![Page 1: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/1.jpg)
Transport of EVD patients Medical evacuation (MEDEVAC)
Dr. Thomas Kratz
Robert Koch Institute, 15-02-25
ECDC Training Course – Ebola and Marburg Diagnostic
24th February to 27th February 2015
Robert Koch Institute, Berlin
![Page 2: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/2.jpg)
Reasons for medical evacuation
• Suspected Ebolavirus Disease
(e.g. Symptoms + Contact)
• Confirmed Ebolavirus Disease
(by PCR)
• High Risk Exposure
(e.g. needlestick injury, splash of body liquids into mucous membranes)
![Page 3: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/3.jpg)
MEDEVAC of EVD Patients
Field location
MEDEVAC Aircraft
International Airport GUI/SLE/LIB
Ambulance System
BSL4-Ward
European International Airport
![Page 4: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/4.jpg)
![Page 5: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/5.jpg)
![Page 6: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/6.jpg)
MEDEVAC of EVD Patients
Field location
MEDEVAC Aircraft
International Airport GUI/SLE/LIB
Ambulance System
BSL4-Ward
European International Airport
… possible constraints
![Page 7: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/7.jpg)
MEDEVAC of EVD Patients
Field location
MEDEVAC Aircraft
International Airport GUI/SLE/LIB
Ambulance System
BSL4-Ward
European International Airport
… possible constraints
Lack of … - physical accessibility (unpaved roads, rainy season) - Access to healthcare - communication means (no cell phone connection etc.)
![Page 8: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/8.jpg)
MEDEVAC of EVD Patients
Field location
MEDEVAC Aircraft
International Airport GUI/SLE/LIB
Ambulance System
BSL4-Ward
European International Airport
- Physical accessibility - Groundhandling
… possible constraints
![Page 9: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/9.jpg)
MEDEVAC of EVD Patients
Field location
MEDEVAC Aircraft
International Airport GUI/SLE/LIB
Ambulance System
BSL4-Ward
European International Airport
… possible constraints
Must be available Must be accessible (physically, financially …)
![Page 10: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/10.jpg)
MEDEVAC of EVD Patients
Field location
MEDEVAC Aircraft
International Airport GUI/SLE/LIB
Ambulance System
BSL4-Ward
European International Airport
… possible constraints
Groundhandling
![Page 11: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/11.jpg)
MEDEVAC of EVD Patients
Field location
MEDEVAC Aircraft
International Airport GUI/SLE/LIB
Ambulance System
BSL4-Ward
European International Airport
… possible constraints
Must be available Must be equipped (Barrier Nursing!)
![Page 12: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/12.jpg)
MEDEVAC – actors in the event of evacuation of a German citizen
• GO / NGO
• Federal Foreign Office
• Robert Koch Institute
• Health Authority (local, federal, state)
• Health Insurance
• MEDEVAC facilitator (e.g. German Red Cross Assistance)
• BSL-4 equipped ward (STAKOB)
![Page 13: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/13.jpg)
STAKOB Competence – and Treatment Centres
MEDEVAC – Airbus „Robert Koch
![Page 14: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/14.jpg)
Public Health Preparedness in Germany
Dr. Iris Hunger
Robert Koch Institute, 15-02-25
ECDC Training Course – Ebola and Marburg Diagnostic
24th February to 27th February 2015
Robert Koch Institute, Berlin
![Page 15: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/15.jpg)
Recognition of EVD cases
What is a “probable EVD case”?
Anamnestic interview:
Clinical picture?
Travel history?
Exposure history?
Differential diagnosis: Malaria tropica
![Page 16: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/16.jpg)
Measures in case of probable or confirmed EVD case outside of special isolation units
PPE
Isolation
Primary care
Patient transport Disinfection Waste, waste water
Laboratory diagnostics
Contact tracing
![Page 17: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/17.jpg)
Measures in case of probable or confirmed EVD case outside
of special isolation units
PPE
![Page 18: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/18.jpg)
Isolation
Measures in case of probable or confirmed EVD case outside of special
isolation units
The following minimum standards are mandatory (“barrier nursing“): • The patient room has vestibule or another designated
entry area separating clean from unclean areas. • Realization of: - appropriate means for disinfection, - possibilities to safely don and doff PPE, and - options for safe collection and subsequent disposal of
used PPE. • Point of care diagnostics (small diagnostic series) for
infectious samples should be available within the isolation unit.
• Appropriate waste management procedures (waste key 180103*) needs to be in place.
![Page 19: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/19.jpg)
Patient transport
Measures in case of probable or confirmed EVD case outside of special isolation units
![Page 20: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/20.jpg)
Waste, waste water
Measures in case of probable or confirmed EVD case outside of special isolation units
• On-site inactivation of waste is the preferred option. • Packaging for shipment of waste to special waste
incineration plants: - Primary receptacle: plastic drum with removable head,
internal volume up to 60 liters available for this purpose, opening diameter approx. 400 mm , leak-proof, lid preferably with adhesive seal, single-use closure (not to reopen).
- Secondary packaging: PE bag with a material thickness of preferably 100 μm, but at least 75 μm.
- Outer packaging: plastic drum with removable head and clamping ring closure, external dimensions approx. 500 mm diameter, 800 mm height.
![Page 21: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/21.jpg)
Measures in case of probable or confirmed EVD case outside of special isolation units
![Page 22: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/22.jpg)
Thank you for your attention ;) !
Questions ? Dr. Thomas Kratz, MD Dr. Iris Hunger Federal Information Centre for Biological Threats and Special Pathogens Robert Koch Institute Nordufer 20 13353 Berlin E-Mail: [email protected], [email protected] The Robert Koch Institute is a Federal institute within the portfolio of the Federal Ministry of Health.
![Page 23: Transport of EVD patients Medical evacuation (MEDEVAC) · · 2015-06-24Transport of EVD patients Medical evacuation (MEDEVAC) Dr. Thomas Kratz Robert Koch Institute, ... (Barrier](https://reader031.vdocuments.mx/reader031/viewer/2022021821/5af6f42b7f8b9a4d4d911ea2/html5/thumbnails/23.jpg)