Aeromedical Evacuation During COVID-19: A Joint Urgent Operational Need Met

Mar 23, 2021 | Defense Transportation Journal, DTJ Online

This article combines content from various news stories published by US Transportation Command and Air Mobility Command.

As the COVID-19 pandemic began spreading worldwide, a Joint Urgent Operational Need (JUON) emerged: The need for aeromedical evacuation of COVID-positive patients. How to transport patients with a highly contagious respiratory illness while safeguarding medical personnel and aircrew health is a formidable challenge. But, for the US Transportation Command (USTRANSCOM), it was a challenge they were determined to meet.

The Transport Isolation System
In 2014, in response to the Ebola outbreak in West Africa, USTRANSCOM officials worked in conjunction with the Defense Threat Reduction Agency (DTRA) and the Department of Health and Human Services (DHS) to develop the Transport Isolation System (TIS). The TIS is a module-system capable of evacuating patients with highly infectious diseases.

The inside of a Transport Isolation System in a hanger at Joint Base Charleston, South Carolina, before it is loaded onto a C-17 Globemaster III. US Air Force photo by SrA Jared Trimarchi, USAF/Released.

Roughly the size of a minivan, the TIS could be loaded aboard a C-17 Globemaster III or C-130 Hercules aircraft. It moved two patients per module, with four modules fitting onboard a C-17. The module isolated the patient, filtered the air that moved through the compartment and allowed access to treat patients with air- or fluid-borne communicable diseases.

While the TIS was built with the intent of transporting Ebola patients, it also had the capability to support evacuations of patients with other infectious diseases such as Severe Acute Respiratory Syndrome (SARS), a viral respiratory disease caused by a coronavirus.

Into Operational Service
On April 10, 2020, Air Mobility Command (AMC) aircrew and medical personnel conducted the first operational use of the TIS since its development during the Ebola outbreak. This also marked the first movement of COVID-19 positive patients aboard US Air Force aircraft.

The mission, REACH 725, consisted of the aeromedical evacuation of three US Government contractors who tested positive for Coronavirus from Afghanistan to Ramstein Air Base (AB), Germany. Upon arrival at Ramstein, the patients were transferred to Landstuhl Regional Medical Center for medical treatment.

Airmen assigned to the 313th Expeditionary Operations Support Squadron transfer a COVID-19 patient following the first-ever operational use of the Negatively Pressurized Conex to transport 12 patients aboard a C-17 Globemaster III aircraft at Ramstein Air Base, Germany, to receive higher level of care at the Landstuhl Regional Medical Center, Germany. US Air Force photo by A1C John R. Wright, USAF/Released.

REACH 725 was comprised of a full TIS force package, which includes one C-17 and aircrew carrying two TIS modules and medical support personnel, consisting of aeromedical evacuation specialists, Critical Care Air Transport Team (CCATT) members, infectious diseases doctors and technicians, and TIS operators.

At the Ready
Upon receipt of a warning order from USTRANSCOM on April 8, the 618th Air Operations Center (AOC) had tasked a TIS-trained AMC aircrew and medical team at Ramstein AB to prepare to execute the mission within 24-hours. Drawn from multiple specialties and units from across the Air Force, these Airmen were pre-staged with a Joint Base Charleston C-17 and TIS at Ramstein’s 86th Airlift Wing in late March in anticipation of Joint Force, allied and partner requirements in Europe, Africa, and the Middle East. From the time of their arrival, the Airmen had trained to increase proficiency on the movement of infectious patients via the TIS.

Hours before the crew stepped to the C-17, Brig Gen Jimmy Canlas, 618th AOC Commander, led a teleconference call in which he provided them with clear guidance in line with the recently released AMC COVID-19 Patient Movement Plan (PMP). The PMP provides aircrew and support personnel a comprehensive and detailed process by which to transport patients aboard pressurized military aircraft, including patients afflicted with highly contagious diseases like COVID-19.

“Through the meticulous effort of AMC’s planners over the past few weeks, in coordination with US Transportation Command, we’ve produced a detailed plan that guides our crews on how to safely and effectively move ill patients to a location where they can receive greater care, all while providing protection for our aircrew, medical personnel, and aircraft,” said Canlas reflecting on the mission. “Within hours of completing and releasing this plan to the force, the crew of REACH 725 validated the hard work of these planners by safely transporting three COVID-19 patients nearly 4,000 miles from Afghanistan to Landstuhl.”

At the start of the pandemic, USTRANSCOM and AMC had been able to foresee the need to transport COVID patients—and in greater numbers than the TIS could accommodate. In anticipation of this need, USTRANSCOM published a JUON statement that spelled out the requirement for high-capacity transport for large numbers of individuals each month who might be infected with COVID-19. So as the TIS commenced aeromedical evacuations, work to develop its successor had already begun.

A NeedPersists
While functional, the TIS has its operational limitations. One of those primary limitations being the relatively low number of patients the TIS could transport at one time.

At the start of the pandemic, USTRANSCOM and AMC had been able to foresee the need to transport COVID patients—and in greater numbers than the TIS could accommodate. In anticipation of this need, USTRANSCOM published a JUON statement that spelled out the requirement for high-capacity transport for large numbers of individuals each month who might be infected with COVID-19. So as the TIS commenced aeromedical evacuations, work to develop its successor had already begun.

In early April, USTRANSCOM, AMC, and Air Force Materiel Command (AFMC) leaders joined forces to invite creative materiel and non-materiel solutions to address the problem. They worked with a team comprised of the Air Force Chemical, Biological, Radiological and Nuclear (CBRN) Defense Systems Branch working with the Joint Program Executive Office for CBRN Defense and partnering with teams across the Air Force and Department of Defense (DOD) under the direction of the Program Executive Office for Agile Combat Support as the JUON lead for the AF.

The NPC offered a significant capacity increase, capable of safely transporting up to 28 passengers, 23 ambulatory patients, or eight litters. It allows for multiple configurations to accommodate combinations of ambulatory and litter patients, as dictated by the situation. The NPC also has notably bigger doors and windows than its predecessors to allow for better visual communication, as well as seats with increased safety factor ratings.

The Solution
The collective team came up with a solution—the “Negatively Pressurized CONEX,” or NPC—a 40-foot metal shipping container outfitted with air-handling and other equipment that can be carried aboard a C-17 transport jet. The system’s onboard equipment ensures negative air pressure on the inside so that the aircrew responsible for transporting it and its patients won’t be put at risk for infection.

A 721st Aircraft Maintenance Squadron Airman marshalls a C-17 Globemaster III aircraft following the first-ever operational use of the Negatively Pressurized Conex. The NPC is the latest isolated containment chamber developed to transport up to 28 individuals with infectious diseases. US Air Force photo by A1C John R. Wright, USAF/Released.

 

The NPC offered a significant capacity increase, capable of safely transporting up to 28 passengers, 23 ambulatory patients, or eight litters. It allows for multiple configurations to accommodate combinations of ambulatory and litter patients, as dictated by the situation. The NPC also has notably bigger doors and windows than its predecessors to allow for better visual communication, as well as seats with increased safety factor ratings.

In addition to the NPC, the team simultaneously developed an “NPC-Lite” (NPCL) model, a custom-built aluminum structure about 12 feet shorter than the NPC. It carries fewer passengers and will fit on the smaller C-130 aircraft. The NPCL is designed to move patients inside a theater of operations, while the NPC will be used to move patients out of theater.

Urgent Need Met with Urgent Action
A huge part of what makes the story of how the NPC came to be so remarkable is the timeframe in which it occurred. The requirement was spelled out on March 28. USTRANSCOM sent the JUON statement to the Joint Staff for validation on the same day that the Joint Rapid Acquisition Cell assigned it for execution to the Air Force. The Air Force assigned the Program Executive Office for Agile Combat Support as its lead for the effort. Having acquisition working with the Joint Staff and USTRANSCOM in parallel, rather than sequentially, was key to expediting the process.

By April 7, a contract was awarded using the Other Transaction Authority (OTA) process. The first proof of concept NPC was constructed in only 13-days and delivered to Joint Base Charleston, South Carolina, on April 20 for validation testing. That testing concluded April 30, at which point Air Mobility Command green-lit the NPC as the system to meet its requirements under the JUON.

On June 30, the NPC flew its first operational mission out of Ramstein Air Base, Germany—just 95 days after USTRANSCOM published that JUON statement spelling out the requirement for the high-capacity transport for large numbers of individuals each month who might be infected with COVID-19. Under normal circumstances, this process could have taken more than a year to complete.

Working effectively together and in parallel across departments and agencies enabled the success of these efforts. The use of the patient movement systems has resulted in the successful and safe transport of nearly 300 COVID-positive patients. As the challenges associated with the pandemic continue to evolve, USTRANSCOM remains ready to meet those challenges.

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