Air ambulance evacuations in the Ebola crisis context

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Shawn Oliver
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1 Air ambulance evacuations in the Ebola crisis context Dr Arnaud DEROSSI Regional Medical Director, Assistance & Global Medical Transport

2 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 2

1,200 full time medical doctors) 27 Assistance Centers 56 clinics (400,000 consultations / year) + 750 remote sites 10 dedicated air

3 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) 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 3

4 4 International SOS: Worldwide presence

5 5 International SOS in Africa

6 International SOS in Western Africa 1 st alert by Intl.SOS in March

7 7 International SOS in Western Africa

8 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 8

9 9 THE BASICS

10 CURRENT SITUATION > cases > death (incl.700 health professionals) Most new cases in Guinea & Sierra Leone Liberia under control Mortality approx. 65% Senegal Nigeria Mali Others?? 10

11 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 11

12 12 Patients evacuation

13 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 13

14 Medical Evacuation Categories Afebrile medical condition Febrile non Ebola medical condition Suspected / Confirmed Ebola case Confirmed high risk contact - Asymptomatic 14

15 Medical Evacuation Categories Condition dependent Clear diagnosis and confirmatory tests Exposure history Afebrile medical condition Febrile non Ebola medical condition Suspected / Confirmed Ebola case Confirmed high risk contact - Asymptomatic 15

Medical Evacuation Categories Afebrile medical condition Febrile non Ebola medical condition Enhanced diagnostics likely to be required

16 Medical Evacuation Categories Afebrile medical condition Febrile non Ebola medical condition Enhanced diagnostics likely to be required Access to EVD testing Delayed/declined evacuation likely Suspected / Confirmed Ebola case Confirmed high risk contact - Asymptomatic 16

17 Medical Evacuation Categories Afebrile medical condition Febrile non Ebola medical condition Suspected / Confirmed Ebola case Confirmed high risk contact - Asymptomatic Commercial airline travel not permitted PMIU required Health Authority clearances 17

18 Medical Evacuation Categories Afebrile medical condition Febrile non Ebola medical condition Clinical condition dependent Nationality dependent Health Authority clearances Suspected / Confirmed Ebola case Confirmed high risk contact - Asymptomatic 18

19 Medical Evacuation from Ebola Affected Countries Detailed risk assessment required Clinical status important Exposure history important Enhanced diagnostics may be required 19

20 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 20

21 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 21

22 EBOLA: Patient s evacuation Non affected, non exposed But Ebola-like symptoms Scoring, communication Intl.SOS: 7 evacuations To Johannesburg, Europe and USA 22

23 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) 23

on the ground Requires perfect internal & external

24 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 24

25 25 Portable isolation unit

26 EVACUATION SOLUTIONS 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?) 26

27 EVACUATION SOLUTIONS Destination: Europe or South Africa Close contact with health authorities Identification of the relevant national infectious diseases reference centers Admission process 27

28 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 28

o 2 years development o US based (Georgia) o Cargo door o Air flow front -> aft o Negative

29 EVACUATION 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 29

30 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 30

31 EVACUATION SOLUTIONS Also some fully dedicated governmental solutions 31

32 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 32

33 Our daily operational challenge: Not only with Ebola cases, but also with non- Ebola cases out of affected countries... 33

34 34

Special Session on IHR and Ebola Virus Disease

Special Session on IHR and Ebola Virus Disease Roberta Andraghetti, WHO/PAHO/CHA/IR 12th Meeting Caribbean National Epidemiologists & Laboratory Directors Port of Spain, Trinidad and Tobago, 17-19 September