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

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)

MEDEVAC of EVD Patients

Field location

MEDEVAC Aircraft

International Airport GUI/SLE/LIB

Ambulance System

BSL4-Ward

European International Airport

MEDEVAC of EVD Patients

Field location

MEDEVAC Aircraft

International Airport GUI/SLE/LIB

Ambulance System

BSL4-Ward

European International Airport

… possible constraints

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.)

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

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 …)

MEDEVAC of EVD Patients

Field location

MEDEVAC Aircraft

International Airport GUI/SLE/LIB

Ambulance System

BSL4-Ward

European International Airport

… possible constraints

Groundhandling

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!)

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)

STAKOB Competence – and Treatment Centres

MEDEVAC – Airbus „Robert Koch

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

Recognition of EVD cases

What is a “probable EVD case”?

Anamnestic interview:

Clinical picture?

Travel history?

Exposure history?

Differential diagnosis: Malaria tropica

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

Measures in case of probable or confirmed EVD case outside

of special isolation units

PPE

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.

Patient transport

Measures in case of probable or confirmed EVD case outside of special isolation units

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.

Measures in case of probable or confirmed EVD case outside of special isolation units

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: KratzT@rki.de, HungerI@rki.de The Robert Koch Institute is a Federal institute within the portfolio of the Federal Ministry of Health.