Air ambulance evacuations in the Ebola crisis context Meetings Seminars and...EBOLA: Patient’s...

transcript

Air ambulance evacuations in

the Ebola crisis context

Dr Arnaud DEROSSI

Regional Medical Director,

Assistance & Global Medical Transport

• Still a Hot topic although promising trends

• Challenge: Not only with Ebola cases,

but also with non-Ebola cases out of

affected countries

• Impact: inappropriate timelines and very

limited number of adequate solutions

International SOS in 2015

• Created 1985

• Core business: Helping large corporations

& international/ governmental organizations

through assistance to their staff

• Offices in 89 countries

• 11,000 staff

• 3,500 health professionals (incl. 1,200 full

time medical doctors)

• 27 Assistance Centers

• 56 clinics (400,000 consultations / year) +

750 remote sites

• 10 dedicated air ambulances

• 88,000 accredited medical providers

(excl. USA)

• 1,7 million assistance cases per year, for

80 millions members

• 100,000 evacuations / repatriations

per year

• 7 to 8 air ambulance flights per day

International SOS: Worldwide presence

International SOS in Africa

International SOS in Western Africa

1st alert by Intl.SOS in March 2014

International SOS in Western Africa

THE BASICS

• Virus: severe & haemorrhagic disease

• % mortality ? No vaccine, symptomatic

treatment so far

• Bat & wild animals

• Inter-human contamination by bodily fluids

and NOT airborne (even though...)

• At risk: Relatives & Health professionals

• Prevention: traceability & isolation

THE BASICS

CURRENT SITUATION

> 20.000 cases

> 10.000 death (incl.700 health professionals)

Most new cases in Guinea & Sierra Leone

Liberia under control

Mortality approx. 65%

Senegal

Nigeria

Others ??

EBOLA: Patient’s evacuation

Paris Assistance Center

Patient & Context assessment

Scoring

Recommendations

Assets identification (with Frankfurt &

Johannesburg Intl.SOS Flight Desks)

Proposal

Activation & Global coordination

Patients evacuation

Evacuations from Western Africa

• Since the outbreak, much more complex

to evacuate ANY type of patient out of

the affected countries (especially if

Ebola-like symptoms)

• Reluctances from many aviation

providers

• Screening & quarantine procedures

• Most countries only accept their own

citizens

• NGOs, governmental & international

organizations sending more staff

Medical Evacuation Categories

Afebrile medical condition

Febrile non Ebola medical

condition

Confirmed high risk contact -

Asymptomatic

Suspected / Confirmed Ebola case

• Condition dependent

• Clear diagnosis and confirmatory tests

• Exposure history

condition

Asymptomatic

• Enhanced diagnostics likely to be required

• Access to EVD testing

• Delayed/declined evacuation likely

condition

Asymptomatic

• Commercial airline travel not permitted

• PMIU required

• Health Authority clearances

condition

Asymptomatic

• Clinical condition dependent

• Nationality dependent

• Health Authority clearances

condition

Asymptomatic

Medical Evacuation from Ebola Affected

Countries

Detailed risk assessment required

Clinical status important

Exposure history important

Enhanced diagnostics may be required

Non affected, non exposed

Normal passengers … but…

Scoring, screening, communication

Intl.SOS: 2 wide-body charters

Total 210 passengers

Specific screening procedures

To Johannesburg and Lisbon

But coming from an Ebola-affected

country

Scoring, communication

Intl.SOS: 41 medical evacuations (on a

total of 810 assistance cases in these 3

countries over the past 12 months)

To Johannesburg and Europe

But Ebola-like symptoms

Intl.SOS: 7 evacuations

To Johannesburg, Europe and USA

Exposure, suspect, probable

Confirmed

(Early stage / Later stage)

Intl.SOS: 9 high risk exposure cases

1 confirmed case

To Johannesburg and Europe

(Amsterdam, Geneva, London)

PROCEDURES & CAVEAT

Technically possible

Maximum isolation during transport, depending

on status & scoring

In flight & on the ground

Requires perfect internal & external

coordination

Subject to approval by multiple health national

authorities

Portable isolation unit

Dedicated Intl.SOS aircrafts in South Africa

Appropriate for asymptomatic high risk exposed or

early stable EVD cases

Not suitable for secretory phase or unstable EVD

patients due to limited monitoring and intervention

capability

Need for a PMIU or walk-in isolation chamber for

ALL types of patients (Exposure cases ?)

EVACUATION SOLUTIONS

Destination: Europe or South Africa

Close contact with health authorities

Identification of the relevant national infectious

diseases reference centers

Admission process

EVACUATION SOLUTIONS • Very limited options

• Most operators not willing to move such

patients, either suspect, confirmed or even

“non-Ebola” patients from the affected

countries

• Current options:

– 4 operators in Europe, plus a German

wide body aircraft

– Intl.SOS in South Africa

– 1 US provider under exclusive contract

with the US Department of State

– A few Spanish, US and British military

solutions

• Specially modified Gulfstream G III, equipped

for moving highly contagious patients.

o 2 years development

o US based (Georgia)

o Cargo door

o Air flow front -> aft

o Negative pressure isolation chamber,

HEPA filters

o For any type of patients

• Exclusive contract with US Dpt of State

• Will mainly accept symptomatic patients

•More than 20 “Ebola” missions already

Government Lead Medical Repatriations: Open Isolation

• Government lead and coordinated

Military / State contracted providers

Public health supported

• All healthcare/humanitarian workers

• All missions were repatriations

Also some fully dedicated governmental solutions

Clinical Caveats and Criteria for PMIU

Early diagnosis and activation are critical

Stable clinical condition for at least 48 hours

Patient safety of paramount importance

Flight crew and medical team safety equally important

• Our daily operational challenge: Not

only with Ebola cases, but also with non-

Ebola cases out of affected countries ...

Air ambulance evacuations in the Ebola crisis context Meetings Seminars and...EBOLA: Patient’s...

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