FAI has worked to repatriate patients from Covid pandemic hotspots around the world – tell us a bit about how FAI has handled this mission – which are the hotspots you have flown to?
FAI received numerous client requests from the first weeks of the novel coronavirus outbreak, on behalf of governments, international agencies, insurance companies and private clients.
During those early days, there was a very high level of anxiety, uncertainty, and fragmented response from governments around the world. Airspace was becoming restricted in a disjointed way, borders were closing without uniform implementation and quarantine regulations were changing rapidly and unpredictably. It became almost impossible to project and plan for all contingencies.
After close alignment with multiple global and regional health and aviation authorities, we commenced portable isolation unit air ambulance transport missions, in late-January 2020.
There was a clear pattern early on, of requests for repatriation from the five high-risk locations to home country. The pandemic, as we now well know, peaked sequentially through developed countries from east to west. Now, five months later, we are flying Covid-positive missions in our isolation units from all regions and countries, including rescue evacuation missions and long-haul repatriations.
Some of the locations we have operated from include Accra, Baghdad, Bangui, Canary islands, Djibouti, Dushanbe, Juba, Kabul, Lagos, London, Marrakesh, Menorca, Mogadishu, Munich, Niamey, Pointe Noire, Port Harcourt, Rabil, Rio de Janeiro, and even the island of Sao Tome off the west coast of Africa.
As soon as it became clear that the world was facing an imminent global health crisis, FAI procured two of the latest version portable medical isolation unit (PMIU) solid-shell EpiShuttles
Can you talk about your operations – how crucial has your service been when mobility has been shut off around the world?
FAI operates the largest fleet of fixed-wing long- haul intercontinental aircraft, with 10 dedicated air ambulance aircraft, and we perform around 1,000 missions per year to all destinations around the world, including hostile locations.
This has helped us build a very extensive network of global partners in every area of our operation.
We have really needed to leverage that network to the full to overcome the multiple operational restrictions and limitations encountered at every turn during this global aviation crisis.
We’ve had to deal with delays, diversions, cancellations, difficulties with overflight clearances and landing permissions, changing health restrictions into destination ports of entry, and previously unannounced mandatory quarantine on arrival for our flight crews and medical teams. Many times, we have had to call on established diplomatic channels to achieve what had seemed impossible a few hours earlier. We’ve developed contingency plans in advance for all missions, and we’ve become progressively more efficient at anticipating and avoiding complex and costly logistical nightmares.
Covid-positive Medical Transport Missions – what are the latest version portable medical isolation units that you have on board, and how has this affected your mission execution?
As soon as it became clear that the world was facing an imminent global health crisis, FAI procured two of the latest version portable medical isolation unit (PMIU) solid-shell EpiShuttles, manufactured in Norway by EpiGuard AS. We‘ve had a soft-shell IsoArk N35 transport unit since the days of the Ebola crisis that we now use for non-critical care patients who are in a more stable condition, and we are n the process of adding a second IsoArk unit.
All these units have full isolation capability with fully recycled air supply through multiple HEPA filtration systems. They have double port systems with sealed fitted high-density glove attachments, which let us access the patients without contamination.
You have had to make adjustments to your aircraft, including customised stretcher configurations with specific EpiShuttle equipment – can you explain more about this?
The customised stretcher configuration is a double-stretcher layout, on a Challenger CL604 aircraft, which is our largest dedicated air ambulance jet. The door has to be large enough to accommodate the dimensions of the EpiShuttle, which is loaded via a mechanised system. Once onboard, the isolation unit is mounted on the first stretcher system, and all the accessory modules needed are fitted to the second stretcher.
The EpiShuttle allows full critical care monitoring and related ICU care in flight. We also mount all related equipment on the second stretcher including oxygen supply, ventilator, invasive monitoring for all vital signs and cardiac monitoring, as well as infusion pumps for medications and supportive care. All these devices can access the patient via sealed ports built into the solid structure of the isolation unit, so we can work intensively with the patient without having to break the contamination seal.
Interestingly, for those patients who are awake and alert, we have a two-way radio communication system so they can talk freely with our teams.
These units are fully transparent so we can see the patient at all times and they can see us, and this gives the patient reassurance and helps overcome any feelings of anxiety or claustrophobia. There are also ways to pass refreshments securely into the unit, so awake patients can maintain their hydration and their nutrition. We are also able to frequently re-position patients for maximum comfort
Tell us a bit about the FAI team
All our flight medical and nursing teams are specialized in aeromedical transportation to start with, and are highly experienced. We created dedicated Covid teams who volunteered with special interest for the first missions, and underwent special training to ECDC standard through EpiGuard AS. Now into our fifth month of Covid-19 dedicated transportation, we have run repeat training sessions and enlarged the team considerably, so that all our staff are competent and comfortable working with all the units.
All missions are crewed by a medical team of three, including one ICU flight doctor and two ICU nurse/flight paramedics. Some of the missions are very long – in excess of 18 hours– so we now perform crew changes mid-way through the longer missions. This gives all our medical staff good exposure to ongoing mission experience, without excessive crew fatigue, and gives them the chance to rest and recuperate.
What have you learned on this complex journey, that you can share with our readers, your colleagues, in the aeromedical transportation industry?
Patient selection, fitness to fly, and the timing of the mission in relation to the progression of the underlying illness, are all crucial factors in planning a successful mission using these solation units. Accurate and timely pre-flight clinical information is absolutely crucial.
One of the hardest lessons has been n making decisions on which patients should NOT be transported, for their own safety, and for the safety of our crews.
While it is true that these units isolate the patient n order to protect the medical teams and flight crews, you have to remember that there are still significant limitations in access to the patients once inside, in case of emergency. Covid-positive patients can deteriorate very quickly at altitude. It s almost impossible to resuscitate patients from cardio-respiratory arrest within a closed capsule.
We’ve also learned through experience just how exhausting these missions can be for both patients and crew alike, and we now implement medcrew changes at mid-point tech stops wherever possible. Patient preparation, and the close co-operation of our clients and the treating medical teams on the ground, are all critical factors in each and every case.
We’ve learned never to take anything for granted, and we’ll keep on learning ... there’s always a first time for everything at FAI!