Medical Evacuation of Patients With Infectious Diseases
Authors: Bybee Karen 
Published: February 2015

This article, written by Assistant Technology Editor Karen Bybee, contains highlights of paper SPE 136648, ’The Medical Evacuation of Patients With Infectious Diseases From Developing Countries: Duty of Care,’ by R.L. Quigley, International SOS Assistance Inc., originally prepared for the 2010 SPE Middle East Health, Safety, Security, and Environment Conference and Exhibition, Manama, Bahrain, 4-6 October. The paper has not been peer reviewed.
During the severe acute-respiratory-syndrome epidemic, innovative safety measures were developed to protect medical teams/flight crews from contamination during medical evacuation/transport. Those measures included the design, in accordance with international-health-authority guidelines [e.g., World Health Organization and Centers for Disease Control (CDC)], and implementation of a compact, portable isolation unit (PIU), ideal for regional ground/air travel. More recently, a disposable biological containment unit (BCU) has been developed that is designed for a Gulfstream III aircraft and is thus, ideal for transocean/continental travel.
Introduction
There are multiple factors to explain the continued prevalence of infectious diseases in the developing world. These include, but are not limited to, accessibility to medical care (vaccination/medicines), hygienic practices (drinking water), malnutrition, education, and pest control (vectors). Business travelers and expatriates alike, from developed nations, continue to visit/work in these under-privileged regions and may actually be immune to certain endemic infectious diseases through vaccination (e.g., measles) or prophylactic medicines (e.g., malaria). However, they are not immune to many of the other serious infectious diseases [e.g., Avian/Swine Flu, tuberculosis (TB), and viral hemorrhagic fevers] for which such proactive precautionary measures are irrelevant. Not only can these latter infections be lethal but they are highly contagious. With the lack of adequate healthcare facilities/resources, in many of these developing countries, transportation to the closest developed country for definitive care in a center of medical excellence (COME) may be the difference between life and death. Logistically speaking, such transportation invariably requires an air ambulance (AA) staffed by a team of medical experts. Even routine (universal) precautions (i.e., gown, cap, mask, eye wear, and gloves) frequently are not adequate to protect the transport team from the risk of contamination. To reduce the exposure risks of our medical-transport teams, a protocol has been developed and equipment has been designed to mitigate these infectious risks. The full-length paper presents the protocols, equipment, and reference data and outlines some of the logistical challenges that have been addressed in the medical evacuation of the highly contagious patient to the nearest COME. Furthermore, an enhanced biologic unit that will enable transcontinental travel is introduced. No doubt the development of such extreme measures has been catalyzed by the efforts of multiple organizations in the emergency-management industry to achieve compliance in their duty of care.