Transcript (HCID) Patient Movement

SO, WHAT’S THE BIG IDEA?
The Transport Isolation System and future
of High Consequence Infectious Disease
(HCID) Patient Movement
Nicholas Conger, Col, USAF, MC
Chief of Medicine, 88 MDG / Infectious Disease Consultant to the AF/SG
Melissa Buzbee-Stiles, Maj, USAF, NC
Branch Chief, Clinical Operations, AMC/SG
William Sherman, Maj, USAF, MSC, CMRP
Branch Chief, AE Medical Readiness Logistics, AMC/SG
Disclosures
• The presenter has no financial relationships to disclose.
• This continuing education activity is managed and accredited by Professional
Education Services Group in cooperation with AMSUS.
• Neither PESG,AMSUS, nor any accrediting organization support or endorse
any product or service mentioned in this activity.
• PESG and AMSUS staff has no financial interest to disclose.
• Commercial support was not received for this activity.
Learning Objectives:
At the conclusion of this activity, the participant will be able to:
a.
Identify policy challenges/considerations in HCID patient movement
b.
Identify clinical challenges/considerations in HCID patient movement
c.
Outline current and future capabilities for HCID patient movement
TRANSPORT ISOLATION SYSTEM (TIS)
Transport Isolation System provides the Department of Defense the capability
to safely transport multiple patients while providing hands-on care with
known or suspected exposure to a contagious and infectious diseases, and to
protect the aircrew, support personnel and the aircraft from contamination.
TIS History:
August 2014:
 USTRANSCOM/SG tasked to provide an air transportable capability to
contain and transport multiple highly contagious patients exposed to blood
borne or airborne pathogens
 Interagency/Joint collaborative effort between USTRANSCOM, DTRA, AMC,
and JPM-P to develop an interim solution for personnel/aircraft protection
 Work began on Mission Execution of Aeromedical Evacuation of Ebola Virus
Disease (EVD) Exposed, Asymptomatic, Non-infectious and Symptomatic
Infectious Patients Concept of Operations (CONOPS)
TIS History:
September 2014:
 POTUS announces Ebola outbreak a threat to global national security
 USAFRICOM leads OPERATION UNITED ASSISTANCE, TRANSCOM recognizes
need to support medical evacuation of potentially exposed personnel
 Joint Urgent Operational Need (JUON) request approved to develop, test and
acquire an isolation system for use on DoD aircraft
 Development of TIS led by Defense Threat Reduction Agency (DTRA)
 Acquisition process led by the Joint Project Manager-Protection (JPM-P)
 Designed and manufactured by Production Products
TIS History:
October 2014:
 Infectious Disease Physician, Support Personnel, & Medical
Crewmember training began
December 2014:
 TIS testing completed, Airworthiness certificate awarded
 Mission Execution of Aeromedical Evacuation of EVD
Exposed, Asymptomatic, Non-infectious and Symptomatic
Infectious Patients CONOPS approved
January 2015:
 Air Force accepts delivery of first three “Generation-I” units
 “Generation II” tested/approved Jun 2015
 AMC/CC deemed system mission capable 22 Jan 2015
TIS Current Capabilities:
 25 total units postured across the US
 Provides enclosed negative-pressure environment intended to prevent spread of
biological contaminates by contact, droplet or airborne methods
 TIS Support Team – Joint Base Charleston
 Maintains TIS, pre-flight configuration, in-flight troubleshooting, post mission decon
 Adaptable configuration: Antechamber and Patient Care Modules
 C-17 Max: Two sets of three-module system
 C-130J-30 Max: One set of three-module system
 C-130H Max: One set of two-module system
TIS Current Capabilities: Antechamber
 Antechamber Module
 Medical crew transition point
 Contained space for removal of contaminated PPE prior to exiting TIS
 Components include:




Two Independent Blowers and HEPA Outflow Filtration Units
HEPA Filter
Internal/External Pressure Alarms
Biohazard Waste Container
TIS Current Capabilities: Patient Care
 Patient care modules: one or two per TIS configuration
 Provides direct patient care capability
 Utilizes standard Patient Support Pallet (PSP) system
 Adjustable configuration capability: seats, litters or combination of both
 Components include:
 Multiple ports for oxygen tubing, electrical cords or monitoring cables
 Two chemical toilets for patient use
 Prepositioned body fluid spill kit
TIS Current Capabilities: Decontamination
 After patient offload, TIS modules sealed and transported for decon,
disassembly, disposal/reconfiguration at JB Charleston
 Disposable contents removed and incinerated
 TIS Hot Humid Air Decon System (THADS)
 Enclosed trailer that delivers heat/humidity decontamination
 170 degrees (F)/90% humidity up to 120 hours
Comparable Capabilities:
Transport Isolation
System
Patient Isolation
Unit (DoD)
Phoenix Air Group
Containerized Bio(Civilian Contracted) Containment System
(DoS)
Max # of Patients
8
1
1
4
Direct patient care
Yes
Limited
Yes
Yes
Yes (C-17, C-130H/J)
Yes
Yes (G-3)
ATTLA only
Yes (THADS)
Yes
Yes
unknown
Certified for
Airworthiness
DECON solution
Clinical Challenges and Considerations:
 Crew component tailored to meet specific mission requirements
 Personnel identified:
 Aeromedical Evacuation Crew (augmented)
 Critical Care Air Transport Team
 Infectious Disease Physician
 TISST member
 Training Requirements:
 Initial 2-day course and Just-In-Time training prior to mission execution
 Personal Protective Equipment
 System set-up, preflight and operation
 Emergency procedures
Clinical Challenges and Considerations:
 Hands-on patient care capable through appropriate PPE
 Tyvek suit with foot covers
 PAPR or N-95 mask with Tyvek hood and face shield
 Surgical gloves (3 pairs)
 Surgical gown
 Surgical mask (N/A with PAPR)
 Communication challenges
 White board
 Hand signals
 AWIS
Clinical Challenges and Considerations:
 Onload/Offload Procedures
 Isolation maintenance during transfer of care
 PPE requirements for patient and ground medical teams
 Protection of environment during transition
 Patient hand-off/report procedures
Policy Challenges:
 Current DoD policy for HCID is Treat in Place
 Use of TIS requires an Exception to Policy based on:
 Operational Threats
 Level of Indigenous Healthcare available
 Bed availability at accepting facilities within CONUS to receive HCID
patients
 Limited by current capacity at:




University of Nebraska
Emory University
CDC
Walter Reed Medical Center
TIS Future State:
 Designated as Program of Record and managed as War Readiness Material
(WRM)
 Provide enduring capabilities beyond original JUON requirements that should
remain in joint force
 Requires USG and/or DoD policy action
 Force multiplier ISO myriad of plans (i.e. USNORTHCOM CONPLAN 3591
response to known or suspected contagions, contingency/humanitarian ops)
 Support tenants of Global Health Security Objectives
 Continued improvements/updates based on end user inputs
 Expansion of CONOPS to include HCID
TIS In Action: Exercise Mobility Solace
 Provided validation of current CONOPS
 4 phase exercise:
 Deployment of TIS, medical crew, equipment and support personnel
 Execute safe evacuation of simulated EVD exposed patient using AE system
 Demonstrate safe patient transfer to Walter Reed Medical Center
 Demonstrate decontamination procedures upon return to JB Charleston
Exercise Mobility Solace Video
Questions???
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