didn't go lights and sirens and make a big production,

we certainly had a heavy law enforcement presence that escorted us.

We had a helicopter overhead that filmed live back to the biocontainment

unit so they could track us.

We had law enforcement both in front and behind us that blocked

off the entrances and exits to the highway and interstate system that

we used to get to the hospital.

And really it was, other than that, a routine transport

from a safety standpoint.

Everybody wore their seat belts in the ambulance.

We drove normal status.

Used our radios for communication, and successfully completed the mission.

I love the other than that.

Other than all that.

Wade, I assume your answer is similar?

Very similar, Jill.

The first couple we had heavy federal law enforcement presence, because of some of

the credible threats that we had received.

After that we went with local law enforcement.

Much like Ben, it was a typical transport just being escorted by

several law enforcement vehicles.

I would love to hear some of the funny or crazy anecdotes

of what happens in these transports.

And, I was gonna start with Vance.

I think about when I was receiving patients in either the emergency

room or the ICU or then eventually in biocontainment, you're never sure

what a patient's gonna bring with them.

Vance, you had a story about passports or having to stop at an airport.

The rest of us have to go through immigration and border

patrol and all that stuff.

What happened to these patients when you guys came into the country with them?

That was a big learning curve for us because we were so focused

on the clinical care and the actual transport that we often weren't thinking

about personal belongings, passport, medical records and things like that.

But it was in the beginning when there was so much fear and in

the unknown of the transfers.

Just as an example, on our way back to the States, we would refuel in the Azores

and they parked us way out by the cliff and wouldn't allow us to open the door.

And we just put a sign in the window of how much fuel we wanted.

And then we said, well, how are we gonna pay?

And they said, don't worry about it.

And off we went.

And of course, customs and border and so forth, when we coming in, they had

their normal procedures of looking at patients and looking at passports.

And no one was gonna come on the aircraft.

It really wasn't appropriate for them to come on.

And then there were other concerns when we would receive these items, with

the patient, are they contaminated?

Do they know if they're contaminated or, the sending staff, did they

know if they've been, sequestered?

So sometimes if you don't know, you would have to just give it in a plastic bag

and spray the bag and put it in another bag and spray the bag and so forth

just to make the receiving personnel comfortable with what you were doing.

And then luggage was the same thing.

That became something we had to deal with pretty soon after

that, how do you do that?

And then do you put it in the cabin, which is clean, or do you

put it inside the isolation unit?

And, everything is very tight in the isolation unit.

There's no way to secure things for takeoff and landing.

We're not able to sit in there for takeoff and landing.

There's no seat for us because the tent encompasses the floor as well.

So we had to work through a lot of these and try to ask a lot of subject

matter experts about the risk.

It looks bad to have someone's suitcase that's been sprayed and bagged in

the cabin with you when it was taken from a contaminated environment.

It was all very big learning things beyond just the patient care.

The patient care was fairly straightforward.

It was all these other issues, and it got to the point where we would

come back into the states and they all just would stay back and just

nodded and go, you know carry on.

You are good.

No one's gonna stow away on that aircraft.

That's absolutely true.

Oh my goodness.

Wade and Ben, are there any things that really stand out to you?

I will tell you that a lot of people probably remember watching on the news, as

Wade said, our first patient was able to walk down the steps of the aircraft into

the ambulance, and then again was able to walk from the ambulance into our unit.

But that patient doesn't remember that themselves.

Everybody else remembers it, but they were ill enough that they have

no recollection of that transport.

Wade or Ben, what do you have that are this, oh my gosh, as if

these things couldn't get more complicated than they already were.

Ben, you were in the back with the, the patients.

Do you have anything?

Not about being in the back, but when we were driving off the Air

Force base with the first transport, we had everything down to a T. We talked

about the law enforcement escort.

We talked about waste management when we get to the hospital.

We had rehearsed transferring the patient to the hospital.

What we didn't talk about is, the Department of Defense

has their own radio system.

Due to us having to be escorted through the base, we just

wanted to be in communication with the lead law enforcement

officer that was, taking us off.

And before I left, I said, what would you like me to do with this radio once

we're off base, because it's a DOD asset.

That's protected frequencies.

He said, oh, just give it to the the security guard at the front.

I'm like, okay.

So we get up and we slow down and he looks at me and backs up and I said,

I'm supposed to hand this radio to you.

And he said, oh, we don't want it.

You can keep it.

And so we ended up taking that to the hospital and processing it there.

And, the other thing to the point of passports, they have successfully

survived autoclaves and are usable again.

That's fantastic.

Ben and Alex, I think we had our own hoopla.

We heard Ben talk about the helicopter overhead, but, can you just mention

a little bit about what was like from a... hoopla standpoint.

Because y'all spend a lot of time thinking about campus security and

the other ways that Emory has to be prepared for, threats of all kinds.

What did this look like?

I don't think I'd ever thought about the airspace over the hospital

before, frankly, as a nurse.

Tying this back to comical anecdotes.

Jill, I mean there was a lot of hoopla about this patient transport.

It's understandable.

People wanna know what's going on.

We had a procedure as you know, from the ground transport unit communicating

with the serious communicable diseases unit, Jill, where you were.

To provide updates about where we are in the course of arriving at Emory, so that

you have an understanding about how much longer it's gonna be before we arrive.

And we have a procedure where we check in with you at, various

milestones in that transit.

And at some point we, I think I was calling with the

third update about location.

And, the person on the other end of the phone said, you can

stop providing location updates.

They said, We're watching you on CNN.

Come all the way in.

Every mile of that transit was covered by national media outlets.

I thought that was funny.

On a more serious note, because there was so much attention to this

patient movement, where I think we would typically want to move patients

quietly from point A to point B without getting a whole lot of attention.

There was a lot of media interest in this is the first time a patient had

been transported to the United States, infected with Ebola Virus Disease ever.

Understandably a lot of, media attention.

And so it was important to have an escort on the road.

And it was important, for the handoff area from where the patient's coming

out of the ambulance and getting moved into the serious communicable

diseases unit, that area was secure.

Understandably, people wanna get video, they want to get pictures, with no idea

how bold the media might be in trying to get, scoop photos or scoop video.,

And so it was really important to have the cooperation of facilities, and

the public safety personnel, and Emory Police in securing the areas, for the

ambulance route and the handoff areas, for the safety of the patient, and safety

of the personnel doing the transport.

I know that in our unit, have windows, and the windows

had blinds, but we hadn't thought about the importance of a helicopter.

And, now with good cameras and helicopters and you can get images that just, we

hadn't thought about that possibility.

And our patient woke up one morning and, was like, is there supposed

to be a guy outside my window?

And it was actually the guy putting the opaque film on the window because we

still wanted them to be able to see out, but we had to protect their privacy.

We'd like to think about patient care and patient rights and privacy and things

like that as being really important.

But certainly, news outlets and social media and things like that,

don't consider those as we do.

I've really enjoyed hearing all these stories and I would like to wrap

this up with some of the lessons you guys think are important for others

thinking about their transport.

Thinking about the future of a patient, whether it's during the

World Cup or just during any sort of, outbreak, anywhere in the world that

you will be called to action again.

And if it's not Phoenix Air delivering the patient, if it's not Emory or Nebraska

EMS transporting that patient, it will be somebody else across the country.

We really do need for other departments to think about their readiness

and how they can get prepared.

So I'd love to hear some of the lessons learned things you guys

think are really important for people moving forward with this.

And, I would love to riff off of this idea that

we've come a long way since, as, Vance said at the start, the whole

idea was just treat in place.

I think the vulgar phrase I would use is, sucks to be you.

You just might be outta luck if you ended up with a pathogen someplace

and you would just get whatever care somebody was willing to deliver.

And now our goal is to be able to deliver the highest quality of care

safely anywhere across this country.

That takes EMS, that takes transport, that takes people being prepared and really

creating those relationships that let you know what's gonna happen ahead of time.

Vance, let's start with you.

what do you think now, looking back on your illustrious career?

What message would you like for people to get from your experience?

The great thing about the fixed wing aspect is that

we really are in the sweet spot.

We're the ones that are in between.

Of course, EMS is in the toughest spot.

I would just say that as part of NETEC's ongoing educational outreach, it's that

EMS, on both the receiving and sending in have their procedures and protocols

in place and they practice them.

Our.

Interface with them, especially on receiving a patient is, they don't have

to do, and I think this would be the same for any other transport organization,

is that they don't have to do anything special, just follow their protocols.

Whatever PPE or protective garb that they may be in when they're brought to

the aircraft, the transport crew will then follow their protocol in terms

of how they prepare them for boarding and brought into the aircraft and

get into the isolation environment.

We didn't really care how patients were brought to us, which is good because in

the beginning it was pretty frightful.

On the other end, that's part of what our trained observer does, is

they'll go out and interface with the receiving unit and say, how do

you want to receive the patient?

We typically will put them in our PPE and we'll bring them out.

But, some agencies wanted to have them in an isopod, some would take them in PPE.

So really there's no reason for the transport organization to, insist

that the receiving unit has to take it in a certain way because.

By then, it's their patient and they need to, whatever we can do to facilitate the

way they want to receive the patient.

But really it's just education and training and it's ongoing.

And, looking to the future, even with the there's some very large

distances involved in regions.

If a patient, especially in say, the Southeast region, we've got two

fantastic hospital units to receive them.

But some of the transportation times would just be very extensive and then multiple

agencies are involved in everything else.

So it could easily be where air transportation comes into play, and

especially even if a region's RESPTC facilities and beds are full, you

could easily go to another region and air would really come in for that.

So mainly it's just everybody have their correct education and ongoing

protocols and the transportation entity in between can deal with that very easily.

It really is a matter of, knowing your protocols and doing

that planning, laying the groundwork, so that you can adjust when needed.

Ben, what do you think?

What do you think, EMS agencies or crews that might be involved with

this should be thinking about?

I think all EMS agencies have protocols or standard operating

procedures or guidelines, and that's just what they are, guidelines.

You can't plan for every single thing that's going to happen, but when something

happens, That you're not quite sure what to deal with, you're gonna go back to your

muscle memory and, rely on your training.

And one of my good friends, Kate, who just retired, she was a nurse manager

at the biocontainment unit in Nebraska.

She would throw something at us during a scenario and she said, what would you do?

And we'd be scrambling trying to find an answer.

And the answer was always take a break and perform a risk assessment.

Use your resources based on that risk assessment and the people

around you pick what you're gonna do.

It might not be written down in your protocol.

You're gonna have some training or some instinct or some guidelines to figure

out how to address that situation safely for both you and the patient.

I am so glad that you saluted Kate in that answer.

' I am so indebted to Kate Boulter and what she's done at UNMC and what she's

done for preparedness across our country.

So thank you for that.

And yes, I can certainly imagine Kate saying take a breath and step back

and think about your risk assessment.

Wade and Alex, what do you think?

I know you guys spent a lot of time doing EMS training and education and thinking

about this, interface between, fixed wing transport and ground transport.

What do you think people need to know, and how do we get 'em there?

We all receive these patients by design, right?

We were preparing for them.

But with 911, EMS, you just never know what your next call is.

And so I think being prepared the best you can, is important.

Building the relationships is important.

And I think that hoping that you never get a patient with

an HCID is clearly not a plan.

Get the education and the training when you can.

I'm gonna bring us all the way back to Vance's comment,

, where he said he felt like he was in a good spot and the tough work

was with the ground EMS crews.

As somebody that's engaged with the ground transport of biosafety

transport i'm gonna flip that around.

I'm gonna say, I think we're in the sweet spot, at least in in our work, moving a

patient from an airfield, where Phoenix Air Group has arrived, and moving him

to a serious communicable diseases unit at Emory, because Vance and his team had

to care for the patient some 14 hours.

We only had to take care of him for about 45 minutes to an hour.

So, I thought he had the harder job.

In terms of lessons learned.

I'm gonna, from a programmatic standpoint.

The reason that we in the United States, were able to respond to this need

to repatriate somebody ill infected with Ebola hantavirus disease, bring

them back to the United States and have them cared for, in a capable

hospital, which gave that patient their best chance at a full recovery.

Is because there had been some funding to afford education and

training for pre-hospital clinicians and hospital-based clinicians.

There was funding for the development of policies and procedures and there

was an opportunity to exercise this mission long before it was needed.

And even if it's trickle funding, I think it's critically important to

always have that kind of funding.

So that when there's a need, there are people that are still very familiar

and have proficiency with these procedures, with these operations,

that can do the mission, but then also help to rapidly scale capacity

through education and training and sharing of best practices, et cetera.

I think that's critically important.

And, from a on the ground perspective, I think, Vance, Ben,

wade, they've really nailed it.

It is about education and training and it's about really, Jill, and you'll

appreciate this, understanding infection prevention measures that are effective

through the application of standard and transmission based precautions,

implementation of a hierarchy of controls, which is easier said than done.

It's important to have an understanding of these principles so that to use

Ben's example of you can't script every contingency, it's critically important

to apply strict infection prevention measures to get the care for the patient

done and do it in a way that's safe for the clinicians that are involved.

That's not just a written protocol.

That's having an understanding of what the patient's needs are, what the risks are.

And when people ask me, can you sum up transport of patients with a

high-consequence infectious disease in one sentence, I say, sure,

providing compassionate care for the patient while keeping potentially

infectious bodily fluids out of your eyes, nose, mouth, or broken skin.

That's it.

Simple one liner.

you gotta have the education, training, and practice to do it well.

Yep, absolutely.

Knowing your equipment.

Knowing what it does and doesn't protect you from, these things

are so fundamentally important.

Whether we're transporting somebody with measles or with Ebola or Marburg,

you really need to, A, protect yourself and B, know what those tools, that you,

that might have at your disposal are.

I want thank you guys.

I think that if I could have one last message here, it's really that.

In an awful lot of places, what I hear people talking about is, we've

got a long transport time, we'll just call in for air transport.

And as you guys have really made clear, this is a complicated interface

between aircraft, ground transport, knowing what's gonna happen.

It takes preparation.

It takes advanced thought.

It also takes people who can think in the moment and take a breath and

do a risk assessment and figure out what the safest action is to take.

So please, if you are at a hospital, if you're at an EMS agency, think

about how you will do this when it lands in your backyard, whether

it's from the World Cup or from any other thing going on that brings a

high-consequence infectious pathogen.

We don't all have to have a house fire to have spoke detectors or to have a

fire department that's well funded.

As, Alex mentioned, this does take funding.

It does take preparation.

It does take time, and equipment and expertise.

Alex and his team have created some great resources for high-consequence

infectious disease transport.

Alex, do you want to go ahead and mention the Biosafety

Transport classes and toolkit?

There are a number of resources that we've worked together

with partners around the country to develop for the EMS community.

All of them actually can be found on the NETEC website.

There's a landing page for resources aimed at the EMS community.

So that they can safely transport patients suspected or confirmed to have

high-consequence infectious disease.

And some of this is anchored in the standard education and training

that we provide to EMS clinicians for the management of patients.

Some of it is in the form of written guidance.

The ASPR TRACIE EMS Infectious Disease Playbook is a great resource that a number

of us have contributed to or reviewed.

The NETEC EMS workgroup has also developed

model procedural guidelines for donning and doffing of PPE, for the

protection of environmental surfaces in an ambulance, for the packaging of waste.

How to manage issues like a biohazard spill, a PPE breach, a

clinician down in the hot zone.

NETEC has resources to assess any agency's readiness.

You can go to the website and complete a special pathogens

operational readiness assessment.

And answer the questions and NeTEC subject matter experts will review those

answers and provide written feedback with links to more resource documents.

There's always more to do, Jill, but, Ben and Vance, and Wade, and I

work together as does Benjamin Matson and Lisa Stone in the EMS workgroup.

This is where this material is curated and maintained, so we hope

people will take advantage of it..

Thanks and thank you guys.

Vance, I'm grateful for all the work that you have done, and I hope

that you have a little easier life moving forward and don't have to

jump out of the bed every time the phone rings for the next 20 years.

Ben, Wade, and Alex, it's always a pleasure do business with you and

to share our NETEC work together.

So really thank you guys so much for joining me today.

Thank you, Jill, its been a great pleasure.

Thanks

Alright, well thank you for joining us today on a

conversation about air transport.

For those of you listening at home, thank you for tuning into this episode.

We hope you'll join us on future episodes where we'll cover a wide range of topics,

including the new NSPS, National Special Pathogen System of Care, we'll talk a

little bit more about World Cup coming up.

We also talk about any kind of healthcare worker safety,

personal protective equipment, infectious diseases of all kinds.

If you have questions for NETEC, are looking for resources as

Alex just mentioned, or ideas for future shows, please feel free

to contact us at into@netec.org,

or you can find us on the web at netec.org/podcast, tech.org/podcast

and you can also subscribe there of course to future episodes and

find more about today's topics.

So thank you very much and we'll see you next time on Transmission Interrupted.