Phoenix Air details Ebola flight operations in 'flying ICU'
by Jason Lowrey
Aug 08, 2014 | 4695 views | 0 0 comments | 27 27 recommendations | email to a friend | print
Phoenix Air Press Conference
Dent Thompson, vice president and COO of Phoenix Air Group, answers questions from the news media at a press conference in one of the company’s hangars at the Cartersville Airport. Behind Thompson is the Gulfstream jet that delivered two American Ebola patients to Dobbins Air Reserve Base who were then transported to Emory Hospital in Atlanta. SKIP BUTLER/The Daily Tribune News
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It started with a phone call.

When Phoenix Air Group Inc. Vice President Dent Thompson was on vacation, he received a phone call from someone he described as a highly placed doctor with the U.S. Department of State. The question posed to Thompson that day was simple: if needed, can you transport a patient infected with Ebola to the United States?

Thompson said it was a question he had expected for about five years, though Ebola was not the disease he thought would be involved.

Approximately five years ago, Thompson said during a called press conference at one of Phoenix Air’s hangars at the Cartersville Airport Thursday afternoon, the company worked with the U.S. Department of Defense and Centers for Disease Control to build a containment unit that could transport infected personnel from anywhere in the world to the United States for treatment. This, he explained, came from concerns about H1N1, SARS and other diseases that were cropping up at the time.

“We — it’s a funny world. We spent two years developing this. I knew that one day it would be called into service,” Thompson said after the press conference. “I hoped it would be a lesser disease. I hoped our first time out the gate was going to be the flu, TB, something that’s contagious but treatable. I really hoped that. When they said Ebola, I went, ‘This is like going from the high school basketball team to the NBA.’

“But that’s it. It’s like the guys going in the shuttle to the moon. They practice and everything, but no one had ever done it. And it worked exactly as advertised.”

The press conference drew multiple media outlets, with print, radio, Atlanta news crews and national networks such as CNN in attendance. Thompson and personnel from Phoenix Air’s two flight crews who made the trips to Liberia stood in front of the containment chamber — called an Aeromedical Biological Containment System — as they were peppered with questions. The ABCS on display, however, was not one used in any of the flights. It was a prototype now used for training.

The pair of flights, Thompson emphasized during the press conference, were not paid for by the U.S. government. Samaritan’s Purse footed the bill.

“The mission that we did to Liberia was paid for by the charity and there’s been a lot of questions. Why did the government pay for it? Well, the government did not pay for it. The government supported us and gave us a great deal of assistance, but these two flights were considered a private flight for that organization, but I can assure you we had 110 percent support of the entire United States government behind us. Because everybody very much wanted these two American citizens brought back here,” Thompson said.

Thompson declined to provide a dollar amount for the contract, citing customer privacy. Similarly, questions about Dr. Kent Brantly and Nancy Writebol’s condition and symptoms were not answered, as they are protected under medical privacy laws.

Both flights followed the same route: outbound flights stopped at a U.S. airbase in the Azores off the northwest coast of Africa before landing in Monrovia, Liberia, while inbound flights stopped at the Azores and continued on to Bangor, Maine, to reenter the U.S. Both flights landed at Dobbins Air Force Reserve base, where the patients were transported by a specialized ambulance to a wing of Emory University Hospital.

The flight crew and onboard nurses were not overly concerned about treating Brantly and Writebol during their 14-hour flights.

“We were actually pretty comfortable and the reason is serveral-fold,” said Chief Flight Nurse Vance Ferebee. “We trained, but the procedures to take care of someone in an isolation environment are pretty well established and thought out. That was really the thinking behind the design on this was to replicate a hospital environment for isolation in an aircraft and you just have to adapt in the way you have to work in an aircraft.”

After the questions ended, Ferebee explained how the ABCS functioned and allowed the flight crew and nurses to wear their normal clothing during the flight. Unless the nurses moved to have direct contact with the patient, Ferebee said, they did not wear a protective suit, as the ABCS is designed to contain air or fluid borne infections.

The ABCS itself was made by a DOD contractor, while the metal frame that surrounds it was made by Phoenix Air. The metal frame supports the tent-like structure as an exoskeleton. The tent attaches to the frame through dozens of fabric ties that allow the tent to collapse in on itself when it is time for disposal. During plane decontamination — which takes approximately six hours and involves various CDC-approved cleaning methods including vaporized hydrogen peroxide — the interior and exterior of the tent is scrubbed before it is incinerated.

Patients are quarantined inside of the tent in a similar fashion to hospital containment units, Ferebee explained. The tent is kept at a negative pressure, and all airflow goes from the front of the tent to the rear. A zippered airlock is at the front, with a second zippered airlock leading into the patient area. By pulling air from the front to the back, the ABCS ensures that only fresh air enters the airlock and patient compartment, thereby pulling any tainted air into a specialized filter housing behind the tent. All air flows through two sets of HEPA filters — one set in front and a second in back — before moving out through a tube running toward the rear of the Gulfstream III jet. A specially modified baggage door on the plane’s side allows the air to safely flow out.

Ferebee said the negative pressure in the ABCS keeps any airborne infections inside the tent. If it were to leak, only clean air would be drawn into the ABCS and the infection would stay inside the clear plastic and fabric barrier. Low pressure monitors would alert the flight nurses to any leaks. A small camp toilet sits inside the ABCS for patient use.

During the flight, nurses had access to every piece of medical equipment the company has available. Necessary monitors and IVs ran through sealed openings in the ABCS, allowing the unit to operate in the manner of what Ferebee called a “flying ICU.”

Thompson said Phoenix Air, unlike the military, could not order its pilots, maintenance crews and flight nurses to take part in the Liberia trips. However, he said they came together during a series of meetings and gave the “thumbs-up.”

For his part, Ferebee said he wanted to go on the trips in order to see the company’s infectious disease policies in action.

“It was my choice, because I’d been involved on the medical aspect of the [ABCS] for probably the last three years once the engineering got going and then we started developing the medical aspect. I’m always up for anything interesting and new, and plus we had developed all the protocols and so forth,” he said. “So I really felt it would be helpful for me to go and we’d nail down some of those parts of the protocol you never know about until you’re actually doing patient care.”

One of the small details Ferebee came across was getting the patients off the plane. Brantly and Writebol both wore protective suits on and off the plane when they entered and exited the ABCS in order to keep any potential infection contained to their person. However, when the flight nurses suited the patients up inside the ABCS, the outer layer of the patients’ protective suits would be considered tainted. To keep the rest of the plane from being exposed, Ferebee said clean booties were placed on the patients’ feet as they exited the quarantine tent. In addition, layers of plastic were laid on the floor, seats, equipment and supplies throughout the tent. As Brantly and Writebol walked out, Ferebee explained, the nurses made sure they didn’t touch anything.

Once the patients were off, the entire plane was decontaminated.

Though Phoenix Air prepared for the flights by coordinating with 10 to 12 government agencies, going clear through to the Pentagon and Joint Chiefs of Staff in some cases, Thompson said the company never expected the media attention that came with the contract.

“None of us are publicity seekers, so none of us welcomed this,” Thompson said as reporters spoke individually with the crew members and nurses. “I mean we’re very, you know, we’re very happy to show the media what we have and how it works and let them meet some of our professionals that did it. But from a company standpoint we never seek publicity. We just — that’s not what we do. We’re not looking for investors. We have no business reason to want this type of media.”

Following the first flight, Phoenix Air has been getting up to 2 million hits on its website per day. The volume was so large, Thompson added, that the company’s web service provider first thought the traffic was a form of denial of service attack.

Others present at the press conference included Medical Director Dr. Michael Flueckiger, who oversaw the flights’ medial aspects; Flight Physician Dr. Douglas Olson, who flew on one of the flights; Senior Flight Nurse Jonathan Jackson, who was on both flights; Senior Aircraft Captain Randy Davis, who flew on the second flight; Senior Aircraft Captain Brian Edminster, who flew on the first flight; and Senior Aircraft Captain Darrin Benton, who flew on the second flight.

Following both trips, Thompson said the company had not received a single negative comment about its contract.

“But Phoenix Air has not received one telephone call, not received one email, not received one protestor, period. On the flip side, we have received hundreds of emails, phone calls of people thanking us for going forward with this. I can’t speak to the negative side. I can only speak to the positive side and the positive side has been literally overwhelming, and we did not start out thinking this would become a media event,” he said during the press conference.

Throughout all the planning and coordinating with federal officials, doctors and internal personnel, one thing Phoenix Air kept in mind was the potential impact to the Cartersville and Bartow County communities, Thompson asserted.

“Simply that we’re very cognizant that we’re part of the Cartersville-Bartow County community,” he said after the conference. “The local impact was a factor in our decision to do this. That anything that we do, not just this, but anything we do is done with the utmost safety here at this airport. Because we’re aware this is our home ... most of us live here. These are our neighbors and we’re very, very cognizant that this isn’t some operation we have in California. This is here. ... We really go over the top here at this airport.”