Original Articles
Vol. 42 No. 3 (2025)
https://doi.org/10.4081/scenario.2025.612

Proposta di uno schema decisionale per la classificazione del trasporto su strada in biocontenimento mediante l’impiego di un isolatore

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 4 November 2024
Accepted: 28 June 2025
Published: 24 July 2025
277
Views
125
Downloads
Biocontainment, infection control, bioisolator, medical evacuation, decision-making tree

Authors

Ulrico Angeloni
Office 11 - Ministry of Health - General Directorate of Health Prevention, Rome, Italy.
Federico D'Urso
federico.durso@gmail.com
https://orcid.org/0009-0009-8667-0729
Italian Red Cross, Public Health Department, Sicilian Branch, Palermo, Italy.
Edoardo Falcone
https://orcid.org/0009-0005-3433-0328
Italian Red Cross, Public Health Department, Sicilian Branch, Palermo, Italy.
Mara Gracy Basile
https://orcid.org/0009-0007-2543-7881
Italian Red Cross, Public Health Department, Sicilian Branch, Palermo, Italy.
Virgilio Costanzo
Italian Red Cross, Public Health Department, Rome, Italy.
Sabrina Menghini
IN. MM. S.r.l - In Manibus Meis, Ferrara, Italy.

Introduzione: il trasporto su strada in biocontenimento è essenziale per la gestione di pazienti affetti da patologie altamente trasmissibili, tuttavia nella letteratura civile mancano strumenti decisionali standardizzati a supporto dei trasferimenti su strada. Questo studio si propone di sviluppare un modello operativo per supportare le decisioni cliniche e logistiche in tali trasporti.

Materiali e Metodi: è stato elaborato uno schema decisionale attraverso un'analisi retrospettiva di 1.994 trasferimenti effettuati in regime di biocontenimento in Sicilia tra dicembre 2020 e marzo 2022. Le variabili principali includevano le condizioni del paziente, l’impiego di dispositivi di supporto vitale e le caratteristiche logistiche del trasferimento. Il modello è stato perfezionato attraverso briefing strutturati post-missione, arrivando a classificare i trasferimenti in tre livelli di complessità (C1-C3) in base a criteri clinici e logistici.

Risultati: i pazienti sono stati classificati in funzione della capacità di camminare, della necessità di monitoraggio o supporto vitale e del rischio infettivo. Sono stati identificati 590 trasferimenti ad alta complessità eseguiti mediante l’utilizzo di isolatori, mentre 1.403 casi a bassa complessità sono stati gestiti con un minibus di biocontenimento. Non sono stati registrati guasti alle apparecchiature critiche. Lo schema decisionale ha supportato una pianificazione coerente e ha migliorato la sicurezza operativa.

Discussione: Il confronto con le principali raccomandazioni presenti in letteratura ha confermato la validità del modello e ha messo in evidenza criticità operative come la comunicazione inefficace e l’integrazione delle apparecchiature. Si propone l'integrazione dell’indice NEWS2 per migliorare la classificazione del rischio clinico.

Conclusioni: lo schema decisionale proposto fornisce uno strumento riproducibile per classificare la complessità del trasporto sanitario in biocontenimento. È necessaria una validazione prospettica del modello al fine di garantirne l’applicabilità in contesti sanitari più ampi.

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
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. 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. Nicol ED, Mepham S, Naylor J, et al. Aeromedical transfer of patients with viral hemorrhagic fever. Emerg Infect Dis 2019;25:5-14.
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. 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. LeRoy A, Marklund. Transporting patients with lethal contagious infections. Int J of Trauma Nurs 2002;25:51-3.
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. 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. 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. 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. Garibaldi BT, Conger NG, Withers MR, et al. Aeromedical evacuation of patients with contagious infections. Aeromedical Evacuation 2019:317–35.
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. Kling J. The basics of biocontainment. Lab Anim (NY) 2020;49:285-7.
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. 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. 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. 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. 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. 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. 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. Morgan RJM, Williams F, Wright MM. An early warning scoring system for detecting developing critical illness. Clin Intensive Care 1997;8:100.
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. 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. 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.

How to Cite



Proposta di uno schema decisionale per la classificazione del trasporto su strada in biocontenimento mediante l’impiego di un isolatore. (2025). Scenario® - Il Nursing Nella Sopravvivenza, 42(3). https://doi.org/10.4081/scenario.2025.612
Copyright (c) 2025 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.