|LETTER TO EDITOR
|Ahead of print publication
Patient isolation pods for the evacuation of COVID-19 infected patients – Is this the answer?
Shibu Sasidharan1, Vijay Singh1, Harpreet S Dhillon2, M Babitha3
1 Department of Anaesthesia and Critical Care, Level III IFH Hospital, MONUSCO, Goma, Democratic Republic of the Congo
2 Department of Psychiatry, Level III IFH Hospital, MONUSCO, Goma, Democratic Republic of the Congo
3 Ojas Hospital, Panchkula, Haryana, India
|Date of Submission||16-Jun-2020|
|Date of Acceptance||04-Jul-2020|
|Date of Web Publication||31-Jul-2020|
Department of Anaesthesia and Critical Care, Level III IFH Hospital, Goma
Democratic Republic of the Congo
Source of Support: None, Conflict of Interest: None
|How to cite this URL:|
Sasidharan S, Singh V, Dhillon HS, Babitha M. Patient isolation pods for the evacuation of COVID-19 infected patients – Is this the answer?. J Anaesthesiol Clin Pharmacol [Epub ahead of print] [cited 2020 Aug 9]. Available from: http://www.joacp.org/preprintarticle.asp?id=291187
The coronavirus disease (COVID-19) pandemic has changed the way we function on a daily basis and practice medicine. As the safety of health care workers (HCWs) is paramount when handling COVID-19-infected patients, there has been considerable discussion about the use of patient isolation pods (pods) during the evacuation of these patients. Therefore, we analyzed if pods are the ultimate solution to the problem. An isolation pod is a collapsible personnel isolation apparatus with a base used for avoiding unwanted contamination of harmful biological and chemical materials. The cover is connected to the base by a zipper. Several glove box ports are provided to permit rapid and expedient treatment of the patient.
In June 2020, literature searches were performed on PubMed, Ovid, Embase, and the Cochrane Database to identify studies about the aeromedical transfer of patients with COVID-19 or other highly infectious diseases. Our search strategy is outlined in Appendix A [Additional file 1].
There has been a consensus that there was little advantage to be gained in moving patients with COVID-19 in isolation pods and patients are best managed in a sitting position, with supplementary oxygen if required, or on stretchers for those who can be best managed lying down. Only the Norwegians (Norwegian Air Ambulance Service) had experience in using patient isolation pods, and they reported mixed results. Some patients who may have been managed best in a sitting position, were required to lay flat or semi-recumbent, and this had potentially compromised oxygen perfusion. The United Kingdom Royal Air Force and Australian Defence Force experts emphasized the difficulty in managing ventilated patients in isolation pods and believed that the risks imposed outweighed any benefit.
The consensus for COVID-19 management was as follows.,,,,,,
| General|| |
- A risk assessment by a clinician expert in an aeromedical evacuation should be conducted before any decision to move the patient, especially those with evident symptoms of respiratory distress
- An air transport isolator or negative pressure isolation chamber to move COVID-19 patients is not required
- Social distancing (2 m) should be enforced strictly, where possible, during the move
- Hand hygiene, face hygiene, and respiratory etiquette should be practiced
- Personnel not required for the evacuation should not travel on the aircraft
- Personal protection equipment (PPE) guidance throughout the various stages of the evacuation is driven by the health care context (hospital, ground ambulance, aircraft, etc.)
- Ventilated patients should have a high-efficiency particulate air filter in the circuit.
Medical personnel's PPE comprises of:
- Nitrile gloves
- Plastic apron
- Eye/face protection (if the risk of splash present)
- Fluid-resistant surgical mask (FRSM) to be worn when within 2 m of the patient
- Filtering facepiece particles class 3 (FFP3) masks to be worn during aerosol-generating procedures (intubation or if continuous positive airway pressure/bilevel positive airway pressure is being given)
- FFP3 masks need to be fit-tested to ensure they are particulate tight.
| Aircrew|| |
- Aircrew unable to stay outside a 2 m radius of the patient must wear PPE comprising of:
- Nitrile gloves
- Plastic apron
- Eye/face protection.
- Where it is safe to do so, aircrew/cockpit areas should be screened using suitable, easy-to-clean material
- Where possible, cockpit/aircrew areas should have ventilation isolated from the cabin.
| Movement Support|| |
- Senior specialist aeromedical evacuation clinician advice must be available 24/7
- Loading and unloading procedures must be developed for the aircrew, clinical staff, and patient
- Appropriate aircraft stairs and lifts must be planned for and provided to the evacuation team.
The aircraft decontamination process depends on the aircraft type.
- Cargo-style aircraft:
- No disinfectants should be fogged, atomized, or finely sprayed inside the aircraft because it could damage the avionics or the electrical systems
- Soap and alcohol are effective (World Health Organization and European Centre for Disease Control)
- Aircraft foam washing fluid can be used, or 98% isopropanol (this is highly flammable).
- Passenger-style aircraft (where there are a lot of soft furnishings):
- Misted disinfectant approved through the European Union Aviation Safety Agency approved process, can be used for decontamination.
Therefore, the answer to the question in consideration is not an innovation like the isolation pod, but the knowledge, revision, and clear understanding of practices already in place, as stated above. This can help HCWs in a safe air transfer.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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