The Aeromedical Biological Containment System (ABCS) is an aeromedical evacuation capability devised by the U.S. Centers for Disease Control and Prevention (CDC) in collaboration with the U.S. Department of Defense (DoD) and government contractor Phoenix Air between 2007 and 2010. Its purpose is to safely air-transport a highly contagious patient; it comprises a transit isolator (a tent-like plastic structure provided with negative air pressure to prevent escape of airborne-contagious pathogens) and an appropriately configured supporting aircraft. Originally developed to support CDC staff who might become infected while investigating avian flu and SARS in East Asia, it was never used until the 2014 Ebola virus epidemic in West Africa, transporting 36 Ebola patients out of West Africa.
The CDC experienced difficulties and embarrassment relating to safe patient air-transport during an international tuberculosis scare in 2007. [1] Additionally, the memory of the severe acute respiratory syndrome (SARS) epidemic of 2003-2004 and the then-current avian influenza threat (both potentially requiring transport of sick patients back to the U.S. from the Far East) prompted CDC officials to initiate the program that became the ABCS. The Cartersville, Georgia-based military airlift provider Phoenix Air was contracted; the CDC provided medical expertise to the collaboration, while the DoD provided some of the protective technology [2] through its Edgewood Chemical Biological Center. [3]
With the anticipated decommissioning of the U.S. Army’s Aeromedical Isolation Team (AIT) in December 2010, the need for a new system to support transport of highly contagious patients became even more urgent. By that time, the ABCS had been extensively tested and was certified for its mission by the Federal Aviation Administration (FAA). The U.S. Air Force had also approved it for ferrying military personnel. The dedicated air platform for the ABCS was a 32-year-old Gulfstream III jet that had once been owned and operated by the Royal Danish Air Force as military tailcode “F-313”. [4] (F-313 had been sold to Phoenix Air in January 2005. Rechristened as air ambulance jet “N173PA”, it was utilized in support of the 2007 TB incident.)
The international swine flu pandemic of 2009-10 did not occasion the need for air-transport under isolation of any CDC personnel. Consequently, the ABCS—which comprised three isolation units (but only one aircraft) by late-2011—was to some extent mothballed. That changed abruptly in late-July 2014 when Phoenix Air was asked if they could support a patient with a “bloodborne pathogen” (namely Ebola virus) as well as it could an “airborne pathogen” (such as TB or flu, for which it had been designed). [5] Physicians from Phoenix, along with CDC experts, spent a day and a half reviewing the system, after which they all agreed it was suitable for Ebola patients. "In fact, it's probably over-engineered for Ebola, because it's designed for airborne pathogens," the Phoenix director stated. On 2 August 2014, the ABCS carried the first Ebola patient (Dr. Kent Brantly, an employee of Samaritan's Purse) ever to be evacuated to the United States; three days later, it transported another, Nancy Writebol. To date, Phoenix Air and the ABCS have flown five Ebola patients out of West Africa (four Americans—Brantly, Writebol, Dr Rick Sacra, and an unidentified American on September 9 -- and a German doctor from Sierra Leone to Hamburg, Germany). [6] After the first two missions, Phoenix Air—which says it considered them successful "proof-of-concept flights"—decided that it would only undertake future missions under the aegis of the U.S. government. Challenges such as dealing with U.S. customs officials, obtaining permission to transit foreign airspace, and the selection of specific destination medical centers had become too onerous. Since then, the U.S. Department of State has coordinated all such flights, including those for foreigners returning to their own countries. U.S. taxpayers pick up the tab for official government patients, but reimbursement is required for all others. (Brantly and Writebol each cost about $200,000, including the cost of equipment decontamination, which their organization paid.)
Phoenix Air currently keeps only one plane on standby for transporting Ebola victims.
The modular ABCS utilizes a transit isolator consisting of a metal frame supporting numerous items of medical equipment (heart and pulse oxygen monitors, etc.). Most of airframe’s cabin space is taken up by the isolator. The framework is encased in a transparent plastic sheathing, or “tent”. Only one patient—attended by one doctor and two nurses—can be accommodated in one isolator in one aircraft. The patient area is provided with continuous negative air pressure and air filtration to keep pathogens from entering the rest of the cabin. An antechamber to the patient area is used by medical personnel for donning and doffing personal protective equipment as well as for decontamination. Next to the isolator is a toilet for the patient’s use.
After transport of an infected patient is completed, Phoenix Air performs a decontamination process stipulated by the CDC. This consists of spraying a powerful disinfectant inside the module for 24 hours and sending all contaminated contents — including the plastic casing, patient stretchers, and even walkie-talkies — to an incinerator (operated by a federally licensed hazardous-materials disposal team) for burning.
The McDonnell Douglas C-9 was a military version of the McDonnell Douglas DC-9 airliner. It was produced as the C-9A Nightingale for the United States Air Force, and the C-9B Skytrain II for the U.S. Navy and Marine Corps. The final flight of the C-9A Nightingale was in September 2005, and the C-9C was retired in September 2011. The U.S. Navy retired its last C-9B in July 2014. The two remaining C-9s in Marine service were retired in April 2017.
The Defense Threat Reduction Agency (DTRA) is an agency within the United States Department of Defense (DoD) and is the official Combat Support Agency for countering weapons of mass destruction. According to the agency's Strategic Plan for Fiscal Years 2018 to 2022, the DTRA mission "enables DoD and the U.S. Government to prepare for and combat weapons of mass destruction and improvised threats and to ensure nuclear deterrence." The agency is headquartered in Fort Belvoir, Virginia.
Phoenix Air Group, often just referred to as Phoenix Air, is a non-scheduled airline headquartered in Cartersville, Georgia, USA, with the city's airport serving as its base. Founded in 1978 by Army helicopter pilot and race car driver Mark Thompson, Phoenix Air operates worldwide charter flights.
Aeromedical evacuation (AE) usually refers to the use of military transport aircraft to carry wounded personnel.
One use of the concept of biocontainment is related to laboratory biosafety and pertains to microbiology laboratories in which the physical containment of pathogenic organisms or agents is required, usually by isolation in environmentally and biologically secure cabinets or rooms, to prevent accidental infection of workers or release into the surrounding community during scientific research.
The 2007 tuberculosis scare occurred when Atlanta personal-injury lawyer Andrew "Drew" Speaker flew from Atlanta, Georgia to Paris, France and on to Greece and then Italy before returning on a flight from Prague, Czech Republic to Montreal, Canada, where he crossed over the border and back into the United States while infected with multi-drug-resistant tuberculosis. The Centers for Disease Control and Prevention believed at the time that Speaker was suffering from extensively drug-resistant tuberculosis (XDR-TB). The incident sparked a debate in Congress on the failure of federal customs agents to stop him. Upon Speaker's return to the United States, the CDC placed him under involuntary isolation using a provision of the Public Health Service Act. With this action, Speaker became the first individual subjected to a CDC isolation order since 1963.
A flight nurse is a registered nurse who specialises in the field of providing comprehensive pre-hospital, emergency critical care, and hospital care to a vast scope of patients. The care of these patients is generally during aeromedical evacuation or rescue operations aboard helicopters, propeller aircraft or jet aircraft. On board a rescue aircraft you would find a flight nurse accompanied by flight medics and respiratory practitioners, as well as the option of a flight physician for comprehensive emergency and critical transport teams. The inclusion of a flight physician is more commonly seen in pediatric and neonatal transport teams. A critical care flight nurse must be able to deal with all age groups with broad critical emergencies. With no physicians on site the nurses scope of practice is expanded. The critical care experience is transferred over to a flight nurse with impacting factors such as altitude and changes in pressure, gravitational forces, and weather. Some patients may experience exacerbation's because of factors related to the cabin environment including hypoxia, limited mobility, gas expansion, and risk of injury related to turbulence and resources with definitive care are limited. Aeromedical evacuation crews coordinate with other organizations to plan for the safe and timely care and evacuation of patients. Crews must be prepared for patients suffering from trauma and mental health illnesses.
The 153d Airlift Wing is a unit of the Wyoming Air National Guard, stationed at Cheyenne Air National Guard Base, Wyoming. If activated to federal service, the Wing is gained by the United States Air Force Air Mobility Command.
In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient. Various forms of isolation exist, in some of which contact procedures are modified, and others in which the patient is kept away from all other people. In a system devised, and periodically revised, by the U.S. Centers for Disease Control and Prevention (CDC), various levels of patient isolation comprise application of one or more formally described "precaution".
Emory University Hospital is a 733-bed facility in Atlanta, Georgia, specializing in the care of acutely ill adults. Emory University Hospital is staffed exclusively by Emory University School of Medicine faculty who also are members of The Emory Clinic. The hospital is renowned as one of the nation's leaders in cardiology and cardiac surgery, oncology, transplantation, ophthalmology, and the neurosciences.
The 375th Operations Group is the operational flying component of the United States Air Force 375th Air Mobility Wing. It is stationed at Scott Air Force Base, Illinois.
Negative room pressure is an isolation technique used in hospitals and medical centers to prevent cross-contamination from room to room. It includes a ventilation that generates negative pressure to allow air to flow into the isolation room but not escape from the room, as air will naturally flow from areas with higher pressure to areas with lower pressure, thereby preventing contaminated air from escaping the room. This technique is used to isolate patients with airborne contagious diseases such as: influenza (flu), measles, chickenpox, tuberculosis, Severe Acute Respiratory Syndrome (SARS-CoV), Middle East Respiratory Syndrome (MERS-CoV), and Coronavirus disease 2019 (COVID-19).
Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and critical care to all types of patients during aeromedical evacuation or rescue operations aboard helicopter and propeller aircraft or jet aircraft.
The Aeromedical Isolation Team of the US Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland was a military rapid response team with worldwide airlift capability designed to safely evacuate and manage contagious patients under high-level (BSL-4) bio-containment conditions. Created in 1978, during its final years the AIT was one of MEDCOM’s Special Medical Augmentation Response Teams comprising a portable containment laboratory along with its transit isolators for patient transport. Contingency missions included bioterrorism scenarios as well as the extraction of scientists with exotic infections from remote sites in foreign countries. The AIT trained continuously and was often put on alert status, but only deployed for “real world” missions four times. The AIT was decommissioned in 2010 and its mission assumed by one of the US Air Force’s Critical Care Air Transport Teams (CCATTs).
The United States biological defense program—in recent years also called the National Biodefense Strategy— refers to the collective effort by all levels of government, along with private enterprise and other stakeholders, in the United States to carry out biodefense activities.
Four laboratory-confirmed cases of Ebola virus disease occurred in the United States in 2014. Eleven cases were reported, including these four cases and seven cases medically evacuated from other countries. The first was reported in September 2014. Nine of the people contracted the disease outside the US and traveled into the country, either as regular airline passengers or as medical evacuees; of those nine, two died. Two people contracted Ebola in the United States. Both were nurses who treated an Ebola patient; both recovered.
This article covers the timeline of the 2014 Ebola virus epidemic in West Africa and its outbreaks elsewhere. Flag icons denote the first announcements of confirmed cases by the respective nation-states, their first deaths, and their first secondary transmissions, as well as relevant sessions and announcements of agencies such as the World Health Organization (WHO), the U.S. Centers for Disease Control (CDC), and NGOs such as Doctors Without Borders; medical evacuations, visa restrictions, border closures, quarantines, court rulings, and possible cases of zoonosis are also included.
Operation United Assistance is a 2014 United States military mission to help combat the Ebola virus epidemic in West Africa, including the part of the epidemic occurring in Liberia. The 101st Airborne Division headquarters was responsible for leading the mission.
A racal suit is a protective suit with powered air-purifying respirator (PAPR). It consists of a plastic suit and a battery-operated blower with HEPA filters that supplied filtered air to a positive-pressure hood. Racal suits were among the protective suits used by Aeromedical Isolation Team (AIT) of the United States Army Medical Research Institute of Infectious Diseases to evacuate patients with highly infectious diseases for treatment.
John J. Lowe is an American infectious disease scientist, Assistant Vice Chancellor for Health Security at University of Nebraska Medical Center, and Associate Professor in the Department of Environmental, Agricultural and Occupational Health at University of Nebraska Medical Center College of Public Health. In 2014, he led Nebraska Medicine hospital’s effort to treat and care for Ebola virus disease patients and led the University of Nebraska Medical Center’s coronavirus disease 2019 response efforts.