Safety of air medical transport of patients with COVID-19 by personnel using routine personal protective equipment

Abstract

Objective: Air medical transport of patients with known or suspected coronavirus disease 2019 (COVID-19) likely represents a high-risk exposure to crew members as aircraft cabins are quite small resulting in close personal contact. The actual risk to medical crew members is not known. Methods: We conducted an institutional review board-exempt, retrospective study of air medical transport of patients with known or suspected COVID-19 by 8 programs in the Four Corners Region to determine the number of symptomatic COVID-19 among air medical crew members compared to total exposure time. All programs used similar routine personal protective equipment (PPE), including N-95 masks and eye protection. Total exposure time was considered from time of first patient contact until handoff at a receiving hospital. Results: There were 616 air transports: 62% by fixed-wing and 38% by rotor-wing aircraft between March 15 and September 6, 2020. Among transported patients, 407 (66%) were confirmed COVID+ and 209 (34%) were under investigation. Patient contact time ranged from 38 to 432 minutes with an average of 140 minutes. The total exposure time for medical crew was 2924 hours; exposure time to confirmed COVID+ patients was 2008 hours. Only 30% of patients were intubated, and the remainder had no oxygen (8%), low-flow nasal cannula (42%), mask (11%), high-flow nasal cannula (4.5%), and continuous positive airway pressure or bilevel positive airway pressure (3.5%). Two flight crew members out of 108 developed COVID that was presumed related to work. Conclusions: Air medical transport of patients with known or suspected COVID-19 using routine PPE is considered effective for protecting medical crew members, even when patients are not intubated. This has implications for health care personnel in any setting that involves care of patients with COVID-19 in similarly confined spaces.