Articoli originali Open access

Proposal of a decision tree for the classification of road transport in biocontainment regimen using an isolator

Autori

Pubblicato
24 luglio 2025
Fascicolo
V. 42 N. 3 (2025)
Sezione
Articoli originali
DOI
10.4081/scenario.2025.612

Abstract

Introduction: ground biocontainment transport is essential for managing highly transmissible diseases, yet standardized decision-making tools for road-based transfers are lacking in civilian literature. This study aimed to develop an operational model to support clinical and logistical decisions during such transports.

Materials and Methods: a decision tree was developed through retrospective analysis of 1.994 biocontainment transfers performed in Sicily between December 2020 and March 2022. Key variables included patient condition, use of life-support equipment, and transfer characteristics. The model was refined through structured post-mission briefings and categorized transfers into three complexity levels (C1–C3) based on clinical and logistical criteria.

Results: patients were stratified by walking ability, need for monitoring or life support, and infectious risk. A total of 590 high-complexity transfers used isolators, while 1.403 lower-complexity cases were managed with a biocontainment minibus. No critical equipment failures were recorded. The decision tree supported consistent planning and improved safety.

Discussion: Comparison with literature-based recommendations confirmed the model’s validity and highlighted operational issues such as miscommunication and equipment integration. Integration with NEWS2 is proposed to enhance risk stratification.

Conclusions: the proposed decision tree provides a reproducible framework for classifying biocontainment transport complexity. Prospective validation is needed to support its application in broader healthcare contexts.

Parole chiave

Riferimenti bibliografici

  1. 1. Gibbs SG, Herstein JJ, Le AB, et al. Review of literature for air medical evacuation high-level containment transport. Air Med J 2019;38:359-65.
  2. 2. Imbriaco G, Flauto A. The organization of ambulance decontamination during the COVID-19 pandemic: a process analysis based on the Lean Thinking philosophy. Emerg Care J 2023;19:11646.
  3. 3. Nicol ED, Mepham S, Naylor J, et al. Aeromedical transfer of patients with viral hemorrhagic fever. Emerg Infect Dis 2019;25:5-14.
  4. 4. Albrecht R, Knapp J, Theiler L, et al. Transport of COVID-19 and other highly contagious patients by helicopter and fixed-wing air ambulance: a narrative review and experience of the Swiss air rescue Rega. Scand J Trauma Resusc Emerg Med 2020;28:40.
  5. 5. Herstein JJ, Figi CE, Le AB, et al. An updated review of literature for air medical evacuation high-level containment transport during the coronavirus disease 2019 pandemic. Air Med J 2023;42:201-9.
  6. 6. LeRoy A, Marklund. Transporting patients with lethal contagious infections. Int J of Trauma Nurs 2002;25:51-3.
  7. 7. Imperio M, Ireland K, Xu Y, et al. Clinical team debriefing post-critical events: perceptions, benefits, and barriers among learners. Front Med (Lausanne) 2024;11:1406988.
  8. 8. Kessler DO, Cheng A, Mullan PC. Debriefing in the emergency department after clinical events: a practical guide. Ann Emerg Med 2015;65:690-8.
  9. 9. Ediger K, Godbout V, Trinh F, et al. Implementation of a nurse facilitated, structured, clinical event debriefing initiative in four neonatal intensive care units. J Perinatol 2025 Apr 12. doi: 10.1038/s41372-025-02297-y.
  10. 10. Del Romano M, Ciapessoni L, Di Mola F, et al. Rapid Response air medical evacuation by civilian HEMS crew of critical patients during COVID-19 outbreak – First Fixed Points. Emerg Care J 2020;16:134-6.
  11. 11. Garibaldi BT, Conger NG, Withers MR, et al. Aeromedical evacuation of patients with contagious infections. Aeromedical Evacuation 2019:317–35.
  12. 12. Gibbs SG, Herstein JJ, Le AB, et al. Need for Aeromedical Evacuation High-Level Containment Transport Guidelines. Emerg Infect Dis 2019;25:1033-4.
  13. 13. Kling J. The basics of biocontainment. Lab Anim (NY) 2020;49:285-7.
  14. 14. Corradi M, Cattaneo A, Plicco C, Bossi E. HTA of novel biocontainment systems for ambulance transport: public health implications. Eur J Public Health 2021;31.
  15. 15. Lowe JJ, Jelden KC, Schenarts PJ, et al. Considerations for safe EMS transport of patients infected with Ebola virus. Prehosp Emerg Care 2015;19:179-83.
  16. 16. Dindart JM, Peyrouset O, Palich R, et al. Aerial medical evacuation of health workers with suspected Ebola virus disease in Guinea Conakry-interest of a negative pressure isolation pod-a case series. BMC Emerg Med 2017;17:9.
  17. 17. Dang A, Williams B, Warsing WD, et al. Air quality monitoring during High-Level biocontainment ground transport: observations from two operational exercises. Disaster Med Public Health Prep 2022;16:1482-9.
  18. 18. Hilbert-Carius P, Braun J, Abu-Zidan F, et al. Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective. Scand J Trauma Resusc Emerg Med 2020;28:94.
  19. 19. D’Urso F, Meroni L, Rech, et al. Possible care protocols for patients undergoing road transfer on a biocontainment stretcher model N 36 (36 m air>60 ACH). Emerg Care J 2024:20:123334.
  20. 20. Isakov A, Miles W, Gibbs S, et al. Transport and Management of Patients With Confirmed or Suspected Ebola Virus Disease. Ann Emerg Med 2015;66:297-305.
  21. 21. Morgan RJM, Williams F, Wright MM. An early warning scoring system for detecting developing critical illness. Clin Intensive Care 1997;8:100.
  22. 22. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM 2001;94:521-526
  23. 23. DeVita, MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Critical Care Med 2006;34:2463-78.
  24. 24. Araujo AF, Pereira ER, Duarte SDCM, Broca PV. Pre-hospital assistance by ambulance in the context of coronavirus infections. Rev Bras Enferm 2021;74:e20200657.

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