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Brantsæter AB, Hansen AE, Gustavsen AG, Stensvåg V, Aastrøm HA, Heyerdahl F, Tveitane PM, Nakstad ER. Transport of Patients With High-Consequence Infectious Diseases: Development of European Capacity in Norway. Health Secur 2024; 22:S76-S85. [PMID: 39137054 DOI: 10.1089/hs.2023.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
Infection of Western aid workers with Ebola virus disease during the 2014-2016 West African outbreak demonstrated the need for medical evacuation to high-level isolation units in Europe and the United States. In Norway, an ad hoc preparedness team was established for aeromedical evacuation in case of need. In October 2014, this team transported an infected aid worker from the military section of Oslo Airport to Oslo University Hospital. To maintain and strengthen the capacity for domestic ambulance transport on the ground and in the air, the Norwegian Medical Emergency Response Team for High Consequence Infectious Diseases (in Norway known as "Nasjonalt medisinsk utrykningsteam for høyrisikosmitte"), or NORTH, was established as a permanent service in 2017. Recognizing the expertise of this domestic team, Norway was subsequently entrusted with the task of enhancing the European aeromedical transport capacity for high-consequence infectious diseases and establishing the Norwegian rescEU Jet Air Ambulance for Transport of Highly Infectious Patients, or NOJAHIP, in 2022. In this case study, we present experiences and lessons learned from these 2 services and discuss how they can be further developed.
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Affiliation(s)
- Arne B Brantsæter
- Arne B. Brantsæter, MD, MPH, PhD, is a Senior Consultant, Department of Acute Medicine and Department of Infectious Diseases; Andreas E. Hansen, MD, is Section Chief and Consultant Anesthesiologist, Andreas Gisholt Gustavsen, PGdip, CRNA, RN, PM, is a Paramedic, Vidar Stensvåg, MD, is a Consultant Anesthesiologist, Hege Anita Aastrøm, MSc, CRNS, RN, FN, is a Flight Nurse, and Fridtjof Heyerdahl, MD, PhD, is a Consultant Anesthesiologist, all in the Air Ambulance Department, Prehospital Services; and Espen Rostrup Nakstad, MD, PhD, is a Senior Consultant, Department of Acute Medicine; all at Oslo University Hospital, Oslo, Norway. Fridtjof Heyerdahl is also a Researcher, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Per Magne Tveitane is Senior Advisor, Department of Emergency Preparedness, Directorate of Health, Oslo, Norway
| | - Andreas E Hansen
- Arne B. Brantsæter, MD, MPH, PhD, is a Senior Consultant, Department of Acute Medicine and Department of Infectious Diseases; Andreas E. Hansen, MD, is Section Chief and Consultant Anesthesiologist, Andreas Gisholt Gustavsen, PGdip, CRNA, RN, PM, is a Paramedic, Vidar Stensvåg, MD, is a Consultant Anesthesiologist, Hege Anita Aastrøm, MSc, CRNS, RN, FN, is a Flight Nurse, and Fridtjof Heyerdahl, MD, PhD, is a Consultant Anesthesiologist, all in the Air Ambulance Department, Prehospital Services; and Espen Rostrup Nakstad, MD, PhD, is a Senior Consultant, Department of Acute Medicine; all at Oslo University Hospital, Oslo, Norway. Fridtjof Heyerdahl is also a Researcher, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Per Magne Tveitane is Senior Advisor, Department of Emergency Preparedness, Directorate of Health, Oslo, Norway
| | - Andreas Gisholt Gustavsen
- Arne B. Brantsæter, MD, MPH, PhD, is a Senior Consultant, Department of Acute Medicine and Department of Infectious Diseases; Andreas E. Hansen, MD, is Section Chief and Consultant Anesthesiologist, Andreas Gisholt Gustavsen, PGdip, CRNA, RN, PM, is a Paramedic, Vidar Stensvåg, MD, is a Consultant Anesthesiologist, Hege Anita Aastrøm, MSc, CRNS, RN, FN, is a Flight Nurse, and Fridtjof Heyerdahl, MD, PhD, is a Consultant Anesthesiologist, all in the Air Ambulance Department, Prehospital Services; and Espen Rostrup Nakstad, MD, PhD, is a Senior Consultant, Department of Acute Medicine; all at Oslo University Hospital, Oslo, Norway. Fridtjof Heyerdahl is also a Researcher, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Per Magne Tveitane is Senior Advisor, Department of Emergency Preparedness, Directorate of Health, Oslo, Norway
| | - Vidar Stensvåg
- Arne B. Brantsæter, MD, MPH, PhD, is a Senior Consultant, Department of Acute Medicine and Department of Infectious Diseases; Andreas E. Hansen, MD, is Section Chief and Consultant Anesthesiologist, Andreas Gisholt Gustavsen, PGdip, CRNA, RN, PM, is a Paramedic, Vidar Stensvåg, MD, is a Consultant Anesthesiologist, Hege Anita Aastrøm, MSc, CRNS, RN, FN, is a Flight Nurse, and Fridtjof Heyerdahl, MD, PhD, is a Consultant Anesthesiologist, all in the Air Ambulance Department, Prehospital Services; and Espen Rostrup Nakstad, MD, PhD, is a Senior Consultant, Department of Acute Medicine; all at Oslo University Hospital, Oslo, Norway. Fridtjof Heyerdahl is also a Researcher, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Per Magne Tveitane is Senior Advisor, Department of Emergency Preparedness, Directorate of Health, Oslo, Norway
| | - Hege Anita Aastrøm
- Arne B. Brantsæter, MD, MPH, PhD, is a Senior Consultant, Department of Acute Medicine and Department of Infectious Diseases; Andreas E. Hansen, MD, is Section Chief and Consultant Anesthesiologist, Andreas Gisholt Gustavsen, PGdip, CRNA, RN, PM, is a Paramedic, Vidar Stensvåg, MD, is a Consultant Anesthesiologist, Hege Anita Aastrøm, MSc, CRNS, RN, FN, is a Flight Nurse, and Fridtjof Heyerdahl, MD, PhD, is a Consultant Anesthesiologist, all in the Air Ambulance Department, Prehospital Services; and Espen Rostrup Nakstad, MD, PhD, is a Senior Consultant, Department of Acute Medicine; all at Oslo University Hospital, Oslo, Norway. Fridtjof Heyerdahl is also a Researcher, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Per Magne Tveitane is Senior Advisor, Department of Emergency Preparedness, Directorate of Health, Oslo, Norway
| | - Fridtjof Heyerdahl
- Arne B. Brantsæter, MD, MPH, PhD, is a Senior Consultant, Department of Acute Medicine and Department of Infectious Diseases; Andreas E. Hansen, MD, is Section Chief and Consultant Anesthesiologist, Andreas Gisholt Gustavsen, PGdip, CRNA, RN, PM, is a Paramedic, Vidar Stensvåg, MD, is a Consultant Anesthesiologist, Hege Anita Aastrøm, MSc, CRNS, RN, FN, is a Flight Nurse, and Fridtjof Heyerdahl, MD, PhD, is a Consultant Anesthesiologist, all in the Air Ambulance Department, Prehospital Services; and Espen Rostrup Nakstad, MD, PhD, is a Senior Consultant, Department of Acute Medicine; all at Oslo University Hospital, Oslo, Norway. Fridtjof Heyerdahl is also a Researcher, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Per Magne Tveitane is Senior Advisor, Department of Emergency Preparedness, Directorate of Health, Oslo, Norway
| | - Per Magne Tveitane
- Arne B. Brantsæter, MD, MPH, PhD, is a Senior Consultant, Department of Acute Medicine and Department of Infectious Diseases; Andreas E. Hansen, MD, is Section Chief and Consultant Anesthesiologist, Andreas Gisholt Gustavsen, PGdip, CRNA, RN, PM, is a Paramedic, Vidar Stensvåg, MD, is a Consultant Anesthesiologist, Hege Anita Aastrøm, MSc, CRNS, RN, FN, is a Flight Nurse, and Fridtjof Heyerdahl, MD, PhD, is a Consultant Anesthesiologist, all in the Air Ambulance Department, Prehospital Services; and Espen Rostrup Nakstad, MD, PhD, is a Senior Consultant, Department of Acute Medicine; all at Oslo University Hospital, Oslo, Norway. Fridtjof Heyerdahl is also a Researcher, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Per Magne Tveitane is Senior Advisor, Department of Emergency Preparedness, Directorate of Health, Oslo, Norway
| | - Espen Rostrup Nakstad
- Arne B. Brantsæter, MD, MPH, PhD, is a Senior Consultant, Department of Acute Medicine and Department of Infectious Diseases; Andreas E. Hansen, MD, is Section Chief and Consultant Anesthesiologist, Andreas Gisholt Gustavsen, PGdip, CRNA, RN, PM, is a Paramedic, Vidar Stensvåg, MD, is a Consultant Anesthesiologist, Hege Anita Aastrøm, MSc, CRNS, RN, FN, is a Flight Nurse, and Fridtjof Heyerdahl, MD, PhD, is a Consultant Anesthesiologist, all in the Air Ambulance Department, Prehospital Services; and Espen Rostrup Nakstad, MD, PhD, is a Senior Consultant, Department of Acute Medicine; all at Oslo University Hospital, Oslo, Norway. Fridtjof Heyerdahl is also a Researcher, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Per Magne Tveitane is Senior Advisor, Department of Emergency Preparedness, Directorate of Health, Oslo, Norway
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Biselli R, Nisini R, Lista F, Autore A, Lastilla M, De Lorenzo G, Peragallo MS, Stroffolini T, D’Amelio R. A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health. Biomedicines 2022; 10:2050. [PMID: 36009598 PMCID: PMC9405556 DOI: 10.3390/biomedicines10082050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil-military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.
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Affiliation(s)
- Roberto Biselli
- Ispettorato Generale della Sanità Militare, Stato Maggiore della Difesa, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Roberto Nisini
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - Florigio Lista
- Dipartimento Scientifico, Policlinico Militare, Comando Logistico dell’Esercito, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Alberto Autore
- Osservatorio Epidemiologico della Difesa, Ispettorato Generale della Sanità Militare, Stato Maggiore della Difesa, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Marco Lastilla
- Istituto di Medicina Aerospaziale, Comando Logistico dell’Aeronautica Militare, Viale Piero Gobetti 2, 00185 Roma, Italy
| | - Giuseppe De Lorenzo
- Comando Generale dell’Arma dei Carabinieri, Dipartimento per l’Organizzazione Sanitaria e Veterinaria, Viale Romania 45, 00197 Roma, Italy
| | - Mario Stefano Peragallo
- Centro Studi e Ricerche di Sanità e Veterinaria, Comando Logistico dell’Esercito, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Tommaso Stroffolini
- Dipartimento di Malattie Infettive e Tropicali, Policlinico Umberto I, 00161 Roma, Italy
| | - Raffaele D’Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
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Schwabe D, Kellner B, Henkel D, Pilligrath HJ, Krummer S, Zach S, Rohrbeck C, Diefenbach M, Veldman A. Long-Distance Aeromedical Transport of Patients with COVID-19 in Fixed-Wing Air Ambulance Using a Portable Isolation Unit: Opportunities, Limitations and Mitigation Strategies. Open Access Emerg Med 2020; 12:411-419. [PMID: 33269009 PMCID: PMC7701362 DOI: 10.2147/oaem.s277678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/24/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Aeromedical transport of patients with highly−infectious diseases, particularly over long distances with extended transport times, is a logistical, medical and organizational challenge. Following the 2014–2016 Ebola Crisis, sophisticated transport solutions have been developed, mostly utilizing large civilian and military airframes and the patient treated in a large isolation chamber. In the present COVID−19 pandemic, however, many services offer aeromedical transport of patients with highly−infectious diseases in much smaller portable medical isolation units (PMIU), with the medical team on the outside, delivering care through portholes. Methods We conducted a retrospective review of all transports of patients with proven or suspected COVID−19 disease, transported by Jetcall, Idstein, Germany, between April 1 and August 1, 2020, using a PMIU (EpiShuttle, EpiGuard AS, Oslo, Norway). Demographics and medical data were analyzed using the services’ standardized transport protocols. Transport−associated challenges and optimization strategies were identified by interviewing and debriefing all transport teams after each transport. Results Thirteen patients with COVID−19 have been transported in a PMIU over distances up to 7,400 kilometers (km), with flight times ranging from 02:15 hours to 11:10 hours. We identified the main limitations of PMIU transports as limited access to the patient and reduced manual dexterity when delivering care through the porthole gloves and disconnection of lines and tubes during loading and unloading procedures. Technical solutions such as bluetooth−enabled stethoscopes, cordless ultrasound scanners and communication devices, meticulous preparation of the PMIU and the patient following standardized protocols and scenario−based training of crew members can reduce some of the risks. Discussion Transporting a patient with COVID−19 or any other highly infectious disease in a PMIU is a feasible option even over long distances, but adding a significant layer of additional risk, thus requiring a careful and individualized risk−benefit analysis for each patient prior to transport.
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Affiliation(s)
| | | | | | | | - Stefanie Krummer
- Jetcall GmbH&CoKG, Idstein, Germany.,Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
| | | | | | | | - Alex Veldman
- Jetcall GmbH&CoKG, Idstein, Germany.,Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany.,Hudson Institute of Medical Research, Monash University, Melbourne, Australia
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Gibbs SG, Herstein JJ, Le AB, Beam EL, Cieslak TJ, Lawler JV, Santarpia JL, Stentz TL, Kopocis-Herstein KR, Achutan C, Carter GW, Lowe JJ. Review of Literature for Air Medical Evacuation High-Level Containment Transport. Air Med J 2019; 38:359-365. [PMID: 31578975 PMCID: PMC7128392 DOI: 10.1016/j.amj.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Aeromedical evacuation (AE) is a challenging process, further complicated when a patient has a highly hazardous communicable disease (HHCD). We conducted a review of the literature to evaluate the processes and procedures utilized for safe AE high-level containment transport (AE-HLCT) of patients with HHCDs. METHODS A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019). Authors screened abstracts for inclusion criteria and full articles were reviewed if the abstract was deemed to contain information related to the aim. RESULTS Our search criteria yielded 14 publications and were separated based upon publication dates, with the natural break point being the beginning of the 2013-2016 Ebola virus disease epidemic. Best practices and recommendations from identified articles are subdivided into pre-flight preparations, inflight operations, and post-flight procedures. CONCLUSIONS Limited peer-reviewed literature exists on AE-HLCT, including important aspects related to healthcare worker fatigue, alertness, shift scheduling, and clinical care performance. This hinders the sharing of best practices to inform evacuations and equip teams for future outbreaks. Despite the successful use of different aircraft and technologies, the unique nature of the mission opens the opportunity for greater coordination and development of consensus standards for AE-HLCT operations.
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Affiliation(s)
- Shawn G Gibbs
- Department of Environmental and Occupational Health, Indiana University School of Public Health, Bloomington, IN
| | - Jocelyn J Herstein
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE.
| | - Aurora B Le
- Department of Environmental and Occupational Health, Indiana University School of Public Health, Bloomington, IN; Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN
| | - Elizabeth L Beam
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Theodore J Cieslak
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE; Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, NE; National Strategic Research Institute, Omaha, NE
| | - Joshua L Santarpia
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; National Strategic Research Institute, Omaha, NE; Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE
| | - Terry L Stentz
- Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE; The Charles W. Durham School of Architectural Engineering and Construction, University of Nebraska-Lincoln, Lincoln, NE
| | - Kelli R Kopocis-Herstein
- The Charles W. Durham School of Architectural Engineering and Construction, University of Nebraska-Lincoln, Lincoln, NE
| | - Chandran Achutan
- Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | | | - John J Lowe
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE; Department of Environmental, Occupational and Agricultural Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE; Nebraska Biocontainment Unit, Omaha, NE
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