Ebola Medevac Flight From Africa To The U.S.

ua900 · Fri Aug 01, 2014 5:00 am

According to CNN, 2 Americans with Ebola are supposed to be flown from Africa to the U.S. and based on the article, it seems that the plane used is civilian, N173PA, a Gulfstream III.

What are the protocols for civilian planes carrying such patients to areas that are hitherto clear of a virus like Ebola and who authorizes and carries out such flights? I assume that the pilots are insulated somehow and these flights carry a special medical crew in lieu of flight attendants.

For permits, I assume a federal agency like the CDC and the government of the country from where they are extracted at the very least, but what about flyover countries like Canada or in the case of the U.S., does the affected state where the plane lands (e.g. State of GA) get any say?

www.cnn.com/2014/07/31/health/ebola-outbreak/

malaysia · Fri Aug 01, 2014 8:33 am

This is crazy, it could destroy ATL and DL if the disease spreads in ATL thanks to this medevac.

I sure hope this plane is 100% secure

blueflyer · Fri Aug 01, 2014 9:38 am

The plane will be fitted with an Aeromedical Biological Containment System, a fancy tent used to isolate the patient from the rest of the aircraft. The tent is compliant with BSL-4, the highest level of biosafety containment. It was designed by the CDC and the Department of Defense specifically for the two air ambulance Gulfstream III aircraft owned by Phoenix Air (N163PA and N173PA). They are the only GIIIs in the world equipped with a forward cargo door large enough for a stretcher. CNN has a few pictures.
http://www.cnn.com/2014/07/31/health...ion-treatment/index.html?hpt=hp_t2

Emory was probably chosen not only because of its proximity to the CDC, but also because it offers a training course in BSL-4, so they must know a thing or two about keeping the patient in isolation and ensuring the safety of the medical staff.

That said, Ebola is more often than not deadly but is not airborne. It is transmitted through direct contact with the bodily fluids of an infected individual and inappropriate handling of contaminated medical equipment (especially syringes).

The risk of an Ebola epidemic in the US is fairly low. The mode of transmission doesn't facilitate contamination, and the virus kills most of its victims, and kills them quickly, so with proper quarantine, risks of infections are limited.

To date, all Ebola epidemics have been in places lacking the resources, equipment and training to ensure appropriate handling and containment of Ebola patients.

bchandl · Fri Aug 01, 2014 12:21 pm

Quoting blueflyer (Reply 2):
The risk of an Ebola epidemic in the US is fairly low. The mode of transmission doesn't facilitate contamination, and the virus kills most of its victims, and kills them quickly, so with proper quarantine, risks of infections are limited.

None of this is really true.

The death rates in Africa have been around 60-70%. In a western country I would imagine you're looking at a 50% death rate.

Also, not really a quick killer. Infection to death is often well over a week. Infact, infection to symptoms can be over a week.

The saving grace with ebola is the transmission method. It cannot travel airborne, you have to come into contact with an infected persons fluids.

bchandl

dtw2hyd · Fri Aug 01, 2014 1:05 pm

Ebola is not airborne disease. As long as no one exchanges bodily fluids, it is safe to handle patients. I don't see any medical issue during normal ops (or) even in case of unforeseen incident.

Quoting ua900 (Thread starter):
(e.g. State of GA) get any say?

You know that CDC processes lot more unpleasant things than Ebola.

ROSWELL41 · Fri Aug 01, 2014 4:22 pm

How did these Western trained medical professionals get infected in the first place? Did they make mistakes regarding protocol or could the disease be spreading in a way not completely understood? I get how it is spreading amongst the general populace, but the 'only from exposure to bodily fluids' leaves me scratching my head as to how the guys wearing the full body suits contracted it.

adamh8297 · Fri Aug 01, 2014 5:01 pm

Quoting ROSWELL41 (Reply 6):
How did these Western trained medical professionals get infected in the first place? Did they make mistakes regarding protocol or could the disease be spreading in a way not completely understood? I get how it is spreading amongst the general populace, but the 'only from exposure to bodily fluids' leaves me scratching my head as to how the guys wearing the full body suits contracted it.

An infected colleague was in the same shower area from what I've read. This colleague was infected somewhere else.

Quoting blueflyer (Reply 2):
Emory was probably chosen not only because of its proximity to the CDC, but also because it offers a training course in BSL-4, so they must know a thing or two about keeping the patient in isolation and ensuring the safety of the medical staff.

Emory Hospital is on the same street about a mile away. I'm sure they have had plans with CDC for ages concerning handling a patient potentially exposed to an agent in BSL-3 or BSL-4 lab.

Parts of the training course at Emory are taught by a former CDC safety manager and other staff

deltadude · Fri Aug 01, 2014 5:22 pm

Quoting blueflyer (Reply 2):
The risk of an Ebola epidemic in the US is fairly low.

Quoting bchandl (Reply 3):
None of this is really true.

This really IS true. It spreads in Africa because the countries are underdeveloped. Some of the population do not trust their governments and public health officials. They are often uneducated and ignorant of the true causes of Ebola how it spreads. There are people there that think the doctors are killing patients when in fact it's the disease. This is causing them to hide patients from the health officials only causing it to spread more. In a developed country like the United States infected patients can be easily identified, quarantined, and treated.

Quoting adamh8297 (Reply 7):
Emory Hospital is on the same street about a mile away. I'm sure they have had plans with CDC for ages concerning handling a patient potentially exposed to an agent in BSL-3 or BSL-4 lab.

Not even a mile. Emory sold the land that the CDC was built on to the government for $10 in 1947. It's the best place for these patients to be.

A333MSPtoAMS · Fri Aug 01, 2014 5:26 pm

Quoting bchandl (Reply 3):
It cannot travel airborne

Quoting dtw2hyd (Reply 4):
Ebola is not airborne disease.

Yes, this is the "current" known method of transmission. All viruses and bacteria have the potential to mutate and thus the mode of transmission can change.

Additionally, sneezing on someone could transmit the Ebola virus to another person as the potential for the ebola virus to live within the mucus of the upper respiratory tract.

deltadude · Fri Aug 01, 2014 5:27 pm

By the way...to stay on topic, does anyone know the plane registration? I know it's a charter out from a company in Georgia.

blueflyer · Fri Aug 01, 2014 5:44 pm

N173PA operating as Gray Bird 333 (PHA333)

deltadude · Fri Aug 01, 2014 5:57 pm

I found this about the jet, interesting.

http://foxtrotalpha.jalopnik.com/thi...tims-from-afri-1614420685/+barrett

clickhappy · Fri Aug 01, 2014 6:05 pm

This sounds a lot like the plot to Executive Orders by Tom Clancy.

kiffy · Fri Aug 01, 2014 7:31 pm

Quoting deltadude (Reply 12):
I found this about the jet, interesting.

http://foxtrotalpha.jalopnik.com/thi...tims-from-afri-1614420685/+barrett

As that article briefly mentions the flight initially took off early in the morning but then diverted back.

Flightaware has N173PA departing yesterday morning at 2:30am and diverting back to VPC over the Delaware Bay. Then at 5:08pm PHA333 departs to Lajes.

I wounder why it diverted...

Rdh3e · Fri Aug 01, 2014 7:33 pm

Quoting A333MSPtoAMS (Reply 9):
Additionally, sneezing on someone could transmit the Ebola virus to another person as the potential for the ebola virus to live within the mucus of the upper respiratory tract.

Not according to the doctor interviewed by CNN in the article posted up-thread:

"Ebola is not airborne, he said. It cannot be transmitted via coughs or sneezes. If an infected person is exhibiting symptoms, he or she can transmit the disease via bodily fluids such as blood, breast milk or semen. The virus does not die with a patient -- so deceased bodies can transmit the disease."

His listed credentials are: Dr. Eric Legome, chief of emergency medicine at Kings County Hospital in New York

777STL · Fri Aug 01, 2014 7:48 pm

Quoting blueflyer (Reply 2):
Emory was probably chosen not only because of its proximity to the CDC, but also because it offers a training course in BSL-4, so they must know a thing or two about keeping the patient in isolation and ensuring the safety of the medical staff.

From what I heard this morning, Emory is one of only two facilities in the US with the training and the facilities to handle a case(s) like this.

deltadude · Fri Aug 01, 2014 8:10 pm

Quoting RDH3E (Reply 15):
deceased bodies can transmit the disease

That right there is why it's spreading in some case because of burial rituals.

peterinlisbon · Fri Aug 01, 2014 8:35 pm

Whatever they say, I wouldn't want to hire this private jet next week or go anywhere near it or the people flying on it. It seems crazy to knowingly bring the Ebola virus into the USA.

turn720 · Fri Aug 01, 2014 9:00 pm

I think bringing them here is a good thing. This will give the CDC scientist an opportunity to take a look at this disease at an up close and personal perspective. The patient is a doctor so he can communicate to the scientist in a language that only doctors can understand which should be good during those questions an answer sessions. Besides, we have all those expensive equipment that goes "binggg", we should put it to good use.

DiamondFlyer · Fri Aug 01, 2014 9:11 pm

Quoting peterinlisbon (Reply 18):
Whatever they say, I wouldn't want to hire this private jet next week or go anywhere near it or the people flying on it. It seems crazy to knowingly bring the Ebola virus into the USA.

The good news is, you probably can't. Its a Phoenix Air plane, basically operated for the DoD on contract, and other government agencies as needed.

-DiamondFlyer

bchandl · Fri Aug 01, 2014 9:27 pm

Quoting malaysia (Reply 1):
This is crazy, it could destroy ATL and DL if the disease spreads in ATL thanks to this medevac.

I sure hope this plane is 100% secure

It is. Do some research on it. N173PA. There are plenty of articles on it

Quoting A333MSPtoAMS (Reply 9):
Additionally, sneezing on someone could transmit the Ebola virus to another person as the potential for the ebola virus to live within the mucus of the upper respiratory tract.

Great, getting sneezed on is not an airborne transmission. That is the spraying of fluids.

An ebola patent could spit on you too, does that mean it spreads through the air? No.

Let;s not forget anyone interacting with them will have hazmat-esque gear on, which will likely be burned after use.

bchandl

32andBelow · Fri Aug 01, 2014 11:45 pm

Just for discussion sake, what is the security if the airplane winds up in a lower impact crash. I imagine a high impact crash the virus would be killed. But in a lower impact/emergency runway/overrun scenario where the hull is breached and the passengers may be heavily bloodied. I understand this is unlikely but just curious if there are considerations.

wjcandee · Sat Aug 02, 2014 1:25 am

Quoting 777stl (Reply 16):
Emory is one of only two facilities in the US with the training and the facilities to handle a case(s) like this

There are four, but that plus the proximity to CDC is likely the combo that wins them the gold star.

jpdflymhtmlb · Sat Aug 02, 2014 2:54 am

Return flight to the states, stopping in BGR first

http://flightaware.com/live/flight/PHA304

INFINITI329 · Sat Aug 02, 2014 3:38 am

Quoting ua900 (Thread starter):
does the affected state where the plane lands (e.g. State of GA) get any say?

No not really.. 1...it is considered a DOD flight 2.. states don't control airspace (so they can complain all they want) 3.. the flight is going to an air force base

PEK777 · Sat Aug 02, 2014 3:49 am

Quoting RDH3E (Reply 15):
Ebola is not airborne, he said

Well, in this case it kind of is airborne. See, the disease is on a plane, which is airborne.....
that was a joke.....

sldispatcher · Sat Aug 02, 2014 4:13 am

Quoting RDH3E (Reply 15):
"Ebola is not airborne, he said. It cannot be transmitted via coughs or sneezes. If an infected person is exhibiting symptoms, he or she can transmit the disease via bodily fluids such as blood, breast milk or semen.

Sorry, as a medical professional I'm not buying it.
If these were the only transmission routes, then all of the biohazard suits would have been overkill. The MD's working on the patients should not have contracted the virus so easily.

At any rate, the plane and the occupants I hope will land safely and this story will have a happy ending that most citizens will not hear about.

SonomaFlyer · Sat Aug 02, 2014 4:16 am

Try not to panic folks. Ebola is not about to mutate to some airborne pathogen like influenza for pity's sake. American hospitals are in a much better position to support the patient via clotting factors and fluid support as well as studying the virus in the most controlled conditions.

On top of that, these are American citizens who went there to help alleviate the incredible suffering taking place currently in West Africa. They certainly knew the risks but its right that we should bring them home and do all we can to both treat the illness and study ways to combat it in a premier teaching hospital.

sldispatcher · Sat Aug 02, 2014 5:03 am

Quoting SonomaFlyer (Reply 33):
They certainly knew the risks but its right that we should bring them home and do all we can to both treat the illness and study ways to combat it in a premier teaching hospital.

I agree with that sentiment.
And air travel was the only real way to get them here. Risks, albeit very little, and all.

Besides, I would be shocked if these were truly the first ebola cases to make it to the USA.

newhaven · Sat Aug 02, 2014 5:42 am

My god im glad I read it further .. that its only 2 Americans being flown here with Ebola .. I had visions of C130s teeming with infected Africans on their way here now ... just what we need.

Pellegrine · Sat Aug 02, 2014 6:36 am

Quoting ROSWELL41 (Reply 6):
How did these Western trained medical professionals get infected in the first place? Did they make mistakes regarding protocol or could the disease be spreading in a way not completely understood? I get how it is spreading amongst the general populace, but the 'only from exposure to bodily fluids' leaves me scratching my head as to how the guys wearing the full body suits contracted it.

Both of the infected personnel came from Samaritan's Purse Ebola Treatment Center in Foya, Lofa, Liberia. From MSF, "MSF has set up an Ebola treatment center in Foya, in Lofa county in northern Liberia, where cases have been increasing since the end of May. After the initial set up, MSF handed over the management of the center to nongovernmental organization Samaritan’s Purse on July 8."

It seems Samaritan's Purse was ill equipped to deal with ebola, training and equipment-wise.

washingtonflyer · Sat Aug 02, 2014 11:59 am

I recognized that the virus is not an airborne pathogen like SARS, but I have significant concern regarding transmission in an airplane. For example, a person exhibiting early symptoms of ebola might have a fever - leading to sweats.

During the course of the flight, he uses the bathroom once or twice. His sweaty bum has now been on that toilet seat, his sweaty fingers now having touched the door knob, the flush button and the sink handle.

Perhaps his symptoms are a bit more advanced and he threw up in the bathroom.

He uses his seat tray and is sweating slightly through his shirt. His seat and his seat tray is now contaminated.

See the risk exposure?

goboeing · Sat Aug 02, 2014 4:05 pm

Quoting washingtonflyer (Reply 36):
I recognized that the virus is not an airborne pathogen like SARS, but I have significant concern regarding transmission in an airplane. For example, a person exhibiting early symptoms of ebola might have a fever - leading to sweats.

During the course of the flight, he uses the bathroom once or twice. His sweaty bum has now been on that toilet seat, his sweaty fingers now having touched the door knob, the flush button and the sink handle.

Perhaps his symptoms are a bit more advanced and he threw up in the bathroom.

He uses his seat tray and is sweating slightly through his shirt. His seat and his seat tray is now contaminated.

See the risk exposure?

Everything you have typed relates to normal operations.

A passenger simply getting up and going to the lav.

The man is going to be in a TENT inside the plane! This is not normal ops!

I doubt he will be permitted to leave the tent (if he is even physically able to do so) -- the lav will be off limits I would imagine. Or at least, the lav that the rest of them are using. He probably has a bedpan or something in there.

washingtonflyer · Sat Aug 02, 2014 7:09 pm

Quoting goboeing (Reply 37):
Everything you have typed relates to normal operations.

A passenger simply getting up and going to the lav.

The man is going to be in a TENT inside the plane! This is not normal ops!

I was commenting more on the general likelihood of transmission in an airplane - not in a hermetically sealed air ambulance.

CV880 · Sat Aug 02, 2014 7:19 pm

Quoting Pellegrine (Reply 35):
It seems Samaritan's Purse was ill equipped to deal with ebola, training and equipment-wise.

A bit more about Samaritan's Purse in the link. Chaired by Franklin Graham (son of Evangelist Billy Graham)

http://www.samaritanspurse.org/

777STL · Sat Aug 02, 2014 7:53 pm

Quoting jpdflymhtmlb (Reply 28):
Return flight to the states, stopping in BGR first

http://flightaware.com/live/flight/PHA304

That looks like a flight from Gander to Stuttgart?

bchandl · Sat Aug 02, 2014 8:06 pm

Quoting jpdflymhtmlb (Reply 28):

* That's not the right link. No history of that flight number in the FA system in 5 years.

* Wrong tail number. The plane in question is N173PA, you have the incomplete history for N186PA.

FlightAware does not show either the outbound or inbound flight of N173PA.

http://flightaware.com/live/flight/N173PA

However, the plane landed and patient is already at Emory.

fr24 doesn't show much more, either http://www.flightradar24.com/reg/n173pa

bchandl

trex8 · Sat Aug 02, 2014 9:43 pm

Quoting sldispatcher (Reply 31):

If these were the only transmission routes, then all of the biohazard suits would have been overkill. The MD's working on the patients should not have contracted the virus so easily.

You are assuming first world supplies of the necessary protective equipment and facilities having adequate cooling and plumbing. I have been on missionary trips with my relatives who are doctors to many 3rd world places. What would be disposable gowns , gloves, suits in the west may be reused in the 3rd world. These places often have no air conditioning. Imagine trying to work in 100 deg heat AND wearing all the protective stuff you are supposed to. Good technique goes out the window quickly. Don't expect the faucets to have running water all day either . This stuff is not likely to happen in Atlanta.

Quoting bchandl (Reply 3):
The death rates in Africa have been around 60-70%. In a western country I would imagine you're looking at a 50% death rate.

It should be a lot lower. You aren't going to have fancy long central iv lines which last, $1000 per mg coagulation factors you can give and state if the art intensive care and ventilators, dialysis facilities etc etc in these places where they are treating the Ebola patients in west Africa. You will have them at an even half decent community hospital in the US.

Pyrex · Sat Aug 02, 2014 11:11 pm

Quoting bchandl (Reply 3):
Also, not really a quick killer. Infection to death is often well over a week. Infact, infection to symptoms can be over a week.

How is that not quick? Most other viruses don't kill their hosts (thus reducing the probability of spreading themselves...) that quick.

Quoting kiffy (Reply 14):
Then at 5:08pm PHA333 departs to Lajes.

Damn... why did the Portuguese government let it land there?

lightsaber · Sun Aug 03, 2014 3:23 am

First, is there more information on the flight. E.g, the tent inside the plane?
As interesting as the side discussions are, I'd like to know more about the aviation side.

e.g.,
Did he fly in a Hazmat suit like the one he walked into the hospital?
How was he attended to in the plane? e.g., 'hydro therapy' (lots of water) is required to give an individual infected with Ebola a chance of surviving.

Ebola is scary. But let's keep it in perspective.

The issue is touching a sick person. Salivia is a possible (but not proven) transmission method (e.g., kissing or the saliva of bats partially eating fruit and then a human or primate eats the remainder of the fruit).

Quoting deltadude (Reply 17):
That right there is why it's spreading in some case because of burial rituals.

And traditional ways of caring for the sick.

Quoting bchandl (Reply 54):
It can take 3-21 days to present itself after contamination. Before the symptoms are present, the virus is not strong enough to actually contaminate others.

Agreed. With the possible exception of semen. And one difficulty is that male survivors can transmit the disease in their semen for months after recovering. (There is some disagreement on the time, between 7 and 12 weeks after recovery.) It takes only one vector to restart an outbreak. (e.g., a surviving male infecting a prostitute who then infects a variety of 'clients.') Ebola is the ultimate STD...

Lightsaber

FCAFLYBOY · Sun Aug 03, 2014 7:45 am

Emirates have now suspended flights to Conakry in Guinea, start of things to come for the likes of AF/IB/TP/BA etc who all fly to the region of Sierra Leone, Liberia and Guinea?

cf6ppe · Tue Aug 05, 2014 3:59 am

Moderators:

Can any of you - collectively one and/or all - fix this thread so that it can continue as a factual thread without the name calling and political bios.

I find the discussion of the Medevac Flight details and obstacles to be fascinating and quite interesting. Also the challenges in pulling off these critical Medevac flight(s) can possibly make A.net members more informed on this delicate subject.

I know that I am probably treading on thin ice covering boiling water to suggest that the moderators make any adjustments.

I also know that I will probably get a moderator to me message telling me to mind my own business, but so be it.

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