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Air ambulance evacuations in the Ebola crisis context Dr Arnaud DEROSSI Regional Medical Director, Assistance & Global Medical Transport
Air ambulance evacuations in
the Ebola crisis context
Dr Arnaud DEROSSI
Regional Medical Director,
Assistance & Global Medical Transport
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• 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
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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
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International SOS: Worldwide presence
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International SOS in Africa
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International SOS in Western Africa
1st alert by Intl.SOS in March 2014
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International SOS in Western Africa
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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
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THE BASICS
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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
Mali
Others ??
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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
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Patients evacuation
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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
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Medical Evacuation Categories
Afebrile medical condition
Febrile non Ebola medical
condition
Confirmed high risk contact -
Asymptomatic
Suspected / Confirmed Ebola case
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Medical Evacuation Categories
• Condition dependent
• Clear diagnosis and confirmatory tests
• Exposure history
Afebrile medical condition
Febrile non Ebola medical
condition
Confirmed high risk contact -
Asymptomatic
Suspected / Confirmed Ebola case
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Medical Evacuation Categories
• Enhanced diagnostics likely to be required
• Access to EVD testing
• Delayed/declined evacuation likely
Afebrile medical condition
Febrile non Ebola medical
condition
Confirmed high risk contact -
Asymptomatic
Suspected / Confirmed Ebola case
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Medical Evacuation Categories
• Commercial airline travel not permitted
• PMIU required
• Health Authority clearances
Afebrile medical condition
Febrile non Ebola medical
condition
Confirmed high risk contact -
Asymptomatic
Suspected / Confirmed Ebola case
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Medical Evacuation Categories
• Clinical condition dependent
• Nationality dependent
• Health Authority clearances
Afebrile medical condition
Febrile non Ebola medical
condition
Confirmed high risk contact -
Asymptomatic
Suspected / Confirmed Ebola case
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Medical Evacuation from Ebola Affected
Countries
Detailed risk assessment required
Clinical status important
Exposure history important
Enhanced diagnostics may be required
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EBOLA: Patient’s evacuation
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
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EBOLA: Patient’s evacuation
Non affected, non exposed
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
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EBOLA: Patient’s evacuation
Non affected, non exposed
But Ebola-like symptoms
Scoring, communication
Intl.SOS: 7 evacuations
To Johannesburg, Europe and USA
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EBOLA: Patient’s evacuation
Exposure, suspect, probable
Confirmed
(Early stage / Later stage)
Scoring, communication
Intl.SOS: 9 high risk exposure cases
1 confirmed case
To Johannesburg and Europe
(Amsterdam, Geneva, London)
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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
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Portable isolation unit
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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
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Destination: Europe or South Africa
Close contact with health authorities
Identification of the relevant national infectious
diseases reference centers
Admission process
EVACUATION SOLUTIONS
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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
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• 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
EVACUATION SOLUTIONS
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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
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Also some fully dedicated governmental solutions
EVACUATION SOLUTIONS
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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
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• Our daily operational challenge: Not
only with Ebola cases, but also with non-
Ebola cases out of affected countries ...
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