Doctors document IAF’s first Covid-19 air evacuation, suggest modifications in equipment and procedures

Vijay Mohan
Tribune News Service
Chandigarh, September 10

Documenting the first ever air evacuation of a Covid-19 patient by the IAF, doctors have highlighted the unique challenges faced in carrying out the task and suggested certain modifications in the existing equipment and procedures.

A 54-year-old male healthcare worker diagnosed with Covid-19 was required to be transported from Air Force Hospital, Jorhat, in the northeast to a tertiary care hospital in New Delhi after his condition deteriorated sharply, which involved a flying time of around four hours.

Though air evacuation of patients is a routine activity in the Indian Air Force (IAF), evacuation of a patient seriously infected with Covid-19 created a unique and unprecedented situation as the patient was required to be isolated due to the highly contagious nature of the disease and had the potential of infecting the medical team as well as aircrew.

Further, the experience and available literature on evacuating such a case was almost minimal and the guidelines and triage had not been laid down.

Stringent measures were required to be ensured during pre-flight, in-flight as well as post-flight phase to prevent any possibility of deterioration of patient condition.

The selection of an aircraft was also important as distance to be covered by a patient on life support system required high cruising speed, well pressurized and inbuilt power pack up system for medical equipment. A C-130 Super Hercules four-engine turbo-prop was chosen for the mission.

The patient was placed in an airborne rescue pod for isolated transportation (ARPIT), put on non-invasive ventilator (NIV) and all vital parameters were continuously monitored. The patient was donned with a PPE kit and advised to communicate through hand gestures with the team.

During the flight all measures were ensured to maintain the SpO2 level and other medical parameters within satisfactory levels by the critical care air ambulance team. The NIV battery got discharged after two hours and it connected to the direct power supply of the aircraft.

The patient remained stable during the flight, but certain limitations were experienced with the ARPIT, according to the paper published in the latest issue of Indian Journal of Aerospace Medicine by four doctors posted at the Air Force Hospital, Jorhat.

Being enclosed in the isolation pod gives a claustrophobic feeling and there is minimal scope for active intervention by the medical staff. Patients are required to lie down inside the pop, thus complicating the oxygen perfusion. Space constraint also does not permit any change of position or movement by the patient, which is desirable as part of thromboprophylaxis measures.

The authors also pointed out that there was difficulty in placing even simple monitoring equipment such as pulse oximetre and ECG through the isolation pod and it would have been very difficult to remove the pod’s canopy to manage the patient in case of any in-flight emergency.

Changes in the ARPIT’s dimensions and shape to allow a patient to be positioned in a semi-reclining position, appropriately sized and placed ports to introduce monitoring devices and back up batteries for equipment are among suggestions put forth by the authors.