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Fast, Top-Level Containment Helps Transport U.S. Ebola Patients

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Two weeks ago, Dent M. Thompson, vice president of Phoenix Air, received an interesting phone call while he was on vacation in the mountains of North Carolina.

One of the leading air ambulance companies in the world, Phoenix Air had developed what it calls an Aeromedical Biological Containment System (ABCS), and the U.S. State Department wanted to know whether the unit would fly.

"I got a call from a senior doctor with the U.S. Department of State, who asked me if the ABSC was capable of handling Ebola," Thompson recalled. "I said, 'Are you serious?'"

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Vacation over.

What followed were days of intense discussion between Phoenix Air, charities and several domestic and foreign agencies trying to figure out one thing --- could the company get to Monrovia, Liberia, and safely transport two Americans to Atlanta for treatment at Emory University Hospital?

The patients, Dr. Kent Brantly and Nancy Writebol, who were doing charity work for SIM and Samaritan's Purse, were basically trapped in Liberia, where they were stricken with the very virus they had gone over there to fight.

Ebola is ravaging West Africa and has taken the lives of hundreds of people in Sierra Leone, Liberia and Nigeria.

"Finally, we sat down with the flight crew, the medical crew and the maintenance crew," Thompson said. "We came up with a consensus. Let's go for it. There was no reason not to do it."

There even was a safety valve. Once on the ground in Monrovia, if Phoenix Air's medical team decided the patients' condition had deteriorated to the point that transporting them would be dangerous, the crew could scrap the mission and come home empty. It appears that was never a consideration.

"The goal was to bring two Americans home and hopefully save their lives," said Randall Davis, pilot on the second flight from Liberia.

On Tuesday, Writebol became the second of the two to make it safely back to America. Both are being treated at Emory.

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Thursday was a good day for Thompson, as his firm --- at least for now --- is the most famous air ambulance company in the world. With the pilots and medical staff who made the two trips to pick up Brantly and Writebol, Thomposon stood in a hot Cartersville hangar Thursday in front of the gray Gulfstream III --- dubbed the "Angel Airplane" --- with the much-talked-about ABCS. The containment system is disposable: Each one is incinerated after a single use.

Thompson said his company worked with several federal agencies, including the state department, the CDC, the FAA, the Portuguese government, law enforcement, the Defense Department and U.S. Customs and Border Protection.

"Every agency got involved," he said. "We had 110 percent support from the government, because everybody wanted these two American citizens brought back here. Without the full force of the American government, this trip could not have happened."

The missions, however, were paid for by the two charities, not taxpayers.

"The government supported us and gave us assistance, but these were considered private flights," Thompson said.

Phoenix Air's medical crews staffed both flights. They didn't know for certain which patient they would pick up first --- that decision was in the hands of Samaritan's Purse --- but that didn't really matter to the crew.

The flights made stops in Bangor, Maine, and the Portuguese-controlled Azore Islands for refueling. It took about 14 hours to get back to Atlanta from Liberia.

The ABCS is designed to contain patients with contagious diseases --- with airborne and bodily fluid transmission risks. Patients don't have to wear protective suits while inside the vessels, because the vessel itself is disposable. Pilot Randy Davis said the flight crew wore their regular uniforms during the flight. Doug Olson, one of three doctors on each flight, said at least one of them was dressed in full protective gear when they were inside the ABCS with a patient. Otherwise, they were in scrubs.

Since the ABCS units that housed Brantly and Writebol were destroyed, the one on display Thursday was a testing unit.

Olson and medical program manager Vance Ferebee, who was on both flights, said that during the mission, both patients were in good spirits --- aside from complaining of fatigue.

"We were pretty comfortable. We trained hard for this, but the procedures are well-established and thought out," Ferebee said. "It is the same thing that takes place in a hospital unit. These procedures have been around for a long time."

At no point did the patients' conditions worsen during the flight to the point of requiring an emergency landing. That's a contingency, but no one considered it on this flight.

"We did not have any other place we were gonna take them accept Emory University Hospital," said Phoenix Air's medical director, Dr. Michael Flueckiger. "We made the decision, if conditions deteriorated, we were capable of high-level medical care on the flight."

Phoenix Air, based in Cartersville, has been around since the 1970s. In the 1990s, the company started specializing, in what Thompson calls "exotic work for various industries."

"About five years ago, there were a number of diseases --- SARS, bird flu, H1N1 --- that were of growing concern with the CDC," Thompson said, adding that his company contracts with the CDC. "CDC management and some Department of Defense management came to us five years ago and asked us to develop a system to safely transport people from a point of origin back to the United States."
 



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