Ebola Biocontainment at 30,000 Feet

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

Shortly after 2 Americans contracted Ebola after helping to care for patients with the disease in West Africa, the organization that had sent them began looking for a way to have them treated. They reached out to several European countries and African nations, but no one would take them into care. They turned to the US government to see whether they could help.

“Nobody had a solution, except for one guy: Dr William Walters, who ran [the Department of] Operational Medicine, and he knew Dent [Thompson of Phoenix Air], and so he reached out to him and said, ‘Hey, I know you have this biocontainment system. Do you think it'll work for Ebola?’ Dent did not know if it would work for Ebola, but he said, ‘Why don't we all sit down and talk about it?’ And so the government flew down all of its experts, and they went through everything. They looked at the tent; they interviewed the doctors and the nurses who would be involved in treatment. They looked at the specs, and they signed off and said, ‘Hey, look, if you guys are willing.’ And William Walters is colorful, and he said, ‘You guys are going to be the ones in the cylindrical tube of death, so you tell us. Are you willing to do this?’” said Kevin Hazzard, who detailed the mission in his book, No One’s Coming.

After the Phoenix Air pilots and medical personnel signed off on the decision to do the flights, the next step was finding a way to keep everyone on the plane protected from contracting the disease. They would need to wear personal protective equipment (PPE), which requires a process called donning (putting on) and doffing (taking off) PPE, and use Phoenix Air’s specifically designed biocontainment tent.

Reversing the Plane’s Airflow

One of the novel aspects of the biocontainment tent is the need to prevent airborne particles from escaping.

“It's a small tent that fits inside of a private aircraft, and it's got a filter on the front and the back so that air flowing through is filtered on the way in and then air flowing out is filtered on the way out, so nothing that's inside that hasn't been filtered can get out,” explains Hazzard.

“In order for this negative pressure tent that they have to work, they had to reverse the airflow inside of the aircraft. Normally, air comes in from the back and it makes its way to the front. 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. 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?”

Another challenge was the PPE, including the process of doffing it, and working in confined spaces on the plane for a long, transatlantic flight.

“When they're getting out of the tent, they've got to very carefully remove all of these things, and you have to do it in a very specific sequence so that you don't touch anything that has been contaminated but also so that the areas you leave in a graduated way, so that the areas that you're walking out into do not become contaminated. And ultimately, you've got to be able to walk out of the tent and back into the plane and stand next to other unprotected people, and everybody has to be certain that you haven't contaminated yourself. So it's a very intricate process, and it takes about 30 minutes, which is an exhausting thing—and the aircraft is very hot.”

In the next episode, Hazzard discusses the lead-up to the flights, including the travel logistics and the trips from Africa to the US.