Addressing Logistics, Flight Challenges

This is part of a short series discussing the mission to transport American patients with Ebola from Africa to the US to receive treatment.

Logistics and the plan’s flexibility played large roles in the mission to fly to Liberia in West Africa to transport 2 Americans with Ebola back to the US for treatment.

Initially, the plan was to see whether a European or African country would take them in. However, no country would do so, so it fell to the US to go in and bring them back home. Another aspect was that they would have to bring each one of the patients back separately due to limited spacing on the plane and the biocontainment tent.

After Phoenix Air and medical staff said they would fly the mission and the biocontainment tent was set up, they decided to do a test run.

When they took off during the initial test flight, they had trouble attaining pressurization in the airplane cabin. There was something wrong with the reverse airflow system.

“In order for this negative pressure tent that they have to work, they had to reverse the airflow inside of the aircraft,” said Kevin Hazzard, who detailed the mission in his book, No One’s Coming.

Airflow typically goes from the back of the plane to the front, but this was not ideal.

“Problem is, all of the air coming through the plane then comes up underneath the pilot's seat. Ebola is not known to be an airborne virus. But one, does anybody really want to sit in air that has Ebola particulate billowing up from beneath their seat? The answer is no,” said Hazzard. “And two, because the virus was transmitting so rapidly into 3 countries where it had spread, there was a question among doctors treating it that, had this virus evolved? Is there a possibility that it's not just a contact virus anymore?

“So they actually have to turn around midflight and go back and have the maintenance department look at the system and fix it. All this while there are 2 people dying in Africa. And so, from a logistical standpoint, from a flight standpoint, it's incredibly nerve-racking.”

After they had it resolved, they took off for Liberia, but they had other issues, including landing and pumping gas, as the country had completely destabilized.

Additionally, there was still no final landing spot back in the US. Options for the landing airport included the state of Maine, a military base outside of Atlanta, or a private airport north of Atlanta, but fears began to shut down these airports. Finally, a customs official allowed them to land in Bangor, Maine. However, after they landed there, they still had to fly to Atlanta to transport the patient to Emory University Hospital for treatment. After takeoff, they were not given permission to land anywhere in Georgia until a State Department official stepped in and helped resolve the landing issue.

“William Walters, who ran the Department of Operational Medicine, had to call the military base and essentially beg, borrow, steal, and threaten to get them to allow them to land this plane at Dobbins Air Force Base,” Hazzard said.

With the first mission complete, the personnel involved had to do it all over again for the second patient. Fortunately, they were able to do so, and both Americans were taken to Emory. There they were treated, recovered, and were able to go home to their families again, thanks in great part to everyone involved in the mission.

In the final episode, Hazzard discusses the significance of rising to the challenges in dealing with these life-or-death missions and helping Americans come home.