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Historic Firsts: Aeromedical Evacuation and the Transportation Isolation System

Published:December 08, 2020DOI:https://doi.org/10.1016/j.amj.2020.11.005

      Abstract

      This short communication highlights the US Air Force's recent success with having their aeromedical evacuation crews use the Transportation Isolation System for the first time operationally to transport patients positive for coronavirus disease 2019.
      Aeromedical evacuation (AE) has a long and storied history that dates to the early part of the 20th century.
      • Vanderburg K
      Aeromedical evacuation: a historical perspective.
      The Air Force's AE system has been fundamental in transporting war-injured patients since World War II.

      Bedi S. The evolution of aeromedical evacuation capabilities help deployed medicine take flight. Available at: https://www.airforcemedicine.af.mil/News/Display/Article/1466825/the-evolution-of-aeromedical-evacuation-capabilities-help-deployed-medicine-tak/. Published March 15, 2018. Accessed August 25, 2020.

      The AE system provides en route care and transportation to patients while flying to and from medical facilities. Currently, the AE system is composed of 4 active duty AE squadrons, 9 Air National Guard squadrons, and 18 Air Force Reserve AE squadrons.

      Air Mobility Command Aeromedical Evacuation. US Air Force. Available at:https://www.af.mil/About-Us/Fact-Sheets/Display/Article/490683/air-mobility-command-aeromedical-evacuation/. Published August 4, 2014. Accessed August 25, 2020.

      The AE system has revolutionized battlefield medicine; AE continues to advance, evolve, and adapt to meet emerging transport needs in new conflicts, medicine, and flight.

      Bedi S. The evolution of aeromedical evacuation capabilities help deployed medicine take flight. Available at: https://www.airforcemedicine.af.mil/News/Display/Article/1466825/the-evolution-of-aeromedical-evacuation-capabilities-help-deployed-medicine-tak/. Published March 15, 2018. Accessed August 25, 2020.

      Recently, AE made headlines and history by conducting the first operational mission using the Transport Isolation System (TIS) to transport patients positive for coronavirus disease 2019 (COVID-19).

      Mobility airmen conduct historic first aeromedical evacuation mission using transport isolation system. Available at: https://www.amc.af.mil/News/Article-Display/Article/2146663/mobility-airmen-/. Published April 11, 2020. Accessed August 24, 2020.

      The TIS is an infectious disease containment unit that can be used to provide medical care to patients while in-flight.

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      The TIS was originally developed in support of the Ebola outbreak in Africa; during the outbreak, the Department of Defense ordered 25 of the isolation units for the military.

      Svan J. Mobile isolation unit for highly contagious fits Air Force cargo planes. Stars and stripes. Available at:https://www.stripes.com/news/mobile-isolation-unit-for-highly-contagious-fits-air-force-cargo-planes-1.399701. Accessed March 17, 2016.

      It passed it is safe to fly testing in December 2014.

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      The unit is designed to minimize and protect the aircrew, medical attendants, and the aircraft from exposure to infectious and/or contagious diseases.

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      Initial training on the TIS takes 4 days and includes training on TIS familiarization, personal protective equipment, infection control procedures, donning and doffing protocols, practicing patient loading and unloading procedures, and patient transport and care.

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      ,

      Miller C. Airmen perform in-flight Transportation Isolation System training. US Air Force. Available at: https://www.af.mil/News/Article-Display/Article/1782743/airmen-perform-in-flight-transportation-isolation-system-training/. Published March 12, 2019. Accessed August 25, 2020.

      The training can also include simulated patients, simulated patient care, and simulated in-flight transport.

      Miller C. Airmen perform in-flight Transportation Isolation System training. US Air Force. Available at: https://www.af.mil/News/Article-Display/Article/1782743/airmen-perform-in-flight-transportation-isolation-system-training/. Published March 12, 2019. Accessed August 25, 2020.

      The basic version of the TIS system has 2 isolation modules (each one weighing 1,455 lb) and 1 antechamber module (weighing 1,285 lb), all of which are under negative pressure (Figure 1).

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      ,
      • Garibaldi BT
      • Conger NG
      • Withers MR
      • Hatfill SJ
      • Gutierrez-Nunez JJ
      • Christopher GW
      Aeromedical Evacuation of Patients with Contagious Infections.
      The modules are placed on aircraft pallets and can be used on C-17, C-130H, and C-130J aircraft (Figure 2).

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      ,
      • Garibaldi BT
      • Conger NG
      • Withers MR
      • Hatfill SJ
      • Gutierrez-Nunez JJ
      • Christopher GW
      Aeromedical Evacuation of Patients with Contagious Infections.
      These pallets have been retrofitted with watertight enclosures and high-efficiency particulate air filtration systems, all intake and outtake air is high-efficiency particulate air filtered, which is designed to contain infectious pathogens.

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      ,
      • Garibaldi BT
      • Conger NG
      • Withers MR
      • Hatfill SJ
      • Gutierrez-Nunez JJ
      • Christopher GW
      Aeromedical Evacuation of Patients with Contagious Infections.
      The antechamber provides a safe space for the AE crew to don and doff personal protective equipment before and after patient care.

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      Each TIS system can accommodate 4 ambulatory or 2 litter patients; C-17s have the capability to transport 2 TIS systems at a time.

      Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      The full medical support team for a TIS includes an AE crew (usually 2 nurses and 3 AE technicians), a critical care air transport team, infectious disease physicians and technicians, and TIS operators.

      Air Mobility Command. Mobility airmen conduct historic first aeromedical evacuation mission using Transport Isolation System. Available at:https://www.amc.af.mil/News/ArticleDisplay/Article/2146663/mobility-airmen-/. Published April 11, 2020. Accessed August 25, 2020.

      Figure 1
      Figure 1The TIS unit. (Courtesy of Air Mobility Command.)
      Figure 2
      Figure 2The TIS unit in a C-17 Globemaster III. (Courtesy of US Air Force. Photograph by Senior Airman Cody R. Miller.)
      On April 8, 2020, a warning order was issued by the US Transportation Command that a TIS-trained AE crew would be needed for a mission within 24 hours.

      Air Mobility Command. Mobility airmen conduct historic first aeromedical evacuation mission using Transport Isolation System. Available at:https://www.amc.af.mil/News/ArticleDisplay/Article/2146663/mobility-airmen-/. Published April 11, 2020. Accessed August 25, 2020.

      On April 10, 2020, the Air Mobility Command's newly released COVID-19 patient movement plan was followed, and the first operational flight was performed using the TIS.

      Air Mobility Command. Mobility airmen conduct historic first aeromedical evacuation mission using Transport Isolation System. Available at:https://www.amc.af.mil/News/ArticleDisplay/Article/2146663/mobility-airmen-/. Published April 11, 2020. Accessed August 25, 2020.

      The mission took place on a C-17 and safely transported 3 US government contractors who had tested positive for COVID-19 from Afghanistan to Ramstein Air Base, Rhineland-Palatinate, Germany.

      Air Mobility Command. Mobility airmen conduct historic first aeromedical evacuation mission using Transport Isolation System. Available at:https://www.amc.af.mil/News/ArticleDisplay/Article/2146663/mobility-airmen-/. Published April 11, 2020. Accessed August 25, 2020.

      On July 17, 2020, the TIS was used to fly a COVID-19 patient from the Indo-Pacific region to Travis Air Force Base, Fairfield, CA.

      Longoria M. Team Travis conducts first Indo-Pacific aeromedical evacuation mission for COVID-19. Travis Air Force Base. Available at:https://www.travis.af.mil/News/Article/2278985/team-travis-conducts-first-indo-pacific-aeromedical-evacuation-mission-for-covi/. Published July 17, 2020. Accessed August 25, 2020.

      This was the first TIS mission in support of the US Indo-Pacific Command area.

      Longoria M. Team Travis conducts first Indo-Pacific aeromedical evacuation mission for COVID-19. Travis Air Force Base. Available at:https://www.travis.af.mil/News/Article/2278985/team-travis-conducts-first-indo-pacific-aeromedical-evacuation-mission-for-covi/. Published July 17, 2020. Accessed August 25, 2020.

      However, this marked the 18th employment of the TIS for COVID-19 patients since its first operational use on April 10, 2020.

      Longoria M. Team Travis conducts first Indo-Pacific aeromedical evacuation mission for COVID-19. Travis Air Force Base. Available at:https://www.travis.af.mil/News/Article/2278985/team-travis-conducts-first-indo-pacific-aeromedical-evacuation-mission-for-covi/. Published July 17, 2020. Accessed August 25, 2020.

      These historic flights highlight part of the US military's rapid response to meet the challenges of COVID-19. Having the AE capability of safely flying and caring for patients with infectious and contagious diseases is a significant accomplishment. The TIS has proven to be successful operationally and will be ready to meet the challenges presented by any future high-consequence infectious diseases.

      References

        • Vanderburg K
        Aeromedical evacuation: a historical perspective.
        in: Hurd WW Jernigan JG Aeromedical Evacuation. Springer, New York, NY2003
      1. Bedi S. The evolution of aeromedical evacuation capabilities help deployed medicine take flight. Available at: https://www.airforcemedicine.af.mil/News/Display/Article/1466825/the-evolution-of-aeromedical-evacuation-capabilities-help-deployed-medicine-tak/. Published March 15, 2018. Accessed August 25, 2020.

      2. Air Mobility Command Aeromedical Evacuation. US Air Force. Available at:https://www.af.mil/About-Us/Fact-Sheets/Display/Article/490683/air-mobility-command-aeromedical-evacuation/. Published August 4, 2014. Accessed August 25, 2020.

      3. Mobility airmen conduct historic first aeromedical evacuation mission using transport isolation system. Available at: https://www.amc.af.mil/News/Article-Display/Article/2146663/mobility-airmen-/. Published April 11, 2020. Accessed August 24, 2020.

      4. Transport Isolation System (TIS). Air Mobility Command. Available at: https://www.amc.af.mil/About-Us/Fact-Sheets/Display/Article/2132917/transport-isolation-system-tis/. Published April 1, 2020. Accessed August 25, 2020.

      5. Svan J. Mobile isolation unit for highly contagious fits Air Force cargo planes. Stars and stripes. Available at:https://www.stripes.com/news/mobile-isolation-unit-for-highly-contagious-fits-air-force-cargo-planes-1.399701. Accessed March 17, 2016.

      6. Miller C. Airmen perform in-flight Transportation Isolation System training. US Air Force. Available at: https://www.af.mil/News/Article-Display/Article/1782743/airmen-perform-in-flight-transportation-isolation-system-training/. Published March 12, 2019. Accessed August 25, 2020.

        • Garibaldi BT
        • Conger NG
        • Withers MR
        • Hatfill SJ
        • Gutierrez-Nunez JJ
        • Christopher GW
        Aeromedical Evacuation of Patients with Contagious Infections.
        Aeromedical Evacuation. 2019; (Published February 27, 2020): 317-335https://doi.org/10.1007/978-3-030-15903-0_20
      7. Air Mobility Command. Mobility airmen conduct historic first aeromedical evacuation mission using Transport Isolation System. Available at:https://www.amc.af.mil/News/ArticleDisplay/Article/2146663/mobility-airmen-/. Published April 11, 2020. Accessed August 25, 2020.

      8. Longoria M. Team Travis conducts first Indo-Pacific aeromedical evacuation mission for COVID-19. Travis Air Force Base. Available at:https://www.travis.af.mil/News/Article/2278985/team-travis-conducts-first-indo-pacific-aeromedical-evacuation-mission-for-covi/. Published July 17, 2020. Accessed August 25, 2020.